Most people never have symptoms, or
the symptoms are so mild that people don't know that they are infected. But in
some people, the infection causes occasional outbreaks of itchy and painful sores
in the genital area.
After the first outbreak, the herpes virus
stays in the nerve cells below the skin and becomes inactive. It usually
becomes active again from time to time, traveling back up to the skin and
causing more sores. Things like stress, illness, a new sex partner, or
menstruation may trigger a new outbreak. As time goes on, the outbreaks happen
less often, heal faster, and don't hurt as much.
What causes genital herpes?
Genital herpes is
caused by a virus—either the herpes simplex virus type 1 or the herpes simplex
virus type 2. Either virus can cause sores on the lips (cold sores) and sores on the genitals. Type 1 more
often causes cold sores, while type 2 more often causes genital sores.
What are the symptoms?
Symptoms can vary greatly
from person to person. Most people never have any symptoms. Sometimes the
symptoms are so mild that people may not notice them or recognize them as a
sign of herpes. For people who do notice their first infection, it generally
appears about 2 to 14 days after they were exposed to genital herpes.
Some people have outbreaks of itchy and painful
blisters on the penis or around the opening of the
vagina. The blisters break open and turn into oozing, shallow sores that take up to
3 weeks to heal. Sometimes people, especially women, also have flu-like
symptoms, such as fever, headache, and muscle aches. They may also notice an
abnormal discharge and pain when they urinate.
Your doctor may
diagnose genital herpes by examining you. He or she may ask you questions about
your symptoms and your risk factors, which are things that make you more likely
to get an infection.
If this is your first outbreak, your doctor may
take a sample of tissue from the sore for testing. Testing can help the doctor
be sure that you have herpes. You may also have a blood test.
How is it treated?
Although there is no cure,
medicine can relieve pain and itching and help sores heal faster. If you have a
lot of outbreaks, you may take medicine every day to limit the number of
After the first outbreak, some people have just a
few more outbreaks over their lifetime, while others may have 4 to 6 outbreaks
a year. Usually the number of outbreaks decreases after a few years.
Treatment works best if it is started as soon as possible after the start
of an outbreak. This is especially true for outbreaks that come back again and
Finding out that you have herpes may cause you to feel bad
about yourself or about sex. Counseling or a support group may help you feel
Can genital herpes be prevented?
The only sure way
to keep from getting genital herpes—or any other sexually transmitted infection
(STI)—is to not have sex. If you do have sex, practice safer sex.
Before you start a sexual relationship, talk
with your partner about STIs. Find out whether he or she is at risk for them.
Remember that a person can be infected without knowing it.
have symptoms of an STI, don't have sex.
Don't have sex with
anyone who has symptoms or who may have been exposed to an
Don't have more than one sexual relationship at a time. Having
several sex partners increases your risk for infection.
Condom use lowers the risk of spreading or becoming infected with an STI.
Don't receive oral sex from partners who have
Taking medicine for herpes may lower the number of
outbreaks you have and can also prevent an episode from getting worse. It also lower the chances that you will infect your partner.
If you are pregnant, you should take extra care to avoid getting
infected. You could pass the infection to your baby during delivery, which can
cause serious problems for your newborn. If you have an outbreak near your due
date, you probably will need to have your baby by cesarean section. If your
genital herpes outbreaks return again and again, your doctor may talk to you
about medicines that can help prevent an outbreak during pregnancy.
can be caused by either the herpes simplex virus type 1 (HSV-1) or the herpes
simplex virus type 2 (HSV-2). HSV-1 or HSV-2 can cause sores on the lips (cold sores) and sores on the genitals. HSV-1 more often causes cold sores.
HSV-2 more often causes genital sores.
How herpes is spread
You get infected
when the virus enters your body through a break in the skin or through moist
areas (mucous membranes) such as the mouth, anus, and vagina.
Even very small
breaks in the skin allow the virus to infect the body. So herpes can be spread to or from the genitals, anus, or mouth during sexual
activities or through any direct contact with herpes sores.
