Everything you need to know about genital herpes

You might have first heard about genital herpes in your health class. Alongside other well-known sexually transmitted infections (STIs) like gonorrhea and chlamydia, you may think of herpes and the graphic, worst-case images that spring to mind. Unsurprisingly, that can leave anyone feeling confused or a little intimidated if you've just found out you have it or are worried about catching it one day. If this is you, don’t worry. You’ve come to the right place to find out all the information you need to know. 

Because pop culture has often presented genital herpes as an “incurable” STI and a punchline to jokes, it can feel really difficult to speak to friends or your doctor about it. And that means there’s still a lot of myth and stigma that surrounds it. So here, Dr. Renita White, obstetrician and gynecologist, Georgia, US, goes right back to basics. Read on as she talks us through what genital herpes is, how it spreads, and how it might be more common than you first thought.

What is genital herpes?  

First things first, what is genital herpes? You might already know that it’s an STI, but did you know that two different strains of the virus cause genital herpes?

“Genital herpes is a sexually transmitted infection that is transmitted by the herpes simplex virus,” Dr. White says. “It can occur from either herpes simplex 1 (HSV-1) or herpes simplex 2 (HSV-2).” 

We know there are a lot of acronyms to take on, but stay with us. HSV-1 is typically transmitted through kissing (and other mouth-to-mouth contact) and can cause sores around your mouth (also known as cold sores). HSV-2, meanwhile, is transmitted during skin-to-skin contact during sex, and this is what causes genital herpes. Both varieties can be spread to different areas of your body depending on the different types of sex you have. Keep reading to learn more about this. 

In many cases, symptoms won’t be visible all of the time. Instead, you might experience flare-ups or outbreaks now and then (more on the symptoms of genital herpes below). If you want to find out about the symptoms associated with different STIs, then you can learn more by using an app like Flo. 

How common is genital herpes? 

“Herpes is very common,” Dr. White explains. But not everyone realizes quite how common, especially considering that conversations surrounding STIs are still very much shrouded in stigma. But talking about them can help bust these misconceptions. 

The World Health Organization estimates that around 3.7 billion people under the age of 50 worldwide have HSV-1, and 491 million people have HSV-2. It’s estimated that in 2018, there were 572,000 new genital herpes infections in people aged 14 to 49 in the United States and over 18 million cases in the country in total. See why we said it was probably more common than you thought? If you have genital herpes, it might feel a little isolating, but you’re most definitely not the only one. 

That being said, having genital herpes and knowing you have it are two different things. Many people who carry the herpes simplex virus don’t have symptoms — and as many as 87% of those who carry HSV-2 may be unaware they have it. 

What does genital herpes look like? 

If you’ve ever searched the internet for pictures of genital herpes, you’ll likely have been met with some pretty … graphic results. However, it’s important to be skeptical when you see those kinds of images. 

You may have heard the term “outbreak.” This is what it’s called when you start to see physical symptoms of genital herpes. The rest of the time you might not have any symptoms at all. 

“When you have a genital herpes outbreak, it looks like a group of small vesicles (or pimples/white heads) on a red area of skin,” Dr. White explains. “Eventually, those vesicles/pimples pop, and then it looks like little ulcers. By the time you know you have genital herpes, you’re seeing these lesions on your genitals.” However, you should note that you can be contagious — and therefore at risk of passing on HSV — without having visible genital lesions or any kind of flare-up. If you think you’ve been in contact with someone who has HSV, it’s important to contact a doctor.

What causes a herpes outbreak? 

Even if you don’t appear to have any sores on your body, HSV stays in your body once you’ve been infected (that’s where the “incurable” thing comes from). It travels to a group of nerve cells near the base of your spine and remains there until another outbreak is triggered. The virus will then travel back to where it first entered the body, and you might experience a flare-up. 

Outbreaks can be caused by a number of things. For example, if you’re particularly stressed or tired, pregnant, or generally not feeling well (so your immune system is lower), you may have an outbreak. Changes in your hormone levels because of your period can also lead to an outbreak. The thought of an outbreak occurring at any time might leave you feeling on edge, but there are other signs you can look out for if you think you’ve contracted HSV. More on those below.

Genital herpes symptoms 

While the most recognizable symptoms of genital herpes are the sores and lesions that can appear, there are other, earlier signs you could try to tune in to. Genital herpes normally first appears between two and 12 days after you’ve contracted it. Typically, your first outbreak is more severe than others you may have in the future, and it can last for two or three weeks. While it can be a little bit different for everybody, symptoms that are linked to your first outbreak of herpes may include: 

• Fever or other flu-like symptoms
• Headaches 
• Pressure or aches in your body
• Sores or lesions that take a little bit longer to heal than in future outbreaks 

Dealing with outbreaks can be stressful, but the good news is that recurrent outbreaks of HSV are often milder and shorter. Before sores of lesions appear on your skin, you might notice tingling, burning, or itching in the place where the virus first entered your body. These symptoms are known as prodromal symptoms (they appear before the infection is visible). 

Although the sores are most associated with your genitals, they can be spread anywhere in the body including:

• Vulva
• Cervix
• Vagina
• Penis
• Scrotum
• Buttocks
• Thighs
• Anus
• Rectum
• Mouth
• Urethra

You might be curious how lesions can spread from your vulva or rectum to your mouth. While you may initially contract herpes during skin-to-skin contact during sex, if you scratch the infected skin during an outbreak and then touch another part of your body, this can lead to spreading.

Symptoms in women  

Symptoms of herpes are similar in people of all sexes and genders. At the beginning of an outbreak, you might start to feel like you have the flu. The consistency, smell, or general appearance of your vaginal discharge might change. Once they’ve appeared, it can take a week or more for the pimple-like bumps to pop. This might sound a little intimidating, but many people manage genital herpes and still have happy and healthy sex lives. More on that below. 

