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Genital Herpes

Genital Herpes At A Glance

  • Genital herpes is caused by HSV-1 or HSV-2 and can affect the genitals, anus, buttocks, thighs, or nearby skin.
  • Many people have mild symptoms or none, while others develop painful blisters, sores, itching, burning, or pain.
  • It spreads through skin-to-skin or mucosal contact, including vaginal, anal, and oral sex, and it can spread even when no sores are visible.
  • There is no cure, but antiviral medicines can help shorten outbreaks, reduce recurrences, and lower transmission risk.
  • Testing is most accurate when a fresh sore is swabbed, rather than relying on appearance alone.

Table of Contents

Table of Contents

What Is Genital Herpes?

Genital herpes is a sexually transmitted infection (STI) caused by herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). It can affect the genitals, anus, rectum, buttocks, thighs, or nearby skin. HSV-1 commonly causes oral cold sores but can spread to the genitals through oral sex; HSV-2 more often causes recurring genital infection.

After infection, the virus stays inactive in nearby nerves and may reactivate later. Some people have painful outbreaks, while others have mild symptoms or none. There is no cure, but antiviral medicines can shorten outbreaks, reduce recurrences, and lower—though not eliminate—the chance of transmission.

Learn More

About Genital Herpes – CDC
https://www.cdc.gov/herpes/about/index.html

Provides patient-friendly information about symptoms, transmission, treatment, pregnancy, and prevention.

Genital Herpes – NIH MedlinePlus
https://medlineplus.gov/genitalherpes.html

Offers clear information about genital herpes symptoms, tests, medicines, self-care, and prevention.

How Common Is Genital Herpes?

Genital herpes is a sexually transmitted infection (STI) caused by herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). It can affect the genitals, anus, rectum, buttocks, thighs, or nearby skin. HSV-1 commonly causes oral cold sores but can spread to the genitals through oral sex; HSV-2 more often causes recurring genital infection.

After infection, the virus stays inactive in nearby nerves and may reactivate later. Some people have painful outbreaks, while others have mild symptoms or none. There is no cure, but antiviral medicines can shorten outbreaks, reduce recurrences, and lower—though not eliminate—the chance of transmission.

Learn More

About Genital Herpes – CDC
https://www.cdc.gov/herpes/about/index.html

Provides patient-friendly information about symptoms, transmission, treatment, pregnancy, and prevention.

Genital Herpes – NIH MedlinePlus
https://medlineplus.gov/genitalherpes.html

Offers clear information about genital herpes symptoms, tests, medicines, self-care, and prevention.

What Symptoms Might You Notice?

Many people have no symptoms. A first noticeable outbreak may cause:

  • One or more painful blisters, open sores, cracks, or shallow ulcers
  • Tingling, burning, itching, or pain before sores appear (prodrome)
  • Pain when urinating, especially if urine touches sores
  • Genital, anal, rectal, buttock, or upper-thigh pain
  • Swollen or tender groin lymph nodes
  • Fever, headache, body aches, or fatigue
  • Vaginal or urethral discharge in some cases
  • Difficulty urinating from pain or swelling

Later outbreaks are often shorter and milder and may appear in a similar area. Symptoms alone cannot reliably distinguish herpes from syphilis, chancroid, shingles, allergic reactions, trauma, or other skin conditions.

How Is Genital Herpes Diagnosed?

A provider will ask about symptoms, timing, previous outbreaks, partners, oral and genital contact, pregnancy, immune conditions, and medicines. They will examine sores and nearby skin and may check lymph nodes or other affected areas.

When a fresh blister or sore is present, a swab is the best way to confirm herpes and determine HSV-1 versus HSV-2. Visual diagnosis alone can be wrong, and a negative swab from an older or healing sore does not fully rule out infection.

Learn More

Genital Herpes – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/herpes.htm

Provides clinical guidance about diagnosis, antiviral treatment, suppression, counseling, HIV, and pregnancy.

Herpes (HSV) Test – NIH MedlinePlus
https://medlineplus.gov/lab-tests/herpes-hsv-test/

Explains sore-swab and blood testing, preparation, and how results may be interpreted.

Genital Herpes infographic – click to enlarge

What Causes Genital Herpes?