You are most likely to spread
herpes when you have a herpes sore or blister. But many people have time periods (a week
before and a week after an outbreak) when they can still spread the virus even though they don't have symptoms.
And some people spread the
infection because they don't realize that they have a herpes sore. Or they may have different symptoms, such as painful urination, that they don't realize are part of an outbreak.
Most people never have any
symptoms or have ones that are so mild they don't recognize them. But some
people have painful and bothersome symptoms.
Sometimes the symptoms are
confused with other common problems, like yeast infections or vaginosis.
The first herpes outbreak tends to last the longest and be the most severe. Symptoms of the first outbreak may include:
Flu-like symptoms, such as fever, headache,
and muscle aches. These symptoms usually get better within a
Tingling, burning, itching, and redness at the site where an
outbreak is about to occur.
Painful, itchy blisters on
the penis, on the vulva, or inside the vagina. Blisters may also appear on the
anus, buttocks, thighs, or scrotum, either alone or in clusters. They may be
barely noticeable or as large as a coin.
Painful, oozing sores caused by blisters that break open.
Symptoms of later outbreaks
are usually limited to blisters, sores,
and swollen lymph nodes. The blisters are most painful during the first 24 hours
and heal after 6 to 12 days.
When genital herpes symptoms appear, it's usually 2 to 14 days after a person is exposed to the virus. But most people don't notice their first
And sometimes people get their first symptoms months
or even years after being infected.
The herpes virus stays in your body for the
rest of your life. After the first outbreak, it becomes
inactive. Then, in most people, it gets active again from
time to time, causing blisters and sores.
Some people have many outbreaks each year, while others have only a few
or none at all. People
who have symptoms average 5 outbreaks a year during the first few years.
Most have fewer outbreaks after that.
People report that certain things may trigger outbreaks, such as:
infections, such as a cold or the flu.
Physical injury, such as
irritation, of the genital area.
New sex partners.
Any condition that weakens the immune system.
half of the people who have repeated outbreaks can feel one coming a few hours to a couple of days before it happens. They may
feel tingling, burning, itching, numbness, tenderness, or pain where the
blisters are about to appear.
People who have an
impaired immune system are more likely to have longer
and/or more severe outbreaks of genital herpes than people whose immune systems
Although it's rare, genital herpes can cause other health problems—some of them serious—if the virus travels to other parts of the body.
In rare cases, a newborn is infected with the herpes
virus during delivery. Because their
immune systems aren't fully developed,
newborns with herpes infection can have serious health
problems affecting many body systems. It may take up to 3 weeks after a newborn
is infected before he or she becomes ill.
If the mother has a genital herpes blister or sore at the time of labor and delivery, a
cesarean section is usually done. Cesarean section may be recommended if a woman has tingling or pain suggesting an impending outbreak.
What Increases Your Risk
Things that increase your
risk of getting
genital herpes include:
Having more than one sex
Having a high-risk partner or partners (partner has more than one sex partner or has herpes-infected sex partners).
unprotected sexual contact (not using condoms).
Starting sexual activity at a young age. The younger people are when they start having sex, the greater their risk is of getting genital herpes.
weakened immune system.
Being a woman. Women are more likely than men to become infected
when exposed to genital herpes. And their symptoms tend to be more severe and longer-lasting.
Women also are at a greater risk of having
complications from a genital herpes infection.
Having herpes, especially if you have open sores, also
increases your risk for becoming infected with HIV if you are exposed
Any child with genital herpes needs to be evaluated by a
doctor to see if it is the result of sexual abuse. For more
information, see the topic
Child Abuse and Neglect.
When To Call a Doctor
If you haven't been diagnosed with genital herpes, call your doctor if you have any of the following:
Painful blisters or sores in the genital or
Burning or pain while urinating, or you are unable to
Abnormal discharge from the vagina or penis.
to think you've been exposed to genital herpes.
If you have been diagnosed with genital herpes, call your doctor if you are having frequent outbreaks.
