Genital herpes – stages, symptoms and treatment

What is genital herpes?

Genital herpes is a sexually transmitted disease (STD), also known as a sexually transmitted infection (STI). It’s caused by the herpes simplex virus (HSV).

Here’s what you need to know:

• it’s a common infection – globally, about half a billion people live with genital herpes. It’s thought that at least 20% of US adults have it. In the UK, about 70% of adults will have been infected by the age of 25
• there are 2 types of HSV that can cause genital herpes – called HSV-1 and HSV-2. (Find out more about how they’re passed on
• once you’ve caught it, the virus stays in your body – and symptoms can then flare-up at different times during your life
• many people have mild symptoms – and some won’t have any at all
• there’s no cure, but there are treatments – so it’s a manageable condition

What women need to know about genital herpes

“Women can be more affected by genital herpes than men,” says Dr Ann. “It’s important to know why, so you can make sure you get the right checks, treatment and support.”

• genital herpes is more common in women – in the US, about 1 in 5 women aged 14-49 has it, compared with about 1 in 10 men in this age group
• African-American women are at higher risk – about 1 in 2 African-American women aged 14-49 is infected with HSV-2
• female biology makes it easier to catch the virus – the tissues of your vagina are very sensitive. Plus, small tears that can be made during sex can make it easier for the virus to get in
• some health issues that are more common in women may also increase your risk – eczema makes your skin’s barrier weaker, meaning it’s easier for the virus to get in. Research also shows a severe infection with HSV is nearly 4 times more frequent in people with lupus
• some people think periods can be a trigger – there’s limited evidence that periods can reactivate the virus and bring on symptoms, but more research is needed
• for most women, genital herpes doesn’t have serious health risks – and can be successfully treated

Genital herpes and pregnancy

Here’s what you need to know about genital herpes and pregnancy:

• if you have genital herpes before getting pregnant, you’ll usually be able to have a vaginal delivery and have a healthy baby
• if you get genital herpes during pregnancy, there’s a risk of passing it on to your baby during a vaginal delivery, which can lead to neonatal herpes. This can be very serious (even fatal), but most babies recover with antiviral medication
• it’s important to tell your doctor or midwife as soon as possible if you have a history of genital herpes, or get symptoms while pregnant. They’ll advise about whether you should take antiviral medication, and if you should have a vaginal delivery or a cesarean (C-section)

Genital herpes and HIV

• if you have genital herpes, you have a greater risk of getting HIV – “blisters or sores from HSV-2 reduce your skin’s natural protection against infections, making you more vulnerable to HIV,” says Dr Ann
• women with HIV who get genital herpes may have more severe symptoms and longer outbreaks – talk to your doctor, as they’ll be able to support you

How do you catch genital herpes?

Genital herpes is caused by 2 types of the herpes simplex virus (HSV):

• HSV-1 – this more often causes cold sores, also known as ‘oral herpes’. But it can be spread to your genitals during oral sex and cause genital herpes
• HSV-2 – this is the most common cause of recurrent genital herpes. But it can be spread to your mouth during oral sex and cause oral herpes

You can catch either type – or pass them on to other people – through skin-to-skin contact, including during vaginal, anal or oral sex.

“HSV is most often spread when someone has open sores,” says Dr Ann. “But it can also be spread when someone has the virus without any symptoms.”

Can you get genital herpes from a cold sore?

“Yes, the cold sore virus, HSV-1, can be passed on during oral sex and cause genital herpes,” says Dr Ann. “This can happen if you or your partner has a cold sore on their mouth or lip, or even if you carry HSV-1 but have no symptoms such as scabs or blisters.”

In fact, HSV-1 is a growing cause of genital herpes – especially in young women.

“One theory for this is that teenagers today are less exposed to the HSV-1 virus growing up, so they don’t have antibodies to fight it off, and also have more oral sex when they become sexually active,” says Dr Ann. “This combination could make them more likely to get genital herpes from HSV-1.”

Can you get genital herpes from kissing?

“No, you can’t get genital herpes from kissing,” says Dr Ann. “You can get oral herpes (cold sores) in this way. But you won’t develop genital herpes from kissing someone with a cold sore on the mouth.”

Can you get herpes from a toilet seat?