Genital herpes spreads through skin-to-skin or mucosal contact with an infected area. Transmission can occur from sores, saliva, genital fluids, or skin that looks normal because HSV may shed without symptoms.

  • Vaginal or anal sex
  • Oral sex from a partner with oral HSV
  • Direct genital-to-genital rubbing without penetration
  • Sharing sex toys without cleaning or changing condoms
  • Touching an active sore and then another body area before washing hands
  • Transmission during childbirth, especially when infection is newly acquired late in pregnancy

Herpes is not spread by toilet seats, bedding, swimming pools, towels used in normal household settings, or casual contact such as hugging.

Learn More

About Genital Herpes – CDC
https://www.cdc.gov/herpes/about/index.html

Provides patient-friendly information about symptoms, transmission, treatment, pregnancy, and prevention.

What Can Make Genital Herpes Worse?

Genital herpes spreads through skin-to-skin or mucosal contact with an infected area. Transmission can occur from sores, saliva, genital fluids, or skin that looks normal because HSV may shed without symptoms.

  • Vaginal or anal sex
  • Oral sex from a partner with oral HSV
  • Direct genital-to-genital rubbing without penetration
  • Sharing sex toys without cleaning or changing condoms
  • Touching an active sore and then another body area before washing hands
  • Transmission during childbirth, especially when infection is newly acquired late in pregnancy

Herpes is not spread by toilet seats, bedding, swimming pools, towels used in normal household settings, or casual contact such as hugging.

Learn More

About Genital Herpes – CDC
https://www.cdc.gov/herpes/about/index.html

Provides patient-friendly information about symptoms, transmission, treatment, pregnancy, and prevention.

Prevention

No method removes all risk, but you can lower it by:

  • Avoiding sex during sores, pain, tingling, burning, or itching
  • Using condoms or barriers correctly every time
  • Taking daily suppressive antiviral medicine when appropriate
  • Telling partners and making a prevention plan together
  • Using lubricant to reduce skin friction
  • Not sharing sex toys unless cleaned and covered with a new condom
  • Washing hands after touching sores
  • Avoiding oral sex when either partner has an active cold sore
  • Testing for HIV and other STIs based on risk
  • Discussing herpes history early in pregnancy and reporting new symptoms immediately

There is no approved vaccine that prevents genital herpes. Suppressive therapy lowers but does not eliminate transmission.

Learn More

About Genital Herpes – CDC
https://www.cdc.gov/herpes/about/index.html

Provides patient-friendly information about symptoms, transmission, treatment, pregnancy, and prevention.

Condom Use – CDC
https://www.cdc.gov/condom-use/

Provides instructions for correct condom use and explains how condoms reduce STI risk.

Labs

Laboratory options include:

  • HSV PCR or NAAT From a Sore: The preferred, most sensitive test when a lesion is present.
  • Viral Culture: Can identify HSV but becomes less sensitive as sores heal or during recurrent outbreaks.
  • Type-Specific HSV Blood Test: Looks for HSV-1 or HSV-2 antibodies; it cannot identify where HSV-1 is located and may need confirmation when results are low-positive.
  • HIV Test: Recommended for people diagnosed with genital herpes because genital HSV increases the chance of acquiring HIV.
  • Other STI Tests: Syphilis, gonorrhea, chlamydia, hepatitis, or other testing may be offered based on symptoms and exposure.
  • Pregnancy Test: May guide medication and counseling when pregnancy is possible.

Blood antibodies take time to develop, so early testing may be negative. IgM herpes tests are not recommended because they are not type-specific and can be misleading.

Learn More

Screening for Genital Herpes – CDC
https://www.cdc.gov/herpes/testing/index.html

Explains when herpes testing is useful and why routine blood screening is not recommended for everyone.

Herpes (HSV) Test – NIH MedlinePlus
https://medlineplus.gov/lab-tests/herpes-hsv-test/

Explains sore-swab and blood testing, preparation, and how results may be interpreted.

HIV Testing – CDC
https://www.cdc.gov/hiv/testing/index.html

Explains HIV testing options and how to find testing.

Diagnostics

Imaging is not needed for uncomplicated genital herpes. Diagnosis is based on examination and lesion or blood testing when appropriate.

