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Genital herpes is one of
the most common
sexually transmitted infections (STIs). The infection can
Most people never have symptoms, or
the symptoms are so mild that people don't know that they are infected. But in
some people, the infection causes occasional outbreaks of itchy and painful sores
in the genital area.
After the first outbreak, the herpes virus
stays in the nerve cells below the skin and becomes inactive. It usually
becomes active again from time to time, traveling back up to the skin and
causing more sores. Things like stress, illness, a new sex partner, or
menstruation may trigger a new outbreak. As time goes on, the outbreaks happen
less often, heal faster, and don't hurt as much.
Genital herpes is
caused by a virus—either the herpes simplex virus type 1 or the herpes simplex
virus type 2. Either virus can cause sores on the lips (cold sores) and sores on the genitals. Type 1 more
often causes cold sores, while type 2 more often causes genital sores.
Symptoms can vary greatly
from person to person. Most people never have any symptoms. Sometimes the
symptoms are so mild that people may not notice them or recognize them as a
sign of herpes. For people who do notice their first infection, it generally
appears about 2 to 14 days after they were exposed to genital herpes.
Some people have outbreaks of itchy and painful
blisters on the penis or around the opening of the
vagina. The blisters break open and turn into oozing, shallow sores that take up to
3 weeks to heal. Sometimes people, especially women, also have flu-like
symptoms, such as fever, headache, and muscle aches. They may also notice an
abnormal discharge and pain when they urinate.
infections can be severe in people who have
impaired immune systems, such as people with
Your doctor may
diagnose genital herpes by examining you. He or she may ask you questions about
your symptoms and your risk factors, which are things that make you more likely
to get an infection.
If this is your first outbreak, your doctor may
take a sample of tissue from the sore for testing. Testing can help the doctor
be sure that you have herpes. You may also have a blood test.
Although there is no cure,
medicine can relieve pain and itching and help sores heal faster. If you have a
lot of outbreaks, you may take medicine every day to limit the number of
After the first outbreak, some people have just a
few more outbreaks over their lifetime, while others may have 4 to 6 outbreaks
a year. Usually the number of outbreaks decreases after a few years.
Treatment works best if it is started as soon as possible after the start
of an outbreak. This is especially true for outbreaks that come back again and
Finding out that you have herpes may cause you to feel bad
about yourself or about sex. Counseling or a support group may help you feel
The only sure way
to keep from getting genital herpes—or any other sexually transmitted infection
(STI)—is to not have sex. If you do have sex, practice safer sex.
Taking medicine for herpes may lower the number of
outbreaks you have and can also prevent an episode from getting worse. It also lower the chances that you will infect your partner.
If you are pregnant, you should take extra care to avoid getting
infected. You could pass the infection to your baby during delivery, which can
cause serious problems for your newborn. If you have an outbreak near your due
date, you probably will need to have your baby by cesarean section. If your
genital herpes outbreaks return again and again, your doctor may talk to you
about medicines that can help prevent an outbreak during pregnancy.
Learning about genital herpes:
Living with genital herpes:
can be caused by either the herpes simplex virus type 1 (HSV-1) or the herpes
simplex virus type 2 (HSV-2). HSV-1 or HSV-2 can cause sores on the lips (cold sores) and sores on the genitals. HSV-1 more often causes cold sores.
HSV-2 more often causes genital sores.
You get infected
when the virus enters your body through a break in the skin or through moist
areas (mucous membranes) such as the mouth, anus, and vagina.
Even very small
breaks in the skin allow the virus to infect the body. So herpes can be spread to or from the genitals, anus, or mouth during sexual
activities or through any direct contact with herpes sores.
You are most likely to spread
herpes when you have a herpes sore or blister. But many people have time periods (a week
before and a week after an outbreak) when they can still spread the virus even though they don't have symptoms.
And some people spread the
infection because they don't realize that they have a herpes sore. Or they may have different symptoms, such as painful urination, that they don't realize are part of an outbreak.
Most people never have any
symptoms or have ones that are so mild they don't recognize them. But some
people have painful and bothersome symptoms.
Sometimes the symptoms are
confused with other common problems, like yeast infections or vaginosis.
The first herpes outbreak tends to last the longest and be the most severe. Symptoms of the first outbreak may include:
Symptoms of later outbreaks
are usually limited to blisters, sores,
and swollen lymph nodes. The blisters may take up to three weeks to heal.
When genital herpes symptoms appear, it's usually 2 to 14 days after a person is exposed to the virus.
And sometimes people get their first symptoms months
or even years after being infected.
The herpes virus stays in your body for the
rest of your life. After the first outbreak, it becomes
inactive. Then, in most people, it gets active again from
time to time, causing blisters and sores.
Some people have many outbreaks each year, while others have only a few
or none at all. People
who have symptoms average 5 outbreaks a year during the first few years.
Most have fewer outbreaks after that.
People report that certain things may trigger outbreaks, such as:
half of the people who have repeated outbreaks can feel one coming a few hours to a couple of days before it happens. They may
feel tingling, burning, itching, numbness, tenderness, or pain where the
blisters are about to appear.
