Table of ContentsView AllTable of ContentsCausesSymptomsWhat Herpes Look LikeWhen to See a ProviderDiagnosisTreatmentFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Causes
Symptoms
What Herpes Look Like
When to See a Provider
Diagnosis
Treatment
Frequently Asked Questions
Herpes simplex virus type 2 (HSV-2) is the virus most commonly linked togenital herpes, asexually transmitted infection(STI) that causes painful blisters and ulcers on the penis, vagina, or rectum. The virus is passed during intimate sexual contact prior to and following the outbreak of ulcers.
Herpes simplex type 1 (HSV-1) is a related virus more commonly linked tooral herpes(a.k.a. cold sores). Even so, HSV-1 can sometimes be passed to the genitals duringoral sex.
Pornpak Khunatorn / Getty Images
Although HSV-2 accounts for most genital herpes outbreaks, it is impossible to tell which virus caused the infection without lab tests.
This article looks at the causes and symptoms of genital herpes and explains how this common viral disease is diagnosed and treated. It also offers tips on when to seek treatment to potentially reduce the duration and severity of an outbreak, or to suppress and prevent outbreaks and transmission.
HSV-2 Causes
According to the Centers for Disease Control and Prevention (CDC), around 12% of people in the United States between the ages of 14 and 49 have HSV-2. In 2021, an estimated 572,000 people nationwide were newly infected.
Sex is the predominant mode of transmission. Generally, you can only get HSV-2 when there is genital-to-genital contact with someone who has a genital HSV-2 infection. However, receiving oral sex from someone with an oral HSV-1 infection can also lead to genital herpes.
Once you’ve been infected with HSV-2, it does not go away. Instead, the virus remains in the body in a latent (dormant) state, embedded in nerve cells near the spine. Triggers like stress, illness, or hormonal changes can cause the virus to reactivate and travel along the nerve route to the site of the original infection, causing a repeated outbreak (recurrence).
Asymptomatic Infection
Not everyone who gets HSV-2 will develop symptoms of genital herpes. Some people will remain asymptomatic (symptom-free), or they have mild symptoms that go unnoticed as an HSV infection. Still, they are able to pass the virus to others without knowing it.
While exposure to herpes sores can easily transmit the virus, HSV-2 infections most often occur when you have sex with someone who is either asymptomatic or has mild symptoms that are not readily recognized as herpes. In cases like these, there will be periods during which the virus can be “shed” through the skin of the genitals or rectum.
Some studies suggest that asymptomatic HSV-2 shedding can occur as much as 10% of days.
Risk Factors for HSV-2Certain risk factors can increase the likelihood of genital herpes, including:Having vaginal, anal, or oral sex withoutcondomsordental dams)Having multiple and/or anonymous sex partnersThe presence or history of another STIHaving a vagina (which nearly doubles the risk compared to people with penises)Black people are diagnosed with genital herpes 4 times more often than White people.
Risk Factors for HSV-2
Certain risk factors can increase the likelihood of genital herpes, including:Having vaginal, anal, or oral sex withoutcondomsordental dams)Having multiple and/or anonymous sex partnersThe presence or history of another STIHaving a vagina (which nearly doubles the risk compared to people with penises)Black people are diagnosed with genital herpes 4 times more often than White people.
Certain risk factors can increase the likelihood of genital herpes, including:
Black people are diagnosed with genital herpes 4 times more often than White people.
Causes and Risk Factors of Herpes
HSV-2 Symptoms
Not everyone with HSV-2 has symptoms or is even aware that they’ve been infected. Research suggests that around 87% of people with HSV-2 under the age of 50 have never been diagnosed.Most are either asymptomatic or have very mild symptoms that are easily mistaken for other skin conditions.
When symptoms do occur, they usually involve the spontaneous appearance of tiny blisters around the genitals or rectum. Soon after, the blisters will rupture, leaving painful ulcers that ooze, crust over, and eventually heal within two to four weeks.
Symptoms of genital HSV-2 infections can develop within two to 12 days of exposure.
First and Subsequent Episodes
Over time, the number of outbreaks tends to decrease and become less severe.
How to Recognize and Deal With Herpes Discharge
Complications
For most people with genital herpes, symptoms can be aggravating but not life-threatening.
However, for people who areimmunocompromised, such as those withadvanced human immunodeficiency virus (HIV), HSV-2 can cause rare but serious complications likeaseptic meningitis(inflammation of the lining of the brain).