  • Lumbar Puncture: May be used in the hospital when herpes meningitis or encephalitis is suspected.
  • Eye Examination: Urgent slit-lamp evaluation is needed if HSV may involve the eye.
  • Neurologic Examination and Imaging: Used for severe headache, confusion, weakness, seizures, or other nervous-system symptoms.
  • Pregnancy and Fetal Evaluation: Obstetric evaluation guides treatment and delivery planning when genital symptoms occur during pregnancy.

A biopsy is rarely needed, but a dermatologist may sample an unusual or persistent lesion when another condition is suspected.

Learn More

Genital Herpes – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/herpes.htm

Provides clinical guidance about diagnosis, antiviral treatment, suppression, counseling, HIV, and pregnancy.

Treatment & Management

Treatment Options

Antiviral medicine is recommended for every first clinical episode because symptoms may become prolonged or severe. Recurrent outbreaks can be managed with episodic or daily suppressive treatment.

  • First-Episode Therapy: Oral antiviral medicine is taken for a full prescribed course and may be extended if healing is incomplete.
  • Episodic Therapy: Medicine is started at the first tingling, burning, pain, or sore to shorten a recurrence.
  • Daily Suppressive Therapy: Medicine is taken every day to reduce outbreaks and lower transmission risk.
  • Severe-Disease Treatment: Intravenous antiviral medicine and hospital care may be needed for widespread, neurologic, or serious infection.
  • Pain and Skin Care: Cool compresses, gentle cleansing, loose clothing, and safe pain medicine may improve comfort.

Treatment does not remove HSV from the body. Discuss how often outbreaks occur, how much they affect you, partner transmission concerns, pregnancy, kidney health, and cost when choosing a plan.

Learn More

Genital Herpes – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/herpes.htm

Provides clinical guidance about diagnosis, antiviral treatment, suppression, counseling, HIV, and pregnancy.

Lifestyle Changes

Daily habits can reduce irritation and help protect partners.

  • Avoid vaginal, anal, and oral sex during sores or warning symptoms.
  • Use condoms or barriers consistently between outbreaks.
  • Use lubricant to reduce friction when skin is fully healed.
  • Wash hands after touching an affected area or applying medicine.
  • Keep sores clean and dry and wear loose, breathable clothing.
  • Do not share sex toys unless they are cleaned and covered with a new condom.
  • Tell partners before sexual contact so prevention choices can be shared.
  • Use sleep, activity, counseling, or other healthy methods to manage stress.

Condoms reduce risk but cannot cover all skin that may shed virus. Combining barriers, avoiding sex during symptoms, and suppressive medicine provides greater protection than any single step.

Learn More

Condom Use – CDC
https://www.cdc.gov/condom-use/

Provides instructions for correct condom use and explains how condoms reduce STI risk.

Medications

Three oral antivirals have proven benefit for genital herpes:

  • Acyclovir: Treats first and recurrent episodes and can be used for daily suppression.
  • Valacyclovir: Becomes acyclovir in the body and often requires fewer daily doses.
  • Famciclovir: Treats outbreaks and can be used for suppression in selected patients.

Common side effects may include headache, nausea, or stomach upset. Dose adjustments may be needed with kidney disease, dehydration, older age, or certain medicines. Antivirals work best when started early and should be taken exactly as prescribed.

Topical antiviral creams provide little benefit for genital herpes and are discouraged in CDC guidance. Antibiotics, antifungal products, and over-the-counter cold-sore creams do not treat genital HSV unless another condition is also present.

Learn More

Genital Herpes – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/herpes.htm

Provides clinical guidance about diagnosis, antiviral treatment, suppression, counseling, HIV, and pregnancy.

Procedures

Uncomplicated genital herpes does not require a procedure. Swab testing and oral medicine are usually sufficient.

  • Lesion Swab: A clinician rubs a swab over a fresh blister or sore for PCR or culture; discomfort is brief.
  • Urinary Catheter: May be temporarily needed if severe pain or swelling prevents urination.
  • Lumbar Puncture: Collects spinal fluid when meningitis or encephalitis is suspected.
  • Cesarean Delivery: May be recommended when genital lesions or prodromal symptoms are present at labor to reduce newborn exposure.
  • Skin Biopsy: Rarely used for persistent or unusual lesions when the diagnosis remains unclear.

Ask why a procedure is needed, what to expect, risks, recovery, and how it will change treatment.