People who have an
impaired immune system are more likely to have longer
and/or more severe outbreaks of genital herpes than people whose immune systems
Although it's rare, genital herpes can cause other health problems—some of them serious—if the virus travels to other parts of the body.
In rare cases, a newborn is infected with the herpes
virus during delivery. Because their
immune systems aren't fully developed,
newborns with herpes infection can have serious health
problems affecting many body systems. It may take up to 3 weeks after a newborn
is infected before he or she becomes ill.
If the mother has a genital herpes blister or sore at the time of labor and delivery, a
cesarean section is usually done. Cesarean section may be recommended if a woman has tingling or pain suggesting an impending outbreak.
Things that increase your
risk of getting
genital herpes include:
Having herpes, especially if you have open sores, also
increases your risk for becoming infected with HIV if you are exposed
Any child with genital herpes needs to be evaluated by a
doctor to see if it is the result of sexual abuse. For more
information, see the topic
Child Abuse and Neglect.
If you haven't been diagnosed with genital herpes, call your doctor if you have any of the following:
If you have been diagnosed with genital herpes, call your doctor if you are having frequent outbreaks.
If you are pregnant and have genital herpes, or if you think you have genital herpes, tell your doctor.
Watchful waiting is a wait-and-see approach. If you
have only occasional outbreaks of genital herpes and are comfortable
with home treatment,
watchful waiting may be all you need.
Health professionals who can diagnose genital herpes
Treatment may require a referral to a specialist, such as:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor may be able to diagnose genital herpes from
your medical history and a physical exam, especially if the herpes sores are
typical in appearance. Your
doctor may ask you the following questions:
If this is your first outbreak of suspected genital
herpes, further testing may be done to confirm the diagnosis.
Treatment can't cure genital herpes. But it can provide relief from the
discomfort of herpes sores and can speed up healing.
Treatment works best if it is started as soon as possible
after an outbreak begins. This is especially true for outbreaks that come back
again and again.
You can take steps to help keep from getting genital herpes—or any other sexually transmitted infection. You can also take steps to keep from giving herpes to your sex partner(s).
Preventing a sexually transmitted infection (STI) is easier than
treating an infection after it occurs.
For more information, see the topic
Using condoms lowers your chances of
getting or spreading herpes and other STIs, even if you are
already using another birth control method to prevent pregnancy.
must be in place before the start of sexual contact. Use condoms with a new
partner until you are certain that he or she doesn't have an STI. You can use
male condoms or female condoms.
Don't have sex, even with condoms, while you're having herpes symptoms.
Taking daily valacyclovir, an antiviral medicine, can prevent spread of genital herpes to your sexual partner even when you do not have an active outbreak.
A woman who gets
genital herpes while she is pregnant could pass the infection to her
baby during delivery. Herpes can make newborns seriously ill.
If you are pregnant, follow these steps:
Antiviral medicine can be used safely in pregnancy to reduce
the risk of an outbreak at the time of delivery. This lower risk, in turn, makes it less likely that delivery by cesarean section will be needed.
If you are having a genital herpes outbreak, wash your
hands after using the bathroom or having any contact with blisters or sores.
This is especially important for people who are caring for babies.
To reduce discomfort from herpes sores:
Nonprescription medicines, such as acetaminophen (Tylenol) and ibuprofen (Advil), may reduce the pain and fever from genital
To lower the risk of
recurrent outbreaks, reduce or avoid things that trigger outbreaks, such as
fatigue, stress, overexposure to sun, and irritation of the genital area.
Finding out that you have genital herpes may cause you to
have negative thoughts or feelings about yourself or about sex, such as:
A counselor or support groups for people with herpes may be
Antiviral medicines are the recommended
genital herpes. They can relieve the pain and discomfort of blisters and sores and speed healing.
These medicines also decrease the number of days you can spread
the virus (are contagious).
Antiviral medicines work
best when they are taken as soon as symptoms are noticed. For that reason,
people with herpes should keep a supply of the medicine on hand.
If you have 6 or more
outbreaks a year or have severe outbreaks, you may benefit from taking antiviral
medicine every day. It may reduce the number
of outbreaks by about 1 or 2 episodes a year.
If you take antiviral medicine
every day, you may want to talk to your doctor about not
taking the medicine for a short period each year. This can show whether your outbreaks are starting to occur less frequently. Then you can decide
whether to keep taking the medicine.
impaired immune systems may be more likely to:
Other Works Consulted
American College of Obstetricians and Gynecologists
(2007, reaffirmed 2009). Management of herpes in pregnancy. ACOG Practice Bulletin No. 82.
Obstetrics and Gynecology, 109(6):
Cernik C, et al. (2008). The treatment of herpes simplex infections: An evidence-based review. Archives of Internal Medicine, 168(11): 1137–1144.
Johnston C, et al. (2010). Genital herpes. In SA Morse et al., eds., Atlas of Sexually Transmitted Diseases and AIDS, 4th ed., pp. 169–185. Philadelphia: Saunders.
Schiffer JT, Corey L (2010). Herpes simplex virus. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th edition, pp. 1943–1962. Philadelphia: Churchill Livingstone Elsevier.
August 14, 2013
Sarah Marshall, MD - Family Medicine & Jeanne Marrazzo, MD, MPH - Infectious Disease
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