Genital herpes

Genital herpes is an STD. If your partner has genital herpes, you can catch it — even when your partner doesn’t have sores.

Genital herpes: Overview

What is genital herpes?

Genital herpes is a sexually transmitted disease (STD). It’s caused by the herpes simplex virus.

Anyone who is sexually active can catch this virus. Many people who catch the virus never know they have it because they don’t develop symptoms. They never get painful sores.

If genital sores develop, the outbreaks tend to be worse during the first year. Some people have 4 or more outbreaks within a year. In time, the outbreaks usually become less frequent. They may even stop.

If you have genital sores and your partner doesn’t, you should not have sex while you have sores — and for a few days after the sores clear. When you have herpes sores, you can easily infect your partner. The virus can be passed through oral, anal, or vaginal sex.

Even when you don’t have sores, you can still infect your partner. Wearing a condom when you don’t have sores helps prevent spreading the virus to your partner.

Higher risk of getting HIV

If you have genital herpes and have sex while you have sores, you increase your risk of getting HIV (human immunodeficiency virus). This virus can easily get inside your body through a herpes sore.

Myths about genital herpes

You may have heard that people who have genital herpes also have a higher risk of getting cancer. That’s not true. Genital herpes doesn’t increase your risk of getting any type of cancer.

Another popular myth is that you can catch genital herpes from a toilet seat. If the virus gets on a toilet seat, it cannot live long enough to infect you. To survive, the virus must be inside the human body.

Living with genital herpes

Because there is no cure for genital herpes, it is a lifelong infection. If you have outbreaks, medication can reduce symptoms. Taking precautions can reduce the risk of spreading the virus to a partner who doesn’t have genital herpes.

References
Centers for Disease Control. “Genital Herpes - CDC Fact Sheet (Detailed).” Last accessed December 19, 2016.

Fatahzadeh M and Schwartz RA. “Human herpes simplex virus infections: Epidemiology, pathogenesis, symptomatology, diagnosis, and management.” J Am Acad Dermatol 2007; 57:737-63.

Marques AR, Straus SE, “Herpes simplex.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1199-1204.

Genital herpes: Signs and symptoms

Genital herpes sores: The sores usually appear on and around the genitals, anus, buttocks, hips, or thighs.

Many people who have genital herpes never notice any signs or symptoms.

A mild case can cause a few herpes sores that are often mistaken for pimples or ingrown hairs. Because genital herpes often causes no symptoms or very mild ones, most people who have genital herpes don’t know they have it.

If you’re concerned that you or your partner could have genital herpes, here’s what you may notice:

The first outbreak

This usually occurs within 2 days to 3 weeks after having sex with someone who has genital herpes. The person doesn’t have to have sores to infect you.

The first thing you may notice is flu-like symptoms:

• Headache
• Fever
• Fatigue
• Swollen lymph nodes, especially in your groin
• Muscle pains

Some people say they feel tingling or an itch around their genitals or anus. This can last for up to 24 hours.

You may also notice a patch of red, swollen skin on or around your genitals or anus. Sometimes, this patch develops on the thigh or buttocks. If this appears, you may see:

• Small blisters form on the patch.
• The blisters break open, leaving painful sores.
• The sores scab and completely heal, usually within 2 to 6 weeks.

Most people develop only a few sores, but some people have widespread blisters and sores.

If you touch the sores, immediately wash your hands. This helps to prevent the virus from spreading to other parts of your body. If the virus gets in (or near) an eye, it can cause serious problems.

During the first outbreak, some people also notice that they have pain or difficulty when urinating.

If you have HIV

Genital herpes is very common in people who have HIV (human immunodeficiency virus). If you have HIV and get genital herpes, outbreaks can be severe. You may need medicine to get rid of the sores. You’re also more likely to develop complications, such as meningitis or an inability to empty your bladder.

Repeat outbreaks

The virus that causes genital herpes never leaves your body. After the first outbreak, the virus moves to nearby nerves where it sleeps. You may never have another outbreak. It’s also possible that the virus will wake up, causing outbreaks from time to time.

Repeat outbreaks tend to be less severe than the first outbreak, and the sores clear more quickly.

Anyone can have repeat outbreaks, but you’re more likely to have them if you:

• Are a man
• Have a weakened immune system
• Had a first outbreak that lasted longer than 34 days

If you get repeat outbreaks, these are most likely to occur during the first year. Your body will build up an immunity to the virus, provided you have a healthy immune system. As your immunity builds, the outbreaks should become less frequent. They may even eventually stop.

Repeat outbreaks are usually brought on by a trigger. Common triggers for genital herpes include stress, fatigue, illness, sex, and surgery. For some women, getting their period is a trigger.

During repeat outbreaks, some people notice that they develop warning signs, which tell them where the sores will appear. These warning signs include pain, tingling, itching, or a burning sensation. Warning signs can last for 24 hours.

