Genital Herpes (HSV-2)

Overview

What is genital herpes?

Genital herpes is a contagious sexually transmitted infection (STI). People with genital herpes develop painful blisters on their genitals. Blisters sometimes form on or inside the anus. These infections can clear up and then return months or years later.

The herpes simplex virus (HSV) causes genital herpes. HSV spreads through vaginal, oral and anal sex. You can also get HSV from kissing or close (skin-to-skin) contact with someone who has open sores.

What are the types of herpes viruses?

Herpes is a group of contagious viruses. All of these viruses cause blisters and sores. Some of the more common herpes viruses include:

  • Type 1: HSV-1, or oral herpes, causes cold sores to form on lips, gums, tongue and inside the mouth. It can cause genital herpes in some cases This type usually spreads through saliva when you kiss someone with open herpes sores. You can also get HSV-1 by sharing items like toothbrushes, lipsticks or eating utensils.
  • Type 2: HSV-2 causes genital herpes.
  • Herpes zoster: This virus causes chickenpox and shingles.

How common is genital herpes?

Around 1 in 6 Americans between the ages of 14 and 49 have HSV-2, the virus that causes genital herpes.

Who might get genital herpes?

Genital herpes affects teens and adults of all genders and races. It can spread if you have multiple sexual partners and don’t use condoms.

Women are more at risk. Delicate vaginal tissue can tear, making it easier for the infection to get in. Black women are especially vulnerable. An estimated 1 in 2 African-American women between the ages of 14 and 49 is infected with HSV-2, the virus that causes genital herpes.

Where do genital herpes form?

Sores from genital herpes can infect the:

  • Buttocks, anus and inner thighs.
  • Female reproductive system, including the vagina, vulva, labia (vaginal lips) and cervix (tissue that connects the vagina and uterus).
  • Lips, mouth, tongue, cheeks and roof of the mouth.
  • Penis and testicles (parts of the male reproductive system).

Is genital herpes contagious?

The virus that causes genital herpes is highly contagious. You can give genital herpes to others or get it from someone who’s infected. Even when a person doesn’t have blisters or symptoms, it’s still possible to infect another person with the herpes virus.

Can you get genital herpes from someone who has cold sores?

Yes. The different types of herpes viruses can infect other parts of the body. You can get herpes sores on your genitals if you receive oral sex from someone who has open sores from HSV-1 (oral herpes).

Symptoms and Causes

What causes genital herpes?

Genital herpes is a sexually transmitted infection or STI, also called a sexually transmitted disease or STD. A contagious virus causes the infection.

How does genital herpes spread?

The herpes virus that causes genital herpes spreads through saliva, semen and vaginal secretions. It’s possible to get genital herpes from someone who doesn’t have visible symptoms. You can have the infection, not know it and infect someone else.

Research has found it is possible for genital herpes to spread through:

  • Intercourse, including anal, vaginal-penile and vaginal-vaginal.
  • Oral sex (giving or receiving) with someone who’s infected.
  • Skin-to-skin contact without ejaculation.
  • Touching open sores, including while breastfeeding.
  • Childbirth by a mother who has an active infection.

You can’t get genital herpes from objects like toilet seats. But you could pass genital herpes through shared sex toys. (To stay safe, wash sex toys before and after using them, and don’t share them. If you do, protect them with a condom.)

What are the symptoms of genital herpes?

Some people never develop symptoms. They don’t know they have the herpes virus that causes genital herpes. They may unknowingly infect others. You can have the herpes virus for years and not have symptoms, so it’s hard to know when or from whom you got it.

When symptoms occur, they’re usually worse during the first outbreak or flare-up (called primary herpes). Symptoms typically appear within two to 20 days after infection. Active symptoms may last up to four weeks.

You may experience:

Can I get genital herpes more than once?

There isn’t a cure for HSV-2, the virus that causes genital herpes. Infections can come back (called a recurrence). Recurring symptoms are usually milder than the first outbreak. Symptoms don’t last as long with later outbreaks. Some people may only have one or two outbreaks during their lifetime. Others may have as many as four or five outbreaks a year.

After infection, the virus moves from skin cells to nerve cells. In the nerve cells, it becomes inactive (latent). Certain things may reactivate the virus, such as:

  • Illness or fever.
  • Anything that suppresses the immune system.
  • Menstruation.
  • Stress.
  • Sun exposure.
  • Surgery.

Diagnosis and Tests

How are genital herpes diagnosed?

Other STIs, like syphilis, cause similar symptoms. In addition to a physical exam, your healthcare provider will take a fluid sample from the blisters to test for the herpes virus. If your blisters are healed or you don’t have blisters, a blood test can check for HSV-2 antibody, a marker that shows you have been exposed to the virus.

Management and Treatment

How is genital herpes managed or treated?

If you have mild symptoms or infrequent outbreaks, you might not need or want treatment. During an outbreak, these steps can ease symptoms:

  • Apply an ice pack to your genitals. Wrap the ice pack in a washcloth or apply it over your underwear.
  • Keep genitals dry. Wear cotton or other nonsynthetic underpants and avoid tight-fitting clothes. Moist sores take longer to heal.
  • Soak in a warm bath.
  • Take nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain.
  • Wear loose-fitting clothing.

