Genital Herpes

What is genital herpes?

Genital herpes is a contagious sexually transmitted infection (STI) that causes you to develop painful blisters (or sores) on your genitals. The sores can affect your:

• Vulva (external genitals including your vaginal lips).
• Vagina.
• Cervix.
• Penis.
• Testicles.
• Anus (butthole).
• Rectum.
• Buttocks.
• Groin or inner thigh area.

The herpes simplex virus (HSV) causes genital herpes. There are two types of HSV: HSV-1 and HSV-2. Both types can give you genital herpes, although HSV-2 causes it much more frequently.

Genital herpes mainly spreads through vaginal, oral and anal sex. But you can also get genital herpes from someone with oral herpes. Oral herpes can spread from the mouth to the genitals and become genital herpes.

There’s no cure for genital herpes. Once you have the virus in your body, it stays in your body for the rest of your life. Taking medication can help your symptoms and lower the risk of spreading the infection. Using a condom, taking medication and avoiding sexual intercourse when you have a genital herpes outbreak can prevent you from giving it to your partner.

How many people have genital herpes?

The Centers for Disease Control (CDC) estimates that up to 50 million people in the U.S. have genital herpes. Estimates show almost 600,000 people are newly infected each year in the U.S.

Globally, about 491 million people between ages 15 and 49 have HSV-2, the most common cause of genital herpes.

What are the symptoms of genital herpes?

Symptoms vary and depend on if it’s your first outbreak or a recurrent outbreak. Recurring symptoms are usually milder than the first outbreak. Symptoms also 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.

First genital herpes outbreak

When symptoms occur, they’re usually worse during the first outbreak. Symptoms typically appear within two to 20 days after infection. Your symptoms may last up to four weeks.

You may experience:

• Flu-like symptoms, like fever, chills, fatigue and body aches.
• Genital itching, burning or irritation.
• Painful genital blisters or sores that break open.
• Headaches.
• Painful urination (dysuria).
• Swollen lymph nodes.
• Unusual vaginal discharge or discharge from your urethra (the tube that carries pee out of your body).

How do genital herpes appear during recurrent outbreaks?

Recurrent outbreaks or flare-ups happen any time after the first outbreak (even if it’s years later). You can’t control when a recurrent outbreak occurs or how often it occurs. But your symptoms are usually less severe, and the outbreak is generally milder and shorter.

What does genital herpes look like?

Genital herpes typically begins as small, blister-like bumps. They tend to appear in a cluster. You may feel itchiness or tingling in the area 24 to 48 hour before a sore appears. The blister will take on a sore or ulcer-like appearance, then eventually open and ooze. Then, a scab will appear as the ulcer heals. Once the ulcers fully heal, the scabs fall off and that outbreak is complete.

What causes genital herpes?

Genital herpes is a sexually transmitted infection or STI, also called a sexually transmitted disease or STD. The two types of herpes simplex virus (HSV-1 and HSV-2) cause genital herpes. HSV-2 is the most common cause of genital herpes.

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.

Genital herpes can spread through:

• Intercourse, including anal, vaginal-penile and vaginal-vaginal.
• Oral sex (giving or receiving) with someone who’s infected.
• Skin-to-skin genital contact.
• Touching open sores, including while breastfeeding (chestfeeding).
• Childbirth by birthing parent who has an active infection.

You can’t get genital herpes from objects like toilet seats. It’s not likely that you’ll get genital herpes from surfaces like towels or clothing, either. 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.

How contagious is genital herpes?

Genital herpes is highly contagious. You’re most contagious when you have an open sore. Even if you don’t have open sores or symptoms of an outbreak, it’s still possible to infect another person with the herpes virus. This is called asymptomatic shedding.

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

Yes. Both HSV-1 and HSV-2 can infect your mouth and your genitals. You can get herpes sores on your genitals if you receive oral sex from someone who has a cold sore from HSV-1.

Can I get genital herpes more than once?

There isn’t a cure for HSV-1 and HSV-2, the virus that causes genital herpes. Because the virus lives dormant (or inactive) in your body, you can get a genital herpes outbreak again (called a recurrence or flare-up). There’s no rhyme or reason as to why some people get more outbreaks and others get fewer. But healthcare providers know that certain activities tend to reactivate the virus. These include:

• Stress.
• Illness.
• Menstruation.
• Sun exposure.
• Surgery.

How did I get herpes if my partner doesn’t have it?

Some people never develop symptoms. They don’t know they have the 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.

Can my partner have genital herpes and not me?

Yes. If your partner has genital herpes and takes precautions not to spread it to you (like wearing condoms and taking medication), it’s possible that you won’t get it.

Who is most at risk for genital herpes?

Genital herpes affects anyone who’s sexually active and not taking precautions to prevent the spread of STIs. Your risk may be higher if you:

• Don’t use condoms or dental dams every time you have sex.
• Have sex with multiple partners. Your odds of getting genital herpes increase with each new sexual partner. Many people with genital herpes don’t know they have it.
• Have a history of other STIs.
• Have a vagina. The virus can spread more easily to people with a vagina because delicate vaginal tissue can tear, making it easier for the infection to get in.
• Are Black. Black people assigned female at birth (AFAB) are especially vulnerable.

What are the complications of genital herpes?

Complications from genital herpes include:

• Increased risk of getting HIV: People who have open sores from genital herpes are twice as likely to get HIV. This risk is yet another reason why it’s important to use condoms.
• Infecting your baby: A newborn can get genital herpes from their birth parent at delivery. Let your provider know if you’ve had genital herpes so they can give you medication to prevent an outbreak (usually beginning at 36 weeks). If you have an active genital herpes outbreak, you can’t have a vaginal delivery.
• Internal inflammatory disease: Genital herpes can cause swelling or inflammation in organs associated with sexual activity, including your urethra, cervix, uterus or rectum.
• Eye or finger infection: You could spread the virus to other parts of your body like your finger (herpetic whitlow) or your eye.

