Genital Herpes: Common But Misunderstood
First recognize the symptoms and signs, then take action to prevent outbreaks
Genital herpes is a sexually transmitted infection that can cause small, painful sores in the genital area. The symptoms may include low-grade fever, itching, burning, and trouble urinating. But many people with the disease dont realize they have been infected with HSV, because either they have only mild or infrequent symptoms, or no symptoms at all. In women, herpes outbreaks can also be mistaken for vaginitis, urinary tract infections, or even hemorrhoids.
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Is Herpes Simplex Related To Herpes Zoster
Herpes simplex and the varicella-zoster virus are related, but they arent the same. VZV causes chickenpox and shingles.
Like HSV-1 and HSV-2, shingles can cause a painful, blistering rash. The shingles rash usually shows up on the back, side, abdomen , neck and face. It is often only on half of your body, following the pattern of your nerves. See your healthcare provider if you have a new rash and suspect you may have shingles.
A note from Cleveland Clinic
Herpes simplex is a virus. Once you have herpes, its a lifelong condition. A herpes infection can lead to outbreaks , but youll also have times when you have no symptoms. The main sign of herpes is sores that appear on the infected skin. Some people choose not to treat herpes, especially if symptoms are mild. Others take antiviral medications to reduce the severity and frequency of outbreaks.
Last reviewed by a Cleveland Clinic medical professional on 05/17/2022.
Recurrent Episodes Of Genital Herpes
Recurrences are usually less painful and shorter in duration than the first episode of genital herpes. Over time, episodes usually become less frequent and may eventually stop altogether. Infections caused by HSV1 are less likely to recur in the genital area than infections caused by HSV2.
Recurrences may be triggered by:
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If You Have Symptoms Find Out What Youre Dealing With
With genital herpes, the biggest mistake people make is not seeking medical advice, says Gade.
People often find the signs or symptoms of a first herpes outbreak confusing, says Gade. You may mistake herpes symptoms for those of a yeast infection and try curing that condition on your own. But if your healthcare provider diagnoses you with herpes, the first line of treatment will be antiviral medications.
, you can make matters worse by putting things on the herpes sores that you shouldnt put on the sores, she says. People often try using Vaseline, bacitracin, or Aquaphor to soothe the itchy or painful eruptions.
Honestly, not putting anything on the sores is best, says Gade. Do keep the area clean and dry, though.
Warm compresses applied to tender or painful areas can help. So can sitting in a warm bath, using Epsom salt.
Sometimes people have enormous pain with urination, says Gade. For relief, you can urinate in your bathwater or while taking a shower to dilute the urine stream and lessen the sensation. You can also use warm water in a spray bottle to dilute the stream while youre urinating.
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The Arginine And Lysine Balance
Both arginine and Lysine are naturally occurring amino acids that are responsible for regulating herpes-related outbreaks. The important thing to remember is that high arginine and low lysine levels in your diet can worsen your condition. Why is this? The herpes virus needs arginine to replicate itself. Lysine on the other hand has properties that can control it.
Although lysine supplementation can be helpful, be sure to check with your healthcare provider as you want to avoid upsetting the balance between your arginine and lysine intake. Too much lysine at the exclusion of arginine may work against you.
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Talk To Your Doctor About Suppressive Therapy
Valacyclovir has been shown to lower the risk of herpes transmission to a virus-free partner by 50%. A daily regimen of 500 milligrams of valacyclovir has been effective for partners with a history of recurrent attacks. Its likely that a combination of suppressive valacyclovir and condoms provides greater protection than either method alone.
Genital Herpes Treatment In Pregnancy
You may be offered antiviral treatment:
- to treat outbreaks in pregnancy
- from 36 weeks to reduce the chance of an outbreak during birth
- from diagnosis until the birth if you first get herpes after 28 weeks of pregnancy
Many women with genital herpes have a vaginal delivery. You may be offered a caesarean, depending on your circumstances.
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Recognize The Early Symptoms
You might not be able to stop an outbreak, but you might be able to reduce the severity and length of it. Many people have warning signs of an outbreak, including itching, tingling, genital pain, or shooting pain in the legs, hips, or buttocks, according to the Centers for Disease Control and Prevention . These signs can occur hours or days before the outbreak, so knowing them gives you the chance to treat the outbreak before it happens.
Antivirals That Require A Prescription
- Acyclovir is a prescription medication used to improve the healing of sores or blisters caused by a number of conditions, including first-time and repeat outbreaks of genital herpes. It works by slowing or stopping the spread of the herpes virus within the body, but it cannot cure genital herpes.
- Valacyclovir is another antiviral prescription drug used to treat genital herpes and shingles. Taken twice a day for five days, Valtrex may decrease uncomfortable symptoms and help sores heal faster. In some cases, this antiviral can also prevent new sores from forming.