Learn More

Pregnancy and Herpes – NIH MedlinePlus
https://medlineplus.gov/ency/article/001368.htm

Explains pregnancy risks, antiviral prevention near delivery, and delivery planning.

What Should You Expect Long-Term?

HSV remains in the body for life. Recurrences often become less frequent and less severe over time, but the pattern is different for each person. Genital HSV-1 generally recurs and sheds less often than genital HSV-2.

Daily suppression substantially reduces recurrences for many people and can lower transmission risk. The need for suppression can be reviewed periodically because outbreak frequency and personal priorities change.

Learn More

Genital Herpes – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/herpes.htm

Provides clinical guidance about diagnosis, antiviral treatment, suppression, counseling, HIV, and pregnancy.

About Genital Herpes – CDC
https://www.cdc.gov/herpes/about/index.html

Provides patient-friendly information about symptoms, transmission, treatment, pregnancy, and prevention.

What Can You Do At Home?

During an outbreak:

  • Start prescribed episodic medicine immediately if your plan says to do so.
  • Wash gently with water or mild fragrance-free soap and pat dry.
  • Apply a cool compress for pain or itching.
  • Wear loose clothing and cotton underwear.
  • Use an approved over-the-counter pain medicine when safe for you.
  • Pour lukewarm water over the genitals while urinating if urine touching sores causes pain.
  • Avoid picking, shaving, or applying harsh chemicals.
  • Avoid sexual contact until sores are completely healed and warning symptoms are gone.
  • Seek care if you cannot urinate or symptoms are unusually severe.

Emotional reactions are common. Reliable information, partner communication, peer support, and counseling can help reduce shame and anxiety.

Learn More

Genital Herpes Self-Care – NIH MedlinePlus
https://medlineplus.gov/ency/patientinstructions/000653.htm

Provides practical steps to relieve discomfort and help sores heal.

Frequently Asked Questions

Can I spread herpes when I have no sores?

Yes. Asymptomatic viral shedding can occur. Risk is highest during sores or warning symptoms but is not zero between outbreaks.

Does a cold sore mean I have genital herpes?

A cold sore usually means oral HSV. Oral HSV-1 can spread to a partner’s genitals through oral sex.

Can I tell when or from whom I got herpes?

Usually not. Symptoms may appear long after infection, and blood testing cannot determine when transmission occurred or identify a partner.

Will condoms completely prevent herpes?

No. Condoms reduce risk but may not cover every area that sheds virus.

Should everyone get a herpes blood test?

No. CDC does not recommend routine screening for everyone because blood tests have limitations and false positives can occur.

Can genital herpes affect fertility?

It does not usually cause infertility. Pregnancy and delivery require special planning because newborn infection can be serious.

Is herpes the same as HPV or HIV?

No. HSV, HPV, and HIV are different viruses with different tests, health effects, prevention, and treatment.

Do I need to disclose genital herpes to partners?

Talking before sexual contact allows partners to make informed choices and use prevention strategies together.

Questions To Ask Your Provider

Consider asking:

  • Can you swab this sore before it begins healing?
  • Is this HSV-1 or HSV-2, and how does the type affect recurrence?
  • Would a blood test help, and could the result need confirmation?
  • Should I use episodic medicine or daily suppression?
  • How soon should I start medication when symptoms begin?
  • How much can treatment lower transmission risk?
  • Should I be tested for HIV or other STIs?
  • How should I talk with current or future partners?
  • How does herpes affect pregnancy or delivery planning?
  • What symptoms require urgent or emergency care?
  • When should we review whether I still want daily suppression?

Specialist Referrals

Most cases can be managed in primary care, sexual-health care, or gynecology. Referral may be made to:

  • Infectious Disease or STI Specialist: Helps with severe disease, immune suppression, antiviral resistance, or uncertain diagnosis.
  • Gynecologist or Obstetrician: Manages pregnancy, pelvic symptoms, recurrent vulvar pain, and delivery planning.
  • Urologist: Evaluates severe penile symptoms, urinary retention, or persistent urinary problems.
  • Dermatologist: Evaluates unusual, persistent, or difficult-to-diagnose genital lesions.
  • Ophthalmologist: Provides urgent treatment if the eye may be involved.
  • Neurologist or Emergency Specialist: Evaluates meningitis, encephalitis, nerve symptoms, or severe headache.
  • Mental Health Professional: Supports coping, disclosure anxiety, relationship stress, or depression.

