Quick answer
What is genital herpes?
Genital herpes is a common viral STI caused by herpes simplex virus (HSV-1 or HSV-2) — causing painful blisters or sores on genitals, anus, or buttocks. Many people have mild or no symptoms but can still transmit the virus. Outbreaks often become less frequent over time. Antiviral tablets (aciclovir, valaciclovir) shorten outbreaks and reduce transmission. See a sexual health clinic for diagnosis and free treatment.
Genital herpes — HSV explained
Genital herpes is a lifelong viral infection caused by herpes simplex virus (HSV) — usually HSV-2, increasingly HSV-1 (the cold sore virus) from oral sex.
It is extremely common — many adults carry HSV without knowing. Stigma exceeds medical seriousness for most people — outbreaks are manageable with antivirals, and recurrences often fade over years.
Symptoms
First episode (primary infection)
Often most severe — may include:
- tingling, burning, or itching before sores appear
- painful blisters on genitals, anus, buttocks, or thighs
- blisters rupture into ulcers — painful
- pain urinating if urine touches sores
- flu-like illness — fever, aches, swollen glands
- lasts 2 to 4 weeks without treatment; shorter with antivirals
Recurrent episodes
- local tingling (prodrome) hours before sores
- fewer sores, heal faster (7 to 10 days)
- less systemic illness
- frequency decreases over time for most
Asymptomatic infection
Many never notice symptoms but can transmit virus — discovered via partner diagnosis or blood test.
Diagnosis
Best test: viral swab from fresh blister/ulcer — PCR for HSV — within 48 hours ideally.
Blood test (serology): detects past exposure — does not pinpoint genital vs oral site; used selectively.
Sexual health clinic — free, confidential, expert diagnosis.
Treatment — antiviral medicines
See also NHS medicines: aciclovir, valaciclovir, famciclovir.
Episodic treatment (outbreak)
Start within 5 days of onset (sooner is better):
- aciclovir 400mg three times daily for 5 days
- valaciclovir 500mg twice daily for 5 days
Reduces duration and severity.
Suppressive therapy
If 6 or more outbreaks per year or severe distress:
- valaciclovir 500mg daily (or aciclovir 400mg twice daily)
- reduces recurrences by 70 to 80%
- reduces asymptomatic shedding — lowers transmission to partners
Safe for years under medical review.
Self-care during outbreaks
- salt water baths
- petroleum jelly on sores
- paracetamol/ibuprofen
- plenty of fluids
- loose clothing
- avoid sex until fully healed
Transmission — the honest facts
- Most contagious during active sores — avoid contact
- Asymptomatic shedding — virus present on skin between outbreaks — condoms reduce but not eliminate risk
- Suppressive antivirals cut transmission roughly 50% in discordant couples (partner studies)
- Disclosure to partners — ethical and practical; allows joint prevention decisions
Not spread by: toilet seats, towels, pools, cutlery.
HSV-1 vs HSV-2
| HSV-1 | HSV-2 | |
|---|---|---|
| Typical site | Mouth (cold sores) | Genitals |
| Genital recurrences | Often fewer | Often more frequent |
| Trend | Rising genital HSV-1 from oral sex | Still common genitally |
Both managed identically with antivirals.
Genital herpes and pregnancy
Tell midwife if you or partner have herpes.
Risk: neonatal herpes if first outbreak in late pregnancy or active sores at delivery — rare but serious for baby.
Management:
- suppressive aciclovir from 36 weeks if recurrent genital herpes
- caesarean section if active genital lesions at labour onset (first episode)
Specialist obstetric plan — most women with known herpes deliver safely.
Mental health and stigma
Diagnosis causes distress, shame, relationship fear — disproportionate to medical impact for most.
Support:
- sexual health counsellors
- Herpes Viruses Association ( helpline and facts)
- accurate partner education reduces breakups based on myth
Normal sex life possible with management — many couples navigate successfully for decades.
Genital herpes vs other conditions
| Condition | Difference |
|---|---|
| Syphilis | Painless ulcer often — blood test |
| Chlamydia | Discharge, rarely blisters |
| Thrush | Itching, white discharge — no ulcers typically |
| Ingrown hairs | Single bump, no cluster pattern |
| Contact dermatitis | After new products — resolves |
Clinic excludes lookalikes.
Prevention
- condoms — partial protection
- avoid sex during outbreaks
- Suppressive therapy if discordant couple
- disclosing HSV status — partner choice
No vaccine currently available for HSV despite research.
Genital herpes is chronic but manageable — antivirals, honest communication, and time reduce its impact on life far below what fear suggests at first diagnosis.
Common questions
- How do you catch genital herpes?
- Skin-to-skin contact with infected area — vaginal, anal, or oral sex. HSV-1 from cold sores on mouth can infect genitals via oral sex. You can catch it from someone with no visible sores — asymptomatic shedding transmits virus. Not caught from towels, toilet seats, or swimming pools.
- Is genital herpes curable?
- No — the virus stays in nerve cells for life after infection. Antiviral medicines control outbreaks and reduce shedding but do not eliminate the virus. Many people have few recurrences after the first years.
- How often do herpes outbreaks occur?
- Varies widely — some have one outbreak ever; others monthly initially. Average recurrences decrease over time — often 4 to 5 in first year, then fewer. Triggers include stress, illness, UV exposure, friction, and menstruation.
- Can I have sex with genital herpes?
- Avoid sex during active outbreaks until sores fully healed. Use condoms between outbreaks to reduce transmission — not 100% protective as virus sheds from skin not covered. Daily suppressive valaciclovir reduces partner transmission risk by about half in studies. Honest partner communication is essential.
- What is the difference between HSV-1 and HSV-2?
- HSV-1 usually causes oral cold sores but increasingly causes genital infection. HSV-2 prefers genital area — more likely recurrences genitally but both can infect either site. Blood tests distinguish type — swab confirms active infection.
- Does genital herpes cause infertility?
- No direct effect on fertility. Rarely severe infection in pregnancy needs specialist care to prevent neonatal herpes — tell midwife if you or partner have herpes.
- What medicines treat genital herpes?
- Aciclovir, valaciclovir (Valtrex), or famciclovir — short course for outbreak (5 days) or daily suppressive dose if frequent recurrences (6+ per year). Available free from sexual health clinics and NHS prescription from GP.