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Talk To Your Doctor Before Using Herbal Methods Or Supplements
There are a few herbal methods and supplements that have shown some success in treating herpes outbreaks. For example, some studies have shown the amino acid lysine is helpful for some people with herpes, according to ASHA, but other studies have not been able to produce the same results. Also, some herbal treatments and supplements can have side effects or interfere with other medications. Talk with your doctor about whether these methods might work for you.
When Is Preventive Treatment Considered
Some people have outbreaks of genital herpes very often or experience especially severe symptoms. Then it may be a good idea to take antiviral medication for a longer time including during symptom-free phases. The goal is to prevent further outbreaks and to keep the symptoms from becoming so severe. Also, the antiviral medication reduces the likelihood of infecting others. As preventive treatment, the WHO recommends the following:
- aciclovir: 400 mg two times per day,
- famciclovir: 250 mg two times per day or
- valaciclovir: 500 mg once per day.
Research shows that preventive treatment can considerably lower the risk of further outbreaks. The people participating had four or more herpes outbreaks per year before the start of the studies, and then took an antiviral medication or a fake treatment for up to one year. A comprehensive analysis of the study results shows that
- 96 out of 100 people who took a placebo had at least one further outbreak of genital herpes.
- 46 out of 100 people who were given antiviral medication had at least one further outbreak of genital herpes.
In other words, the medication prevented further outbreaks in 50 out of 100 people within one year.
People with very frequent herpes outbreaks also benefited from preventive treatment: In one study involving people with very frequent outbreaks, the medication lowered the number of episodes in one year from 11 to 2.
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What Is Neonatal Herpes
Neonatal herpes can be a very serious infection. Babies generally contract the virus from their birthing parent during childbirth even if the parent doesnt have active lesions. They may also get HSV-1 if an adult with an active cold sore kisses them. Breastfeeding babies can also get HSV-1 from the breast if there are lesions present. But babies cant get herpes from breast milk, so its safe to pump and feed.
Herpes simplex can be more dangerous for young babies because they dont have a fully developed immune system. But most babies with neonatal herpes can recover fully with treatment.
The dangers of neonatal herpes are much higher if the infection spreads to the babys organs. If youre pregnant and have herpes, speak with your healthcare provider about how to lower the risk of passing the infection to your baby.
How To Prevent Herpes
But most people have sex at some point in their lives, so knowing how to have safer sex is important. Using protection like condoms and dental dams when you have sex helps to lower your risk of getting an STD.
Herpes can live on areas of your body that arent protected by condoms , so condoms wont always protect you from herpes. But they do lower your chances of getting herpes.
Dont have sex with anyone during a herpes outbreak, because thats when it spreads most easily. But herpes can also spread when there are no sores or symptoms, so its important to use condoms and dental dams, even if everything looks and feels A-OK.
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How Can I Make Sure I Dont Give Anyone Herpes
If you find out that you have herpes, try not to freak out. There are a few ways that you can stop it from spreading to your partners and other parts of your body.
Talk with your doctor about taking herpes medication every day, which can lower your chances of spreading herpes.
Dont have sex during a herpes outbreak, even with a condom. There may be sores on places the condom doesnt cover.
Learn how to tell when an outbreak is coming, and stop having sex right when you notice these signs. You may feel a burning, itching, or tingling feeling that lets you know youre about to get sores.
Dont have sex until your sores are totally gone, and the scabs heal and fall off.
Dont touch your herpes sores, because you can spread the infection to other parts of your body or other people. If you touch a sore, wash your hands with soap and water right after.
Dont wet contact lenses with spit this might spread your oral herpes to your eye.
If you have a cold sore on your mouth, don’t kiss anyone especially babies, children, or pregnant women.
Always tell your sexual partners that you have herpes before you have sex, so you can work together to prevent it from spreading. Telling someone you have an STD can be hard, but herpes is super common and doesnt lead to serious health problems. So try not to be too embarrassed or stressed out about it.
How To Control Herpes Outbreaks With Meds
Recently, I got a cold sore. At least I thought it was a cold sore but now thinking about it, maybe it was something else, like a fever blister. I had a similar thing happen to me a once or twice before, but Im pretty sure that happens to all teenagers. In fact, I dont think it could have been a cold sore at all because my best friend gets cold sores and this was different.
Whether you were recently diagnosed with herpes or have been living with it for a while, its important to inform yourself about what herpes is, how it impacts your health, and what you can do to identify and prevent the symptoms.
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Facts And Statistics About Herpes
- According to the World Health Organization, an estimated two-thirds of the global population under 50 years old are infected with herpes simplex virus type 1 .
- Estimates for HSV-1 prevalence in the U.S. among people aged 049 years are 178 million women and 142 million men .