If you are pregnant and have genital herpes, or if you think you have genital herpes, tell your doctor.
Watchful waiting is a wait-and-see approach. If you
have only occasional outbreaks of genital herpes and are comfortable
with home treatment,
watchful waiting may be all you need.
Who to see
Health professionals who can diagnose genital herpes
Your doctor may be able to diagnose genital herpes from
your medical history and a physical exam, especially if the herpes sores are
typical in appearance. Your
doctor may ask you the following questions:
Do you think you were exposed to genital herpes
or another sexually transmitted infection (STI)? How do you know? Did your
partner tell you?
What are your symptoms?
Do you have sores in the genital area or
anywhere else on your body?
Do they usually come and
Do you have any urinary symptoms, including frequent urination,
burning or stinging with urination, or urinating in small
If you have discharge from the vagina or penis, does it have any smell or color?
What method of birth control do you use? Did you
use condoms to protect against STIs?
Have you had an STI in the past? How was it
If this is your first outbreak of suspected genital
herpes, further testing may be done to confirm the diagnosis.
Treatment can't cure genital herpes. But it can provide relief from the
discomfort of herpes sores and can speed up healing.
Treatment works best if it is started as soon as possible
after an outbreak begins. This is especially true for outbreaks that come back
again and again.
Medicines to make blisters and sores less painful and heal faster or to help prevent outbreaks. For more information, see Medications.
Home treatment, such as taking warm
sitz baths and wearing cotton underwear, to help sores heal. For more information, see Home Treatment.
Taking steps to prevent the spread of genital herpes.
These include avoiding any sexual contact if you (or your partner) have symptoms
or are being treated for genital herpes. For more information, see
You can take steps to help keep from getting genital herpes—or any other sexually transmitted infection. You can also take steps to keep from giving herpes to your sex partner(s).
Practice safer sex
Preventing a sexually transmitted infection (STI) is easier than
treating an infection after it occurs.
Talk with your partner about STIs before
beginning a sexual relationship. Find out whether he or she is at risk for an
STI. Remember that it is quite possible to have an STI without
knowing it. Some STIs, such as
HIV, can take up to 6 months before they can be
detected in the blood.
Avoid sexual contact if you have symptoms
of an STI or are being treated for an STI.
Avoid sexual contact
with anyone who has symptoms of an STI or who may have been exposed to an
Don't have more than one sexual relationship at a time. Your
risk for an STI increases if you have several sex partners.
Using condoms lowers your chances of
getting or spreading herpes and other STIs, even if you are
already using another birth control method to prevent pregnancy.
must be in place before the start of sexual contact. Use condoms with a new
partner until you are certain that he or she doesn't have an STI. You can use
male condoms or female condoms.
Don't have sex, even with condoms, while you're having herpes symptoms.
Take antiviral medicine
Taking daily valacyclovir, an antiviral medicine, can prevent spread of genital herpes to your sexual partner even when you do not have an active outbreak.
Take care during pregnancy
A woman who gets
genital herpes while she is pregnant could pass the infection to her
baby during delivery. Herpes can make newborns seriously ill.
If you are pregnant, follow these steps:
Tell your doctor if you have been exposed to
genital herpes or have had an outbreak in the past.
Let your doctor
know if you are currently having an outbreak, especially if
you are in the last part of your pregnancy.
Avoid unsafe sex.
Herpes is often transmitted by people who don't know they
are infected and don't have symptoms. Use condoms.
oral sex from partners who have
cold sores. Herpes in newborns can be caused by HSV-1,
the virus that most commonly causes cold sores. Most experts advise pregnant
women not to receive oral sex in the last 3 months of their pregnancy. It
increases their risk of genital infection with HSV-1.
Antiviral medicine can be used safely in pregnancy to reduce
the risk of an outbreak at the time of delivery. This lower risk, in turn, makes it less likely that delivery by cesarean section will be needed.
Wash your hands
If you are having a genital herpes outbreak, wash your
hands after using the bathroom or having any contact with blisters or sores.
