Genital herpes affects the skin or mucus membranes of the genitals. The virus is spread from one person to another during sexual contact.
There are two kinds of HSV:
HSV-1 most often affects the mouth and lips and causes cold sores or fever blisters. But it can spread from the mouth to the genitals during oral sex.
HSV-2 most often causes genital herpes. HSV-2 can be spread through fluids (secretions) from the mouth or genitals.
You may become infected with herpes if your skin, vagina, penis, or mouth comes into contact with someone who already has herpes.
You are most likely to get herpes if you touch the skin of someone who has herpes sores, blisters, or a rash. But the virus can still be spread, even when no sores or other symptoms are present. In some cases, you do not know you are infected.
Genital HSV-2 infections are more common in women than men.
Many people with genital herpes never have sores. Or they have very mild symptoms that go unnoticed or are mistaken for insect bites or another skin condition.
If signs and symptoms do occur during the first outbreak, they can be severe. This first outbreak most often happens within 2 days to 2 weeks of being infected.
Muscle aches in the lower back, buttocks, thighs, or knees
Swollen and tender lymph nodes in the groin
Genital symptoms include small, painful blisters filled with clear or straw-colored fluid. Areas where the sores may found include:
Outer vaginal lips (labia), vagina, cervix, around the anus, and on the thighs or buttocks (in women)
Penis, scrotum, around the anus, on the thighs or buttocks (in men)
Tongue, mouth, eyes, gums, lips, fingers, and other parts of the body (in both genders)
Before the blisters appear, there may be tingling, burning, itching, or pain at the site where the blisters will appear. When the blisters break, they leave shallow ulcers that are very painful. These ulcers crust over and heal in 7 to 14 days or more.
Vaginal discharge (in women) or inability to empty the bladder that requires a urinary catheter
A second outbreak can appear weeks or months later. It is usually less severe and it goes away sooner than the first outbreak. Over time, the number of outbreaks may decrease.
Exams and Tests
Tests can be done on skin sores or blisters to diagnose herpes. These tests are most often done when someone has a first outbreak and when a pregnant women develops genital herpes symptoms. Tests include:
Polymerase chain reaction (PCR) done on fluid from a blister. This is the most accurate test to tell whether the herpes virus is present in the blister.
Blood tests that check for antibody level to the herpes virus. These tests can identify whether a person has been infected with the herpes virus, even between outbreaks. A positive test result when a person has never had an outbreak would indicate exposure to the virus at some time in the past.
Genital herpes cannot be cured. Antiviral medicines (such as acyclovir or valcyclovir) may be prescribed.
These medicines help relieve pain and discomfort during an outbreak by healing the sores more quickly. They seem to work better during a first attack than in later outbreaks.
For repeat outbreaks, the medicine should be taken as soon as tingling, burning, or itching begins, or as soon as blisters appear.
Persons who have many outbreaks may take these medicines daily over a period of time. This helps prevent outbreaks or shorten their length. It can also reduce the chance of giving herpes to someone else.
Pregnant women may be treated for herpes during the last month of pregnancy to reduce the chance of having an outbreak at the time of delivery. If there is an outbreak around the time of delivery, a C-section will be recommended to reduce the chance of infecting the baby.
Side effects are rare with acyclovir and valcyclovir.
You can ease the stress of illness by joining a herpes support group. Sharing with others who have common experiences and problems can help you not feel alone.
Once you are infected, the virus stays in your body for the rest of your life. Some people never have another episode. Others have frequent outbreaks that can be triggered by fatigue, illness, menstruation, or stress.
Pregnant women who have an active genital herpes infection when they give birth may pass the infection to their baby. Herpes can be severe and life threatening in newborn babies. It is important that your provider know if you have herpes sores or have had an outbreak in the past. This will allow steps to be taken to prevent passing the infection to the baby.
The virus may spread to other parts of the body, including the brain, eyes, esophagus, liver, spinal cord, or lungs. These complications can develop in people who have a weakened immune system due to HIV or certain medicines.
When to Contact a Medical Professional
Call your health care provider if you have any symptoms of genital herpes or if you develop fever, headache, vomiting, or other symptoms during or after an outbreak of herpes.
If you have genital herpes, you should tell your partner that you have the disease, even if you do not have symptoms.
Condoms are the best way to protect against catching genital herpes during sexual activity.
Use a condom correctly and consistently to help prevent spread of the disease.
Only latex condoms prevent infection. Animal membrane (sheepskin) condoms do not work because the virus can pass through them.
Using the female condom also reduces the risk of spreading genital herpes.
Although it is much less likely, you can still get genital herpes if you use a condom.
Mendoza N, Madkan V, Sra K, et al. Human herpesviruses. In: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 80.
Palmore TN, Henderson DK. Nosocomial herpesvirus infections. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 308.
Workowski KA, Berman S. Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1-110.
Cynthia D. White, MD, Fellow American College of Obstetricians and Gynecologists, Group Health Cooperative, Bellevue, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.