Antiviral medications can prevent outbreaks. They can also lessen symptoms and help symptoms go away faster. You take this medicine as a pill, intravenous injection or skin cream. When taken daily, antivirals can prevent an outbreak. They lower the chances of spreading the virus to other people.

What are the complications of genital herpes?

People who have open sores from genital herpes are twice as likely to get HIV compared to people without herpes. This risk is yet another reason why it’s important to use condoms.

How does genital herpes affect pregnancy?

Genital herpes doesn’t affect fertility or your ability to conceive. Pregnant women with a diagnosis of herpes genitalis are recommended to start a daily antiviral at 36 weeks of pregnancy to prevent outbreaks during time of delivery. If you have an active infection at the time of childbirth, you can pass the herpes virus to your baby. Neonatal (at birth) herpes puts a baby at risk for blindness, brain damage, skin infections and death. Your healthcare provider will perform a cesarean section to lower this risk.

Is it safe to breastfeed if I have genital herpes?

Yes- as long as there is no open lesion on chest or breast . If you have an active outbreak while breastfeeding, it’s possible to spread the infection to your nipples through touch. Careful hand-washing can prevent this spread. You shouldn’t nurse from a breast that has herpes sores. You can pump breast milk until the sores heal. Don’t give your baby expressed breast milk if the pump comes into contact with an open sore.

Prevention

How can I prevent genital herpes?

If you’re sexually active, you can take these steps to protect yourself and others from herpes virus and other STIs:

  • Be monogamous with one sexual partner or limit your number of partners.
  • Get tested for STIs and complete any needed treatment.
  • Tell your sexual partners if you have genital herpes so they can get tested.
  • Use condoms, including dental dams during oral sex.
  • Wash your hands often if you have an outbreak or are around someone with symptoms.

If your sexual partner has genital herpes, these actions can lower your risk of getting the virus:

  • Don’t have sex when your partner has active symptoms. (Condoms may not cover all sores, so you may still get the virus.)
  • Make sure your partner takes antiviral medication as prescribed.
  • Wait to have sex until scabs fall off.

Outlook / Prognosis

What can I do if I have herpes?

Many people who find out they have herpes feel depressed knowing they will always have the virus and can give it to others. But you are not alone. Herpes is one of the most common STIs, both in the US and worldwide. Exact numbers of people affected are not known. This is because many people don’t realize they have it, especially if symptoms are minor and are not bothersome. If you have herpes, you should:

  • Learn all you can about it. Information will help you to manage your disease and feel better about yourself.
  • Talk about your illness with your doctor.

If you have herpes, you can still:

  • Have sex if you use a condom (and/or have your partner use a condom), and you tell your partner about your illness. Some couples, who have sexual relations only with each other, may choose not to use condoms even though one partner has herpes. Because each situation is different, you should talk to your doctor if this is a right choice for you in your relationship.
  • Have children. Women with herpes can still give birth to healthy babies. If you have herpes and plan to have children, discuss your illness with your health care provider.

If you have herpes, you should also get checked for HIV (AIDS) and other STIs (syphilis, gonorrhea, chlamydia).

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

  • Genital irritation or itching.
  • Genital or anal blisters.
  • Painful intercourse.
  • Painful urination (dysuria).
  • Unusual or foul-smelling penile or vaginal discharge.
  • Vaginal or penile redness, soreness or swelling.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

  • What is the best treatment for me?
  • What are the side effects of antiviral medications?
  • How can I reduce the risk of future outbreaks?
  • What’s the best way to prevent getting another STI?
  • How can I protect my partner from getting genital herpes?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

Millions of people are living with the herpes virus that causes genital herpes. It’s a common STI. You shouldn’t be embarrassed or put off seeking medical care if you develop symptoms. Treatments can ease symptoms, reduce outbreaks and protect sexual partners from infection. Having the virus shouldn’t affect your relationships or sexual health. However, you do need to tell your sexual partners that you have the virus. Your healthcare provider can discuss ways to prevent spreading this STI.

Last reviewed by a Cleveland Clinic medical professional on 11/23/2020.

References

  • American Academy of Dermatology Association. Herpes Simplex: Signs and Symptoms. (https://www.aad.org/public/diseases/a-z/herpes-simplex-symptoms) Accessed11/25/2020.
  • American Academy of Family Physicians (AAFP). Herpes. (https://familydoctor.org/condition/herpes/) Accessed 11/25/2020.
  • Centers for Disease Control and Prevention (CDC). Genital Herpes — CDC Fact Sheet. (https://www.cdc.gov/std/herpes/stdfact-herpes.htm) Accessed 11/25/2020.
  • InformedHealth.org. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Genital herpes: Overview. (https://www.ncbi.nlm.nih.gov/books/NBK525769/) 2018 Jun 27. Accessed 11/25/2020.
  • Merck Manual Consumer Version. Herpes Simplex Virus (HSV) Infections. (https://www.merckmanuals.com/home/infections/herpesvirus-infections/herpes-simplex-virus-hsv-infections) Accessed 11/25/2020.
  • NHS. Genital Herpes. (https://www.nhs.uk/conditions/genital-herpes/) Accessed 11/25/2020.
  • Planned Parenthood. Oral and Genital Herpes. (https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/herpes) Accessed 11/25/2020.
  • U.S. Department of Health and Human Services (HHS) Office on Women’s Health. Genital Herpes. (https://www.womenshealth.gov/a-z-topics/genital-herpes) Accessed 11/25/2020.

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