Symptoms in men 

As we’ve mentioned above, the symptoms of HSV are similar for everyone. Alongside tingling or burning around your groin and flu-like symptoms (which can impact anyone, regardless of their sex), pimples and sores may appear shortly afterward, which can pop and leave small ulcers. Lesions can appear around the top of the penis or the buttocks. 

How contagious is genital herpes? 

Like many other STIs, genital herpes is very contagious. You can learn more about STI symptoms using an app like Flo. Both HSV-1 and HSV-2 are more transmittable when you’re experiencing visible symptoms (such as sores). However, you can still pass it on even when you don’t have any symptoms at all. Keep reading to find out how. 

How is genital herpes transmitted? 

Now that you know what herpes is, as well as the difference between HSV-1 and HSV-2, you’ll probably want to get to the bottom of how it’s transmitted. The short version is that genital herpes is passed on through physical contact with someone who has it. That can be contact with many different parts of the body or through different types of sex. 

Dr. White points out that herpes can be spread: 

• By coming into contact with a herpes sore
• Through the saliva from a partner with a cold sore (i.e., kissing)
• By coming into contact with the genital fluid of a person with a herpes infection (using barrier protection like condoms can prevent this)
• Through skin-to-skin contact with a person with a cold sore
• Through skin-to-skin contact with a person with a genital herpes infection during a flare-up

Remember, not everyone with herpes will have symptoms or know they have it, but it can still be passed on. 

It’s perhaps equally as important to know how herpes isn’t passed on because it can be easy to get carried away and become unnecessarily wary. Herpes can’t be transmitted from toilet seats, bedding, makeup, or passing around tubes of lip balm. You get the idea — it’s not passed through objects. 

One way to ensure that you’re protecting both yourself and your partner from herpes or any other STI is by getting clued up on different barrier protection options and practicing safe sex. For example, using a condom during penetrative sex or a dental dam during oral sex can limit the skin-to-skin contact you may have. Apps like Flo can help you explore your different birth control options. And if you have noticed you’re having an outbreak, it’s better not to have sex until your symptoms have cleared up. 

Genital herpes tests

If you’ve gotten an STI test in the past, you might have noticed that your doctor didn’t test you for herpes. This is because detecting herpes during an STI screening can be a little bit more difficult than for chlamydia or gonorrhea. The test for herpes all depends on whether you have any visible ulcers or not. 

If you think you’ve been in contact with someone who has HSV, but you don’t currently have any symptoms, then speak to your doctor. They will be able to run a blood test to check for antibodies in your bloodstream. This determines if you’ve been exposed to HSV-1 or HSV-2, but there are limitations to these tests. If you’ve recently been infected, there may be a delay before the infection shows up on testing. That means if you think you’ve been exposed, you should let your doctor know when this may have been, and they might ask you to come back at a later date. 

If you’ve started to exhibit some of the symptoms associated with herpes, your doctor will take a medical history from you and may ask you to describe what you’re experiencing as well as when it started. If you have any sores, they may look at them and take a sample for testing. 

Treatment options 

While there’s currently no known cure for genital herpes, there are a number of options that will help you manage your symptoms and enjoy a happy and healthy sex life. 

Antiviral treatments can help sores heal, lessen the frequency of outbreaks, and reduce transmission. How often you take them will be up to you and your doctor. It’s really important to speak to a medical professional before you start taking any new treatments.  

Because the first outbreak is often more extreme, your doctor may prescribe you an antiviral medication that you take orally (often in the form of a pill). If you have recurrent outbreaks after your first, but they aren’t frequent, and you don’t experience many symptoms, then you may not need to take this medication again. 

However, if the outbreaks you experience after your first one continue to be severe and difficult to manage, other medications may be able to help. You can take a pill every day (this is called suppressive antiviral therapy) that aims to reduce outbreaks and symptoms. 

It’s always important to talk to your doctor about what’s right for you. They’ll also be a listening ear and can offer you any mental health support you might need after you’ve been diagnosed. Testing positive for any STI can be difficult to take in, but it’s crucial to know that you’re not alone. Your doctor will be able to explain to you what you might expect and answer any of your questions. 

Complications of genital herpes

As so many myths and misconceptions surround genital herpes, it can be hard to work out what’s true and what’s fiction. While they’re generally incredibly rare, there are some complications linked to HSV-1 and HSV-2. They include: 

• Finger and eye infections 
• Increased risk of other STIs 
• Increased risk of developing inflammation that can cause severe pain during sex and while peeing
• Infection of internal organs (very rarely when the herpes simplex virus enters your bloodstream it can cause infections in other internal organs) 

Dr. White explains that many of these complications are highly unlikely. She adds that one common myth about genital herpes is that you can’t safely have children. That’s not true; it’s just important that you tell your doctor that you have HSV. It is possible to pass on HSV to your baby through the birth canal if you’re having an outbreak. However, if you let your doctor know that you have HSV, they can try to reduce the risk of an outbreak around the time of delivery. They may offer you suppressive antiviral therapy from 36 weeks gestation and will be able to answer any of your questions if you’re concerned. 

Genital herpes: The takeaway

So, what should you remember about genital herpes? “That it is common but preventable, easily managed, and possible to live with and have a happy and safe sex life,” Dr. White says. 

Very wise words. And though there’s not a genital herpes cure yet, there are lots of ways to manage your infection — and it’s definitely nothing to be ashamed of. If in doubt or you’re left with any questions at all, your doctor will be able to help you find the best way forward.