If you’re immunocompromised, you may experience more severe outbreaks. Rarely, genital herpes can cause infections in your brain (encephalitis) or the membranes around your brain and spinal cord (meningitis).

How does genital herpes affect pregnancy?

Genital herpes doesn’t affect fertility or your ability to conceive. Pregnant people with genital herpes should start a daily antiviral at 36 weeks of pregnancy to prevent outbreaks during delivery. If you have an active infection at the time of childbirth, you can pass the herpes virus to your baby. Your healthcare provider will perform a C-section to lower this risk.

Is it safe to breastfeed if I have genital herpes?

Yes, as long as there isn’t an open lesion on your chest or breast, you can breastfeed (chest feed). If you have an active outbreak while breastfeeding, it’s possible to spread the infection to your nipples through touch. Careful handwashing 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.

How do you know if you have genital herpes?

In addition to a physical exam, your healthcare provider will take a fluid sample from an open sore to test for the herpes virus. If your blisters have healed or you don’t have blisters, a blood test can check for HSV-1 and HSV-2 antibodies, a marker showing you have the virus in your bloodstream.

The blood test doesn’t show an active infection (especially in the absence of open sores or lesions). But it informs your provider that you’ve been exposed to the herpes virus in the past. If this is your first infection, you likely won’t test positive for herpes because there hasn’t been enough time for your body to develop antibodies.

Your healthcare provider will likely recommend you have a blood test to check for other STIs (syphilis, gonorrhea, chlamydia).

How is genital herpes managed or treated?

There isn’t a cure for genital herpes. But there are ways to treat active genital herpes outbreaks and manage the symptoms it causes. You should avoid sexual contact until genital herpes sores have completely healed.

Antiviral medication for genital herpes

Your healthcare provider may prescribe antiviral medications like valacyclovir (Valtrex®) or acyclovir (Zovirax®) to help manage symptoms of genital herpes. These medications can:

• Reduce the severity of symptoms in future outbreaks.
• Lower the frequency of recurrent genital herpes outbreaks.
• Reduce the risk of spreading genital herpes to others.
• Help genital herpes sores heal more quickly.

The benefits vary according to how often you take the medication. Treating a single outbreak doesn't have any effect on the severity or frequency of future outbreaks. But your provider may prescribe chronic suppressive therapy (taking medication every day) to help you have less severe and less frequent outbreaks in the future.

At-home care for genital herpes

If you have mild symptoms or infrequent outbreaks, you might not need or want treatment.

During an outbreak, these steps can ease your symptoms:

• Apply an ice pack to your genitals. Wrap the ice pack in a washcloth or apply it over your underwear.
• Keep your 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.
• Apply topical 1% or 2% lidocaine to numb the area.

Wash your hands after contact with any genital herpes sore. Try not to touch the sores, as this just increases the risk of spreading it to other parts of your body.

How long does it take for genital herpes to go away?

It depends on if it’s your first outbreak or a recurring outbreak. Your first outbreak tends to last longer than recurrent outbreaks. You can expect to have symptoms of a first outbreak for up to four weeks. In subsequent outbreaks, your symptoms may go away after two weeks.

Keep in mind that genital herpes doesn’t ever go away. You may not have visible sores or blisters, but you’ll always have HSV, the virus that causes genital herpes.

Can your body get rid of herpes?

No. Once you have HSV, the virus that causes genital herpes, you have it for life.

How can I prevent genital herpes?

If you’re sexually active, you can take these steps to protect yourself and others from the 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 or 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 sores. (Condoms may not cover all sores, so you may still get the virus.)
• Make sure your partner takes antiviral medication.
• Wait to have sex until scabs fall off.

What can I do if I have herpes?

Many people who find out they have herpes feel embarrassed or ashamed knowing they’ll always have the virus and can give it to others. But you aren’t alone. Herpes is one of the most common STIs, both in the U.S. and worldwide. 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.
• Join a support group in your area or online. You can learn from other people who have the disease and share ways to cope.
• Talk about your illness with your healthcare provider or a counselor. They may have other ideas about ways to cope or how to discuss genital herpes with your partner.
• Be open and honest with your partner about your diagnosis. While it may be difficult to share this information, it’s a way to build trust in your relationship.

If you have herpes, you can still:

• Have sex if you use a condom (and/or have your partner use a condom). 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 ask your provider if this is the right choice for you in your relationship.
• Have children. People with herpes can still give birth to healthy babies. If you have herpes and plan to have children, discuss your illness with your healthcare provider.
• Have a fulfilling life. A genital herpes diagnosis can make you feel unworthy and affect your confidence. Don’t let the virus trick you into believing you’re not worthy. This virus is common, and the right partner will accept you no matter what.

How long does genital herpes last?

Your first outbreak may last up to four weeks. Recurrent outbreaks usually last between one to two weeks.

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

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

What questions should I ask my healthcare provider?

You may want to ask your healthcare provider:

• What’s 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

Hundreds of millions of people are living with genital herpes (and some may not even know!) around the world. Still, it’s normal to feel shame or embarrassment about a diagnosis, especially when you have to discuss the virus with your healthcare provider or your sexual partners. But don’t let your emotions hold you back from having honest conversations or seeking medical care. Treatment with antiviral medication can ease your symptoms, reduce outbreaks and protect sexual partners from infection. Having genital herpes shouldn’t affect your relationships or sexual health. But you should tell your partners that you have it. Wearing condoms, taking antivirals and avoiding sex when you have an active outbreak are the best ways to lower the risk of spreading genital herpes to your partners.