- In total, about 75 percent or more of the American adult population has the HSV-1 virus that usually causes oral herpes , and about 20 percent to 30 percent have HSV-2 that usually causes genital herpes.
- Men and women are affected by HSV-1 about equally. Roughly 6 million women in the U.S. become infected with HSV-1 each year, along with 5 million men.
- Slightly more women than men are affected by genital herpes, whether from HSV-1 or HSV-2. Middle-aged women are most likely to acquire genital herpes.
- Transmission of HSV most often occurs without symptoms, so its estimated that 85 percent of people with genital herpes dont know it. Many dont have any symptoms at all after the initial infection, and only about 15 percent ever receive a HSV-2 infection diagnosis in their lifetimes.
- Most primary oral/facial HSV infections are caused by HSV-1 however, facial infection by HSV-2 is increasingly becoming common.
- Less children are becoming infected with HSV-1 than in the past in high-income countries, mostly due to better hygiene and living conditions.
- After someone comes into contact with an active herpes outbreak on another person, the incubation period takes about one week.
Other Triggers For Genital Herpes Outbreaks
Other triggers of genital herpes may include:
- Sexual intercourse. Some people find that the friction of sexual intercourse irritates the skin and brings on symptoms. Using a water-based lubricant can help reduce irritation. Don’t use one that contains the spermicide nonoxynol-9, however. Nonoxynol-9 can irritate mucous membranes, such as the lining of the . Oil-based lubricants are a no-no, too. They weaken latex, making condoms more likely to break. Even if the friction of intercourse seems to be a trigger for symptoms, it probably won’t cause a flare-up every time you have sex.
- Colds and sunlight. The common cold and sunlight seem to trigger outbreaks of oral herpes , but no proof exists that they trigger genital herpes outbreaks.
- Hormones. Hormonal changes, like those that occur in the menstrual cycle, can affect genital herpes outbreaks. No one knows why.
- Surgery, weak immune system. Trauma to the body, such as having surgery, may make herpes symptoms appear. It’s possible that having a weakened immune system does, too. People whose immune systems are weakened by HIV, for example, tend to have outbreaks more often than people with normal immune functioning.
Remember that triggers may not be the same for everyone, and doctors are not certain how much lifestyle affects outbreaks of herpes symptoms. If you think something in particular triggers symptoms, ask your doctor what you should do about it.
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Do Condoms Help Prevent The Spread Of Genital Herpes
Yes. To prevent transmission of herpes, we recommend that condoms be used 100% of the time. Many patients will shed the virus and be contagious when they dont have symptoms. Studies have shown that asymptomatic shedding occurs between 1% and 3% of the time in patients with HSV II genital infections. Many new herpes infections occur from partners who are shedding the virus asymptomatically, so condoms are highly recommended.
Condoms may not be an attractive option for monogamous couples or for couples who desire to become pregnant. Couples may opt to have serological tests to determine if either partner has an asymptomatic infection. In close monogamous relationships, the risks of transmission can be weighed against other relationship issues, such as intimacy and pregnancy.
Myth: People With Herpes Must Be Promiscuous
The reality of any STI is you dont need to sleep around to get infected. This is especially true for herpes, considering theres such a large population of asymptomatic carriers, says Dr. Dardik. While having more partners obviously increases your risk of any kind of any kind of sexually transmitted infection, the reverse doesnt always hold, she points out. In other words, all it takes is one partner.
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How Is Genital Herpes Treated
Herpes has no cure. But antiviral medicines can prevent or shorten outbreaks during the time you take the medicine. Also, daily suppressive therapy for herpes can lower your chance of spreading the infection to your partner.
Your doctor will either give you antiviral medicine to take right after getting outbreak symptoms or to take regularly to try to stop outbreaks from happening. Talk to your doctor about treatment options.
During outbreaks, you can take the following steps to speed healing and prevent spreading herpes to other parts of your body or to other people:
- Keep sores clean and dry.
- Try not to touch the sores.
- Wash your hands after any contact with the sores.
- Avoid all sexual contact from the time you first notice symptoms until the sores have healed.
What Are The Complications Of Genital Herpes
Genital herpes may cause painful genital ulcers that can be severe and persistent in persons with suppressed immune systems, such as HIV-infected persons. 5 Both HSV-1 and HSV-2 can also cause rare but serious complications such as aseptic meningitis . 5 Development of extragenital lesions may occur during the course of infection. 5
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How Long Do Herpes Symptoms Take To Show
On average, it takes about 4 days after exposure to start showing the symptoms of herpes. The herpes incubation period ranges between 2 and 12 days. The most common early sign of herpes is sores around the genitals or mouth.
The first time you get the herpes virus, it may cause flu-like symptoms, such as a fever, headache, and body aches. Then, subsequent outbreaks may cause sores and less severe symptoms. Generally, the frequency of outbreaks lessens over time.