“You can’t get genital herpes from a toilet seat,” says Dr Ann. “Or from cutlery, cups, bed sheets or towels – this is because the virus can’t survive once it’s away from your skin.”

What does genital herpes look like?

Although many people don’t get any symptoms of genital herpes, common symptoms include:

• small bumps or blisters around your genitals, bottom (anus), buttocks or thighs
• open sores or ulcers where the blisters have burst
• tingling, burning or itching around your genitals, anus or thighs
• stinging or burning when you pee
• unusual vaginal discharge

If you have any of these symptoms, see a doctor as soon as possible.

This picture shows genital herpes around a vaginal opening (Warning: graphic content)
This picture shows genital herpes on the underside of a penis (Warning: graphic content)

Know your STDs

Symptoms of genital herpes can be confused with other conditions, such as acne, ingrown hairs or a bladder infection (cystitis), or other STDs, including genital warts, syphilis and chancroid.

“‘Is genital warts herpes?’, is something I get asked a lot by patients,” says Dr Ann. “The bumps or blisters you get with genital herpes can be confused with several other STDs, but they’re not genital warts.” Genital warts are caused by a different virus, and they’re treated differently. Read more about symptoms of genital warts.

Genital herpes stages

“Once you get infected with HSV-1 or HSV-2, you have it for life,” says Dr Ann. “After your first outbreak, it can ‘flare-up’ at different times, when certain triggers can bring on symptoms.”

Some people get these flare-ups a lot, others not so often. Here’s what you need to know about the stages and what to expect.

Symptoms during the first outbreak

“The first outbreak of genital herpes is usually the worst,” says Dr Ann. “As well as blisters, you may have flu-like symptoms, such as muscle aches and pains, fever and headaches.”

Between 2 and 12 days after you’ve been infected, you might notice:

• small red bumps that may turn into blisters at the point where the virus entered your body – such as your vagina, mouth or anus. These sores can then crust over and heal without leaving a scar
• another outbreak of sores between 5 and 7 days after the first outbreak
• vaginal discharge that’s not normal for you
• itching or burning around your genitals, anus or thighs
• pain or burning when you pee or poop, or trouble peeing
• swollen lymph nodes in your groin
• a feeling of pressure in your abdomen

The first outbreak may last 2 to 4 weeks, before the blisters heal and the virus ‘retreats’ into your nervous system. It then stays there until another outbreak is triggered.

Symptoms during recurrent outbreaks

Recurrent outbreaks are usually more frequent during the first year after you’re infected.

These are usually less severe than the first outbreak, and don’t last as long – experts say recurrent outbreaks should only last between 3 and 7 days. You may also have fewer outbreaks as time goes on.

• triggers for outbreaks may include stress, being out in the sun, illness, smoking, drinking and your period
• you may get a ‘warning sign’ a few hours before an outbreak, such as tingling in your lower back, hips, thighs, buttocks or genitals. These symptoms are in places where you get outbreaks. This is sometimes called a ‘prodrome’. If this happens, you can start taking medication to help make the outbreak less severe
• you’re more likely to get blisters in the same place as your first infection – the same group of nerves is connected to your genitals, anus, buttocks and thighs, so blisters tend to appear in those areas

What does it feel like to have genital herpes?

Because genital herpes isn’t curable, some women find it affects their confidence and self-esteem. But knowing the facts can help to remove the stigma that’s still sometimes attached to having an STD.

“In my case, getting correct information absolutely transformed my life,” says Marian. “You will find all the facts are totally in your favor. It isn’t something that damages your health. Your body cures itself. Each outbreak goes away with or without treatment. But, just like thrush or chickenpox or glandular fever, it can reappear from time to time… No one suggests you are dirty to carry these ‘germs’.”

Read more women’s stories about what it feels like to have an STD, including genital herpes.

When to see a doctor

If you have any symptoms of genital herpes, see your doctor as soon as possible, so you can get tested and have treatment.

You should also speak to your doctor if genital herpes is affecting your mental health and/or sex life – they’ll be able to offer advice and support.