Treatment can shorten how long you have an outbreak and reduce symptoms.

Genital herpes spreads through sex: You can reduce your risk of getting genital herpes by having one sex partner.

Genital herpes: Who gets and causes

Who gets genital herpes?

Any sexually active person can get genital herpes. It’s very common. According to the Centers for Disease Control (CDC), about 1 in 6 people in the United States who are 14 to 49 years old has genital herpes.

Many people who have genital herpes don’t know it because they never develop symptoms. This makes genital herpes easy to spread.

While it’s easy to get infected, some people have a higher risk of getting genital herpes. Women are more likely to get infected during sex. People who have many sexual partners also have a higher risk.

Anyone who has a weakened immune system also has a higher risk. People can have a weakened immune system for many reasons. Medication is one reason. Medications that weaken the immune system include those taken to prevent losing a transplanted organ and some that control severe psoriasis.

Genital herpes and HIV

Having a disease like HIV (human immunodeficiency virus) also weakens the immune system. If you already have HIV and get genital herpes, you can develop serious problems. People who have HIV and think they may have genital herpes should see their healthcare provider.

What causes genital herpes?

The herpes simplex virus causes genital herpes.

This virus generally spreads during sex. You can get it by having vaginal, anal, or oral sex with someone who has genital herpes. If your sexual partner has a cold sore and performs oral sex on you, you can also get genital herpes this way.

The virus that causes genital herpes lives in herpes sores and genital fluids. When the sores clear, the virus travels to the nerves where it sleeps.

If something triggers the virus, it travels back to the skin or genitals. Stress, fatigue, and surgery are common triggers that can wake up the virus.

When on the surface of the skin (or genitals), the virus may not cause sores or any symptoms. Even though you cannot see anything, a virus on the surface of the skin (or genitals) could be shedding some of its cells.

If you have sex with someone who has genital herpes while the virus is shedding cells, you could get genital herpes. That’s why people who have genital herpes should always wear a condom during sex if their partner doesn’t have genital herpes.

References
Centers for Disease Control. “Genital Herpes - CDC Fact Sheet (Detailed).” Last accessed December 19, 2016.

Fatahzadeh M and Schwartz RA. “Human herpes simplex virus infections: Epidemiology, pathogenesis, symptomatology, diagnosis, and management.” J Am Acad Dermatol 2007; 57:737-63.

Marques AR, Straus SE, “Herpes simplex.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1199-1204.

Additional related resources

• Herpes simplex: Signs, causes, treatment, and tips
• Genital warts: Signs, causes, treatment, and tips

Genital herpes: Diagnosis, treatment, and outcome

How is genital herpes diagnosed?

If you have a herpes sore, your dermatologist can often diagnose you by looking at the sore and taking a swab from the sore. A lab test can tell whether the sore contains the herpes simplex virus (HSV), which is what causes genital herpes.

If you don’t have a sore or any symptoms, the Centers for Disease Control (CDC) doesn’t recommend testing for most people. You can learn whether you should be tested if you don’t have symptoms at:

Genital herpes screening FAQ (Centers for Disease Control)

How is genital herpes treated?

There is no cure for genital herpes, but treatment can help. Self-care can relieve symptoms and help sores heal. Medicine can shorten an outbreak and also relieve symptoms.

Self-care for genital herpes

Dermatologists recommend the following self-care tips for their patients who have an outbreak:

• Keep sores clean and dry.
• Wear loose-fitting cotton underwear.
• If an area feels painful, place a cold compress on it.
• To cleanse and sooth painful sores, reduce itchiness, or decrease tenderness, take an Epsom salts bath. You want to soak for 10 to 20 minutes.

Medicine for genital herpes

To treat genital herpes, your dermatologist may prescribe one of these antiviral medicines:

• Acyclovir (ā-sike-low-veer)
• Famciclovir (fam-see-clo-veer)
• Penciclovir (pen-sike-low-veer)
• Valacyclovir (val-ā-sike-low veer)

Taking medicine is recommended for anyone who has a weakened immune system. With a weakened immune system, your body will likely need help to get rid of sores and symptoms. Without medicine, sores may not clear and symptoms can linger. You should continue taking the medicine until all sores have completely healed.

Medicine works best when started within 24 hours of getting a herpes sore.

If one of the medicines listed above fails to bring relief, you may need another medicine. For a severe infection, getting acyclovir through an IV may be necessary. Other antiviral medicines may also be an option.

Antiviral medicine can be taken daily

For some people, taking an antiviral medicine every day works best because they have:

• Frequent outbreaks
• A partner who doesn’t have the virus

Frequent outbreaks

Even if you treat an outbreak, you can have new outbreaks. Some people have several outbreaks a year. If you have 6 or more outbreaks a year, your dermatologist (or other doctor) may recommend taking an antiviral medicine every day.

