Genital Herpes: What It Is, How It Spreads, and How It Is Managed

Genital herpes is a common sexually transmitted infection caused by herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). CDC estimates there were 572,000 new genital herpes infections among Americans aged 14 to 49 in 2018.

HSV-1 usually causes oral herpes — cold sores or fever blisters around the mouth — mostly picked up in childhood through non-sexual contact with saliva. It can spread to the genitals through oral sex, which is why some genital herpes is HSV-1.

Symptoms

Most people have no symptoms or very mild ones, easily mistaken for a pimple or ingrown hair, so most don't know they are infected.

• Outbreaks: one or more blisters on or around the genitals, rectum or mouth, which break into painful sores that can take a week or more to heal. The first outbreak may bring flu-like symptoms: fever, aches, swollen glands.
• Repeats: outbreaks can recur, especially with HSV-2, but are usually shorter and milder and may become less frequent. The infection is lifelong.

How it spreads

Through vaginal, anal or oral sex — by contact with a sore, with saliva or genital fluids, or with the skin of the mouth or genital area of an infected partner. It can spread from a partner with no visible sore who may not know they are infected. It does not spread through toilet seats, bedding, swimming pools, silverware, soap or towels.

Herpes and HIV

Herpes sores and breaks in the skin give HIV a way in, and even without sores herpes increases the immune cells HIV targets in genital tissue. Having both raises the chance of passing HIV to a partner.

Lowering your risk

• The only sure way to avoid STIs is not to have sex; otherwise, a mutually monogamous relationship with an uninfected partner, and condoms every time — though they don't cover every place sores occur, and skin can shed the virus without a sore.
• If a partner has herpes: they can take daily anti-herpes medicine, and you can avoid sex during outbreaks.

Pregnancy

Genital herpes may raise the risk of miscarriage or premature birth, and can pass to the baby — most often during delivery — causing a potentially deadly neonatal herpes infection. Avoid getting herpes during pregnancy, keep up prenatal visits, and ask about anti-herpes medicine late in pregnancy. With sores or symptoms at delivery, a C-section is likely.

Diagnosis and treatment

• A provider may diagnose it by looking at sores, testing a sample, or — without sores — a blood test for antibodies, which cannot tell who passed the infection or when.
• There is no cure, but medicines can prevent or shorten outbreaks, and daily suppressive therapy lowers the chance of infecting partners. You can still pass it on without symptoms, so talk with partners about the risk.
• Don't touch sores or their fluid; if you do, wash your hands to avoid spreading it to places like your eyes. Herpes can be severe in people with weakened immune systems.

Sources

Based on "Genital Herpes – CDC Fact Sheet," Centers for Disease Control and Prevention; a work of the United States government in the public domain. A stock photo collage is not reproduced.