Genital Herpes: Everything You Need to Know

Genital herpes is a sexually transmitted infection (STI) caused by the Herpes Simplex Virus (HSV). The Herpes Simplex Virus is a common STI, affecting more than 400 million people worldwide.

It has two variants: HSV-1 and HSV-2. HSV-1 is typically transmitted orally via sores or saliva. Some common examples include sharing drinking glasses or kissing. HSV-1 most commonly results in oral cold sores. HSV-2 is sexually transmitted and causes genital herpes. The Centers for Disease Control and Prevention (CDC) reports that 12% of people 14-49 years old have HSV-2 infection.

But an increasing number of genital herpes infections are caused by HSV-1. That means oral, anal, or vaginal contact with HSV-1 can also cause genital herpes

This article will cover how to diagnose, treat, and prevent genital herpes. It’ll also explain how to safely and confidently move forward if you test positive.

Symptoms of Herpes

Many people don’t realize they have genital herpes because the symptoms are so mild. Others have obvious and painful symptoms. 

Outbreaks

The most obvious symptom of genital herpes is a change in the genital or rectal skin, also known as an outbreak. Outbreaks can appear in:

• Small red blisters
• Tiny white bumps
• Blisters
• Ulcers
• Scabs

Marks can appear singularly or in a cluster.

Outbreaks range in severity, with the first being painful and lasting up to four weeks. Repeat outbreaks are usually shorter and less painful. During an outbreak, you may also notice flu-like symptoms, like fever, body aches, or swollen glands.

Asymptomatic

Transmission commonly occurs from contact with an infected sexual partner who does not have visible lesions and who may not know that he or she is infected. With or without symptoms, the herpes virus can be passed to sexual partners. 

Potential Side Effects

There are other side effects that my occur with a herpes outbreak, including additional STIs, bladder problems, meningitis, and more.

Additional STIs

Patients with HSV-2 have a higher risk of contracting the human immunodeficiency virus (HIV) infection.

Skin that has been impacted by a genital herpes outbreak (even after it has healed) has a higher number of immune cells. HIV targets immune cells to enter the body, creating an ideal environment for HIV to enter and spread.

Additionally, active blisters provide an easy entrance for other STIs.

Bladder Problems

It’s not unusual to experience painful urination during a genital herpes outbreak. Blisters or open sores can appear in the urethra (the tube from your bladder), and when they make contact with urine it often causes a stinging sensation.

There is also a chance for urinary retention (when you are unable to empty your bladder) due to reduced bladder sensation and inflammation. In extreme cases like this, a catheter is used to help release urine.

Newborn Infection

Pregnant women who have genital herpes will want to consider a safe birthing plan, as a herpes infection can lead to neonatal herpes, which can be life-threatening to a newborn. You are more likely to pass the infection to your unborn child during the delivery than during pregnancy.

Those infected before or during the first trimester (three months) of pregnancy have a 1% chance of passing the virus to their newborn. This is because the mother’s immune system will have produced antibodies to the virus, which are then passed to the unborn child through the placenta, giving the baby a certain amount of protection.

Infection during the last three months raises the chance of transmitting HSV to 40% if it's a primary/first episode infection. With recurrent HSV infections, it can be as low as 3%. In this case, a cesarian is highly recommended.

Regardless of the infection date, babies are more likely to become infected if the mother has a current outbreak, as they may come in contact with the virus as they move through the cervix and vagina. During an outbreak, a cesarian is usually advised. If you’d like to plan for a natural birth, you can talk to your healthcare provider about taking medicine to reduce the risk of an outbreak leading up to your due date.

Meningitis 

Herpes simplex encephalitis, also known as herpes meningoencephalitis, is a rare neurological disorder where the brain tissue and surrounding tissue become infected and inflamed by the HSV virus. Both strands can cause neurological infection and be fatal.

If diagnosed with HSV-2, it’s important to keep a close eye on any fevers, personality changes, sensitivity to light, or hallucinations. If you notice something unusual, contact your healthcare provider immediately. 

Treatment for herpes simplex encephalitis includes antiviral medication. Depending on the severity of your infection, you may need to be treated in the hospital.

Proctitis

A herpes infection can also result in proctitis, a condition where the rectum becomes inflamed.

Symptoms of HSV proctitis include:

• Pain around the anal region
• Discharge
• Tenesmus (the feeling that you need to go)
• Rectal bleeding

Proctitis is thought to progress from the initial genital herpes outbreak to the perianal skin into the anal canal and then into the rectum. It can also be passed through anal sex with an infected partner.

Who Is At Risk?

Everyone who is sexually active is at risk of contracting genital herpes. But women have a higher rate of contraction than men. Around 8% of men have HSV-2 infection, while about 16% of women test positive.

HSV-2 is more common in women than men for a few reasons. Men with HSV-2 are more often asymptomatic, meaning they may not know they have the virus. The result is higher transmission rates from men to women.

It also shows up in women more frequently because it’s more easily transmitted from men to women than from women to men during penile-vaginal sex.

Treatment

There is no cure for genital herpes. The virus will live in your body forever, but you can manage the symptoms, prevent further spreading, and have a fulfilling love life.

Food and Drug Administration (FDA)-approved daily antiviral medications, also known as suppression therapy, can help prevent reoccurring outbreaks and improve quality of life by suppressing the virus. They also decrease the duration of an outbreak and can help prevent transmission to sexual partners.

Managing an Outbreak

Your comfort and safety should come first when treating genital herpes. Here are some home remedies that may help during an outbreak:

• Soak affected areas in a sitz bath (a warm, soothing bath)
• Take L-lysine, an amino acid found to shorten the length of outbreaks
• Wash sores gently with fragrance-free soap and water
• Take acetaminophen, ibuprofen, or aspirin to relieve pain
• Apply cool compresses to sores several times a day
• Women with painful sores on the vaginal lips (labia) can urinate in a tub of water or low bath to avoid pain

Prevention

Being in a long-term monogamous relationship can lower your risk of contracting genital herpes (or any STIs) after both partners have been tested.

Your risk of contracting genital herpes goes up with the number of sexual partners you engage with. If you choose to engage with multiple partners, advocate for yourself. Ask when they were last tested and/or get tested together.

While condom use has been shown to decrease the risk for HSV-2 transmission from men to women, it does not eliminate it. Getting tested regularly, monitoring your body, and being open and honest with sexual partners is key to preventing genital herpes.

Summary

Genital herpes is a sexually contracted virus that can cause painful outbreaks. It’s more prevalent in women than men and can cause complications with giving birth. Herpes lives in the body forever. There is no treatment but there are management tools to manage outbreaks and improve your quality of life.

A Word From Verywell

There is an unfair amount of shame around genital herpes given how common the virus is. The majority of people with herpes do not know they are infected. Today there are dating apps, groups, and influencers normalizing HSV positivity. If diagnosed, you can still live a happy, fulfilling life full of sex, love, and health. It doesn't need to be the end of your sex life. Whatever the case, do your best to be kind to yourself.