This is especially important for people who are caring for babies.
To reduce discomfort from herpes sores:
sitz baths or wash the area with warm water 3 or 4
times a day.
In between sitz baths, keep the sores clean and
Using a hair dryer to dry off the sores may be more
comfortable than using a towel.
Wear cotton underpants, which
absorb moisture better than those made from synthetic material.
To lower the risk of
recurrent outbreaks, reduce or avoid things that trigger outbreaks, such as
fatigue, stress, overexposure to sun, and irritation of the genital area.
Coping with your feelings
Finding out that you have genital herpes may cause you to
have negative thoughts or feelings about yourself or about sex, such as:
Feeling ashamed or
Being afraid of the consequences of the
Being angry at the person who infected
Feeling frustrated with treatment or recurrent
Feeling scared to have sex.
A counselor or support groups for people with herpes may be
Antiviral medicines are the recommended
genital herpes. They can relieve the pain and discomfort of blisters and sores and speed healing.
These medicines also decrease the number of days you can spread
the virus (are contagious).
Antiviral medicines, such as acyclovir
(Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex), are recommended for
treating primary genital herpes outbreaks. This medicine can be taken when an outbreak occurs. It can also be taken every day to help prevent outbreaks.
Nonprescription medicines, such as ibuprofen (Advil)
and acetaminophen (Tylenol), may reduce the pain and fever from genital
Taking antiviral medicines
Antiviral medicines work
best when they are taken as soon as symptoms are noticed. For that reason,
people with herpes should keep a supply of the medicine on hand.
If you have 6 or more
outbreaks a year or have severe outbreaks, you may benefit from taking antiviral
medicine every day. It may reduce the number
of outbreaks by about 1 or 2 episodes a year.
If you take antiviral medicine
every day, you may want to talk to your doctor about not
taking the medicine for a short period each year. This can show whether your outbreaks are starting to occur less frequently. Then you can decide
whether to keep taking the medicine.
Need daily antiviral medicine to prevent
resistance to some antiviral medicines. For these
people, other medicines are available, but they must be given through a vein
(intravenously, or IV) and can have dangerous side effects.
Other Places To Get Help
American Social Health Association (ASHA): Herpes Resource Center
P.O. Box 13827
Research Triangle Park, NC 27709
1-800-227-8922 Resource Center hotline (919) 361-8400
This organization provides information over the phone and online.
It offers educational materials, including books, booklets, a bibliography,
audiocassettes, videotapes, a quarterly journal, and links to other resources
Centers for Disease Control and Prevention: Sexually Transmitted Diseases (STDs)
1600 Clifton Road
Atlanta, GA 30333
The Centers for Disease Control and Prevention (CDC) provides information and updates on sexually transmitted diseases (STDs), human immunodeficiency virus (HIV), and pelvic inflammatory disease (PID). You can also find fact sheets on these health topics.
National Institute of Allergy and Infectious Diseases
(NIAID), National Institutes of Health
NIAID Office of Communications and Government Relations
6610 Rockledge Drive, MSC 6612
Bethesda, MD 20892-6612
The National Institute of Allergy and Infectious
Diseases conducts research and provides consumer information on infectious and
American College of Obstetricians and Gynecologists (2007, reaffirmed 2009). Management of herpes in pregnancy. ACOG Practice Bulletin No. 82. Obstetrics and Gynecology, 109(6): 1489–1498.
Cernik C, et al. (2008). The treatment of herpes simplex infections: An evidence-based review. Archives of Internal Medicine, 168(11): 1137–1144.
Johnston C, et al. (2010). Genital herpes. In SA Morse et al., eds., Atlas of Sexually Transmitted Diseases and AIDS, 4th ed., pp. 169–185. Philadelphia: Saunders.
Schiffer JT, Corey L (2010). Herpes simplex virus. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., pp. 1943–1962. Philadelphia: Churchill Livingstone Elsevier.
How this information was developed to help you make better health decisions.