Genital Herpes and PregnancyIf you have genital herpes, you may need medication to reduce the risk of active herpes symptoms at the time of delivery, which could makecesarean deliverynecessary. Be sure to tell your healthcare provider about any herpes diagnosis, symptoms, or exposure.
Genital Herpes and Pregnancy
If you have genital herpes, you may need medication to reduce the risk of active herpes symptoms at the time of delivery, which could makecesarean deliverynecessary. Be sure to tell your healthcare provider about any herpes diagnosis, symptoms, or exposure.
3 Surprising Ways That STIs Increase HIV Risk
What Does Genital Herpes Look Like?
Genital herpes symptoms can differ from one person to the next, causing a massive outbreak in some people and an uncomfortable rash or redness that can easily be mistaken for other conditions.
When an outbreak is about to occur, people will often experienceprodromal(precursor) symptoms such as tingling, itching, or burning around the area where the sores are about to appear.
Soon after, a cluster of itchy or painful blisters filled with fluid will appear on the vagina,vulva,cervix, penis,scrotum, buttocks, anus, or upper thighs. The blisters can vary both in size and density. As the blisters begin to rupture, they turn into open sores that can bleed or ooze a whitish fluid.
Over a period of several days, the sores will begin to crust over and heal. Most outbreaks clear within two to four weeks, usually without leaving any scars.
What Does Herpes Look Like?
When to See a Healthcare Provider
The early recognition of genital herpes, ideally during the prodromal stage, allows you to access treatments that can shorten the duration and severity of an outbreak.
Clearly, this can be difficult during your first outbreak, given that you probably won’t be expecting it. But, over time, you will be better able to recognize the tell-tale signs and know when it’s time to act.
When to Start TreatmentThe traditional rule of thumb is that the treatment of genital herpes—in the form oforal antiviral drugs—should begin within 72 hours of the first appearance of lesions.The earlier the treatment in a genital herpes outbreak, the more effective it is.
When to Start Treatment
The traditional rule of thumb is that the treatment of genital herpes—in the form oforal antiviral drugs—should begin within 72 hours of the first appearance of lesions.The earlier the treatment in a genital herpes outbreak, the more effective it is.
Getting treated also can slow the rate of viral shedding.A suppressive antiviral medication can limit both your own outbreaks and the risk of infecting your sexual partners.
HSV-2 Diagnosis
Genital herpes is often diagnosed with a physical exam. A swab of cells from a herpes sore sometimes is done and can be used for tests including:
The two categories of antibody tests used to detect HSV are:
Certain IgG blood tests can also tell you whether you have HSV-1 or HSV-2.
CDC Screening RecommendationsThe CDC does not recommend herpes testing for people without symptoms as it is unlikely to change risk behaviors or slow the spread of the virus. HSV blood testingmaybe useful if:You have symptoms of genital herpes.You are having (or have had) sex with someone with genital herpes.You want acomplete STI exam, especially if you have multiple partners.
CDC Screening Recommendations
The CDC does not recommend herpes testing for people without symptoms as it is unlikely to change risk behaviors or slow the spread of the virus. HSV blood testingmaybe useful if:You have symptoms of genital herpes.You are having (or have had) sex with someone with genital herpes.You want acomplete STI exam, especially if you have multiple partners.
The CDC does not recommend herpes testing for people without symptoms as it is unlikely to change risk behaviors or slow the spread of the virus. HSV blood testingmaybe useful if:
How Genital Herpes Is Diagnosed
There is no cure for genital herpes. However, antiviral drugs can reduce the duration and severity of an outbreak. They can also reduce the risk of outbreaks in people with recurrence and reduce the risk of passing the virus to others.
The treatment varies based on whether this is your first or subsequent outbreak.
First Outbreak
Everyone who gets a first herpes outbreak should be treated. The earlier the treatment in a genital herpes outbreak, the more effective it is. While many experts recommend initiating treatment within 72 hours of the appearance of lesions, there are still benefits if treatment is started after 72 hours.
Among them, people who are not treated during their first outbreak are more likely to experience severe or prolonged recurrences in the future, even if their initial symptoms were mild.
The drugs can be taken with or without food, but the doses need to be evenly spaced throughout the day (every 12 hours for twice-daily doses and every eight hours for thrice-daily doses). If needed, treatment can be extended if the lesions have not fully healed.
Recurrence
In cases of recurrence, antivirals can be prescribed whenever an outbreak occurs, usually at lower doses or for shorter treatment periods. This is referred to asepisodic therapy.