In rare cases, the genital herpes virus can spread throughout your body and cause serious complications, such as meningitis or encephalitis. You should go to the emergency department if you suddenly get symptoms such as:

• a high fever
• vomiting
• a blotchy rash that doesn’t fade when a glass is rolled over it (this won't always develop)
• a stiff neck
• a dislike of bright lights
• drowsiness or unresponsiveness

How is genital herpes diagnosed?

For a genital herpes test, your doctor or nurse will normally:

• ask about your symptoms and sexual partners
• look at any sores or blisters you have
• swab some fluid from a sore to test in a lab

You’ll get more accurate results from ‘active’ sores that haven’t started to heal yet. If you don’t have any active sores, they may recommend a blood test instead.

Some people don’t get any symptoms for months or years after catching genital herpes – so your current partner may not be the cause of your symptoms.

Remember, you can also get tested for genital herpes – and other STDs – at a community health clinic (sexual health clinic in the UK), health department or Planned Parenthood center.

Treatment for genital herpes

While there’s no cure for genital herpes, treatments can reduce symptoms and help prevent outbreaks. You can also help to manage your condition with self-care.

Antiviral treatments for your first outbreak

• antivirals are usually prescribed to stop your symptoms getting worse and to speed up healing
• commonly prescribed tablets include include acyclovir, valacyclovir and famciclovir
• they’re most effective during the first few days of an outbreak, so it’s best to see your doctor as soon as you notice symptoms

Episodic therapy for recurrent outbreaks

• taking antivirals whenever you have an outbreak is called ‘episodic therapy’
• it “won’t reduce the number of outbreaks you have, but can reduce the length and severity of each outbreak,” says Dr Ann
• it’s normally for people who have less than 6 outbreaks a year
• it should be used at the first sign of an outbreak – including when you get warning signs

Suppressive therapy to reduce your outbreaks

• if you’re having frequent outbreaks, your doctor may recommend ‘suppressive therapy’
• you take small doses of antiviral medication every day
• this can reduce the number of outbreaks you have
• it can also lower your risk of transmitting genital herpes to partners

“Although taking antiviral medication every day is considered safe, your doctor may recommend you take a break now and again – usually after a maximum of a year – to see if it’s still necessary,” says Dr Ann. “If you do have more outbreaks, they’ll advise on whether to start taking it again.”

Self-care for genital herpes symptoms

There are things you can do yourself to soothe an outbreak and help prevent blisters becoming infected:

• keep the area clean and dry – moisture makes the sores last longer
• use an ice pack wrapped in a cloth to relieve any pain – don’t use ice directly on your skin
• sit in a warm bath – plain or salt water can stop the sores getting infected, but avoid strongly perfumed soaps or bubble bath
• when you pee, pour water over your genitals to help relieve any pain
• apply petroleum jelly (such as Vaseline) or painkilling cream (such as 5% lidocaine) to help with pain when you pee – make sure you wash your hands before and after
• avoid wearing tight or irritating clothing
• take a painkiller such as ibuprofen
• avoid oral, vaginal or anal sex – or touching your genitals – until the blisters have healed

Over-the-counter genital herpes cream isn’t recommended – this can irritate the area every time you apply it, and stop your skin from healing.

How to stop genital herpes spreading

Remember, you can pass on the virus even if you have no symptoms – although it’s more likely to happen when you do have symptoms.

Things you and your partner can do to reduce the risk of spreading genital herpes include:

• using condoms when you have vaginal, anal or oral sex – this will reduce your risk, but as condoms don’t cover all areas of potentially affected skin, there’s still a chance of passing it on
• avoiding sexual contact if there are any active blisters or sores, and waiting until a few days after they’re completely healed and symptoms have gone. This includes kissing, touching and oral sex, or sex if you have cold sores
• avoiding sexual contact if there are any warning signs, such as tingling or burning
• not sharing sex toys – or if you do, washing them and putting condoms on them
• talking to your doctor about suppressive therapy with antiviral drugs
• limiting the number of partners you have, or agreeing to be monogamous – as with all STDs, the risk increases the more people you have sex with

“Attitudes towards genital herpes are slowly changing,” says Dr Ann. “Genital herpes may be with you for life, but knowing how to reduce you and your partner’s risk of getting it, as well as treating the condition and managing outbreaks, means you can get on with living.”

Quotes are the views of the authors of these statements, and aren’t necessarily the views of Healthily, its medical team or writers.