Learn More

Genital Herpes – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/herpes.htm

Provides clinical guidance about diagnosis, antiviral treatment, suppression, counseling, HIV, and pregnancy.

Is Genital Herpes Curable?

No. There is currently no cure that removes HSV from the body. The virus remains inactive in nerve cells between outbreaks and can reactivate later.

Antiviral medicine can shorten outbreaks, reduce pain, lower the number of recurrences, and reduce transmission risk. Many people have healthy relationships, sex lives, pregnancies, and births while living with genital herpes.

Learn More

About Genital Herpes – CDC
https://www.cdc.gov/herpes/about/index.html

Provides patient-friendly information about symptoms, transmission, treatment, pregnancy, and prevention.

Genital Herpes – NIH MedlinePlus
https://medlineplus.gov/genitalherpes.html

Offers clear information about genital herpes symptoms, tests, medicines, self-care, and prevention.

Emergency Symptoms / When To Seek Immediate Help

Seek urgent or emergency care for:

  • Inability to urinate or severe genital swelling and pain
  • Severe headache, stiff neck, light sensitivity, confusion, weakness, or seizures
  • Eye pain, redness, light sensitivity, blurred vision, or sores near the eye
  • Rapidly spreading sores, high fever, or severe illness
  • A widespread blistering rash, especially with immune suppression
  • Pregnancy with a first outbreak, new genital sores, or symptoms near labor
  • A newborn or young infant exposed to a suspected herpes sore
  • A severe medication reaction with trouble breathing, facial swelling, fainting, or a blistering rash

Herpes involving the brain, spinal fluid, eyes, or a newborn can be life-threatening or cause permanent injury. Do not wait for a routine appointment.

Learn More

Genital Herpes – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/herpes.htm

Provides clinical guidance about diagnosis, antiviral treatment, suppression, counseling, HIV, and pregnancy.

CALL 911

APNS does not provide emergency medical services. If you believe you are experiencing a medical emergency, including (but not limited to) chest pain, difficulty breathing, stroke symptoms, severe allergic reactions, anaphylaxis, uncontrolled bleeding, seizures, loss of consciousness, or any other potentially life-threatening condition, you are instructed to call 911 immediately or go immediately to the nearest emergency department.

Official Resources / External Links

About Genital Herpes – CDC
https://www.cdc.gov/herpes/about/index.html

Provides patient-friendly information about symptoms, transmission, treatment, pregnancy, and prevention.

Genital Herpes – CDC STI Treatment Guidelines
https://www.cdc.gov/std/treatment-guidelines/herpes.htm

Provides clinical guidance about diagnosis, antiviral treatment, suppression, counseling, HIV, and pregnancy.

Screening for Genital Herpes – CDC
https://www.cdc.gov/herpes/testing/index.html

Explains when herpes testing is useful and why routine blood screening is not recommended for everyone.

Genital Herpes – NIH MedlinePlus
https://medlineplus.gov/genitalherpes.html

Offers clear information about genital herpes symptoms, tests, medicines, self-care, and prevention.

Herpes (HSV) Test – NIH MedlinePlus
https://medlineplus.gov/lab-tests/herpes-hsv-test/

Explains sore-swab and blood testing, preparation, and how results may be interpreted.

Genital Herpes Self-Care – NIH MedlinePlus
https://medlineplus.gov/ency/patientinstructions/000653.htm

Provides practical steps to relieve discomfort and help sores heal.

Pregnancy and Herpes – NIH MedlinePlus
https://medlineplus.gov/ency/article/001368.htm

Explains pregnancy risks, antiviral prevention near delivery, and delivery planning.

This guide is intended for educational purposes only and should not replace medical advice, diagnosis, testing, or treatment from a healthcare provider. Genital sores have several possible causes, and testing is most accurate when a fresh lesion is swabbed promptly. Avoid sexual contact during sores or warning symptoms. Seek urgent care for inability to urinate, severe or rapidly spreading symptoms, neurologic or eye symptoms, pregnancy with a new outbreak or symptoms near labor, possible newborn exposure, or a serious medication reaction.

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