Taken daily, this medicine can reduce how often you have an outbreak. Studies show it’s safe to take daily and can reduce outbreaks by 70% to 80%.

A partner who doesn’t have the virus

If your partner doesn’t have the virus that causes genital herpes, taking an antiviral medicine every day can decrease the risk of passing the virus to your sexual partner.

Even when taking medicine, you can still give your partner the virus. You can reduce this risk by skipping sex when you have sores and wearing a condom when you don’t.

If you decide to take medicine daily, you’ll likely take it every day for at least 1 year. At the end of 1 year, your dermatologist (or other doctor) should re-evaluate you to see if you still need to take an antiviral every day.

What is life like for someone who has genital herpes?

The virus that causes genital herpes stays inside your body forever. While many people carry this virus, some don’t know that they have it because they never have an outbreak.

If you have an outbreak, taking an antiviral medicine can shorten the outbreak and relieve symptoms. Some people have several outbreaks. For most people, the outbreaks become less severe and occur less often with time.

Anyone who has been infected with the virus, however, can spread the virus to others during sex. Even if you never have an outbreak, you can still spread the virus.

References
Centers for Disease Control. “Genital Herpes - CDC Fact Sheet (Detailed).” Last accessed December 19, 2016.

Fatahzadeh M and Schwartz RA. “Human herpes simplex virus infections: Epidemiology, pathogenesis, symptomatology, diagnosis, and management.” J Am Acad Dermatol 2007; 57:737-63.

Madkan V Sra K, et al. “Human herpesviruses.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1075-6.

Marques AR, Straus SE, “Herpes simplex.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1199-1204.

US Preventive Task Force. “Serologic screening for genital herpes infection: US Preventive Services Task Force recommendation statement.” JAMA. 2016; 316(23):2525-30.

Women with genital herpes can have healthy children. If you have genital herpes, precautions can help prevent your baby from getting the virus.

Genital herpes: What you should know about sex and pregnancy

People diagnosed with genital herpes often want to know if they can have:

• Sex
• Healthy children

The answer to both questions is “yes,” but you’ll need to take some precautions.

How to prevent spreading herpes to your partner

If you have genital herpes and your partner doesn’t, you can spread the virus that causes it to your partner during sex. For this reason, dermatologists recommend the following:

Tell your partner you have genital herpes

Explain that there is a risk that you can give your partner the virus that causes genital herpes. Be sure your partner knows that the following can reduce this risk:

• Skipping sex when you have sores: To avoid giving your partner genital herpes, it’s recommended that you skip all sexual contact while you have sores and for 1 or 2 days after the sores clear. If your partner’s skin or genitals touches a herpes sore, your partner can easily catch the virus.
  
  
• Using a condom when you’re free of sores: Even when you don’t have sores, it’s possible to spread the virus to your partner. When the virus isn’t active, it travels from your skin (or genitals) to nearby nerve cells.
  
  A trigger can wake up this virus at any time. Common triggers include stress, illness, and surgery. If the virus wakes up, it travels back to your skin (or genitals).
  
  Sometimes, when the virus wakes up, you won’t have any sores or symptoms. During these times, you won’t even know that the virus is on your skin (or genitals). It’s during these times that you can spread it to your partner. Condoms help reduce this risk.

Taking an antiviral medicine every day can also reduce the risk of spreading the virus to your partner. Research shows that if one partner in a relationship has genital herpes and takes an antiviral medicine every day, the medicine can reduce the risk of spreading the virus to the other partner. This research study looked at heterosexual couples who had healthy immune systems.

Even when taking an antiviral every day, a condom must be used every time you have sex.

If taking an antiviral every day interests you, you should talk with your primary care doctor or dermatologist. Women may want to see their OB/GYN.

How genital herpes can affect your pregnancy

If you have genital herpes, it’s possible to spread the virus to your baby. A woman can spread it to her baby while she is:

• Pregnant
• Giving birth
• Taking care of her newborn

If the baby gets the virus while in the womb, the mother may have a miscarriage or deliver the baby too early, causing the baby to be premature.

When the baby catches the virus during birth — or shortly thereafter, this can be deadly for the baby. Be sure your OB/GYN knows that you have genital herpes so that precautions can be taken.

What to tell your OB/GYN

It’s vital for your OB/GYN to know if you:

• Have genital herpes, even if you haven’t had sores or symptoms for a long time
• Don’t have genital herpes but are having sex with someone who does

Taking precautions can prevent your baby from getting the virus.

Living with genital herpes

While there is currently no cure for genital herpes, medicine and self-care can reduce outbreaks.

References
Centers for Disease Control. “Genital Herpes - CDC Fact Sheet (Detailed).” Last accessed December 19, 2016.

Madkan V Sra K, et al. “Human herpesviruses.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1075-6.

Marques AR, Straus SE, “Herpes simplex.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1199-1204.