Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus (HSV).
Most people infected with the virus that causes genital herpes don’t know they have it; their symptoms may be so mild they go unnoticed. But those who are symptomatic may notice blisters that break and turn into painful, itchy sores, and they may have other symptoms, such as difficulty urinating.
If you’re experiencing symptoms, the first outbreak typically occurs within 2 to 12 days after exposure to HSV.
Sores may be visible in these areas:
Inner thighs and buttocks
External areas of the female genitals
Penis and scrotum
Anus
Herpes sores can also erupt inside your body, where you cannot see them. Women can have sores in the vagina and on the cervix. Both sexes can have sores in the rectum, the part of the large intestine closest to the anus.
Herpes sores tend to go through predictable stages:
Small red bumps or tiny white blisters may crop up first, within a few days or a few weeks of the first infection, or in a later outbreak.
Ulcers may form when blisters rupture and ooze or bleed.
Scabs form when the ulcers crust over and start to heal.
Everyone experiences genital herpes somewhat differently. Besides sores, symptoms of genital herpes can include these kinds of uncomfortable or painful sensations:
Burning when you urinate, or if any of your urine touches sores.
Trouble urinating because sores and swelling are blocking the urethra, the tube through which urine passes. This problem can become extreme.
Pain, itching, or tenderness in your genitals
Genital herpes can be caused by either herpes simplex type 1 (HSV-1) or herpes simplex type 2 (HSV-2). If your case of genital herpes is caused by HSV-2, you may have flu-like symptoms, including chills and fever. You may also develop swollen, tender lymph nodes in your throat or groin area, and feel achy and tired.
Lots of people who have been infected with either HSV-1 or HSV-2 don't know it because they have never noticed any signs or symptoms.
People often mistake a herpes outbreak for another problem. You may think you have the flu, another STI, or that you have pimples or ingrown hairs, when in fact you have genital herpes symptoms.
Primary Herpes Outbreak
Generally, first outbreaks last two to four weeks. During a primary outbreak of genital herpes, you may experience symptoms that mimic the flu, such as:
Fever
Achy muscles
Headaches
Swollen lymph nodes in the groin
Malaise, a general feeling of discomfort
Later Outbreaks
Repeat or recurrent outbreaks can appear weeks or months later and are especially common in the first year of a herpes infection. If you have a repeat outbreak, it may begin with some low-level warning symptoms during a period called a prodrome. A few hours before the outbreak, you may feel itchy, tingly, or burning sensations in the area where the virus first entered your body. You may feel pain in your legs, buttocks, and lower back.
“Most people do have a prodrome with a recurrent outbreak, with tingling and burning in their skin. Then they usually break out in sores in the same place over and over when they actually become symptomatic,” says I. Cori Baill, MD, an obstetrician-gynecologist and a professor at the University of Central Florida College of Medicine in Orlando.
For most people, recurrences are somewhat less painful and shorter than the initial outbreak. The frequency of any later outbreaks, or recurrences, varies from person to person. Outbreaks may not occur at all or they may arise several times a year, or less often. Sores that occur in recurrences usually heal faster than the sores associated with a first episode of illness.
In many cases, outbreaks become more widely spaced as years pass.
If you develop any of the symptoms mentioned above, you should see a doctor for an evaluation. Your doctor may be able to diagnose herpes just by looking at your blisters or sores, and there are also lab tests to diagnose herpes.
According to the Centers for Disease Control and Prevention (CDC), the outlook for an individual and the type of guidance that person needs depend on which virus is causing the genital herpes, HSV-1 or HSV-2. Recurrent outbreaks are much more frequent for genital herpes caused by HSV-2 than cases caused by HSV-1.
The CDC recommends testing to find out which virus is involved and also advises that people diagnosed with genital herpes be tested for HIV infection. If you have herpes, it’s easier for you to develop an HIV infection because herpes sores give HIV an open path into your body.
There’s no cure for genital herpes, but if you’re diagnosed with it, treatment involves daily suppressive therapy with the oral medications acyclovir, famciclovir, or valacyclovir. Suppressive therapy reduces the frequency and severity of symptoms and decreases recurrences by approximately 50 percent. At the onset of symptoms, antiviral medications can help make genital herpes sores go away faster, reduce the number of outbreaks, and lower the risk of transmission.
Knowing you have genital herpes allows you to take steps to reduce outbreaks and to protect your sexual partner or partners.
Consistent use of condoms and dental dams during sex also lowers — but doesn’t eliminate — the risk of transmitting the virus.
While HSV-2 usually causes genital herpes and HSV-1 usually causes oral herpes (cold sores), either type can infect either area. This can happen through oral sex.
When Is Genital Herpes Most Contagious?
During active outbreaks, your viral load is heavier, and at those times you are most likely to infect a sexual partner, says Dr. Baill. “Without an outbreak, the viral load is usually insufficient to infect a normal, healthy partner.”
Remember, some people with HSV infections never have signs or symptoms of genital herpes at all. Although you are most contagious during outbreaks when sores are visible, you can also be contagious at times when you are free of any visible sores.
Many people with genital herpes have no symptoms, or symptoms so mild they don’t notice. But people who are symptomatic after contracting the virus may experience an initial outbreak of sores and itching in the genital area, fever, achiness, and trouble urinating.
Outbreaks can occasionally reoccur, though they’re usually shorter and less painful.
A doctor can diagnose genital herpes by looking at the sores and running lab tests to confirm.
There’s no cure for genital herpes but you can manage it with antiviral medication and take steps to reduce the spread of the virus.