There are seven episodic therapies recommended for the treatment of HSV-2 recurrence.
If attacks are frequent and severe, your healthcare provider may recommendsuppressive therapyin which an antiviral drug is taken every day to prevent a recurrence.
The three suppressive therapies recommended for the treatment of recurrent HSV-2 are:
Treatments That Heal Herpes Sores Faster
Summary
Herpes simplex virus type 2 (HSV-2) is the virus most commonly associated with genital herpes. While herpes simplex virus type 1 (HSV-1), the virus linked tocold sores, can also cause genital herpes, it is far less likely to cause recurrent outbreaks the way that HSV-2 can.
HSV-2 doesn’t always cause symptoms. When it does, it can lead to an outbreak of blisters on the genitals or rectum that break open to cause painful, oozing sores. First outbreaks tend to be worse than subsequent ones.
Genital herpes can be passed during sex if a person is exposed to an open herpes sore. But, asymptomatic people with genital herpes can also pass the virus to others during periods of viral shedding
Genital HSV-2 infections can be diagnosed with a physical exam, blood tests, and a swab of a herpes lesion. Treatment involves antiviral drugs, either taken when needed to treat acute episodes or taken daily to reduce the frequency of outbreaks.
A Word From Verywell
The diagnosis of genital herpes can cause extreme anxiety and stress in some people, particularly those who are just starting to date. If this is you, it is important to remember that millions of people have genital herpes and that having the disease doesn’t mean that you are “tainted.”
Coming to terms with genital herpes can take time, and it often helps to join a support group to educate yourself and get perspective on what it is like to live with this common viral disease.
How to Prevent Genital Herpes
The incubation period for herpes simplex virus type 2 (HSV-2) is between two and 12 days following exposure. Most cases of genital herpes will start within four days. With that said, many HSV-2 infections cause no symptoms even though the person can still pass the virus to others.Learn MoreWhat Is the Incubation Period for Common STIs?
The incubation period for herpes simplex virus type 2 (HSV-2) is between two and 12 days following exposure. Most cases of genital herpes will start within four days. With that said, many HSV-2 infections cause no symptoms even though the person can still pass the virus to others.
Learn MoreWhat Is the Incubation Period for Common STIs?
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Sauerbrei A.Herpes genitalis: diagnosis, treatment and prevention.Geburtshilfe Frauenheilkd.2016 Dec;76(12):1310–7, doi:10.1055/s-0042-116494World Health Organization.Herpes simplex virus.World Health Organization.Massive proportion of world’s population are living with herpes infection.Centers for Disease Control and Prevention.About genital herpes.American College of Obstetricians and Gynecologists.Why does herpes cause repeated outbreaks?Centers for Disease Control and Prevention.About Genital Herpes.Schiffer JT, Mayer BT, Fong Y, Swam DA, Wald A.Herpes simplex virus-2 transmission probability estimates based on quantity of viral shedding.J R Soc Interface.2014 Jun 6;11(95):20140160. doi:10.1098/rsif.2014.0160Government of Canada.Genital herpes guide: risk factors and clinical manifestations.Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz L.Trends in seroprevalence of herpes simplex virus type 2 among non-Hispanic blacks and non-Hispanic whites aged 14 to 49 years–United States, 1988 to 2010.Sex Transm Dis, 2013;40(11):860-4. doi:10.1097/OLQ.0000000000000043Looker KJ, Elmes JAR, Gottlieb SL, et al.Effect of HSV-2 infection on subsequent HIV acquisition: an updated systematic review and meta-analysis.Lancet Infect Dis. 2017 Dec;17(12):1303–6. doi:10.1016/S1473-3099(17)30405-XNational Organization of Rare Diseases.Herpes, neonatal.Planned Parenthood.What does genital herpes look like?Mospan CM, Cluck D.Prevention and management of genital herpes.US Pharm.2016;41(4):30-33.Anderson NW, Buchan BW, Ledeboer NA.Light microscopy, culture, molecular, and serologic methods for detection of herpes simplex virus.J Clin Microbiol. 2014 Jan;52(1):2-8. doi:10.1128/JCM.01966-13Centers for Disease Control and Prevention.Screening for genital herpes.Centers for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021: genital herpes.
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Sauerbrei A.Herpes genitalis: diagnosis, treatment and prevention.Geburtshilfe Frauenheilkd.2016 Dec;76(12):1310–7, doi:10.1055/s-0042-116494World Health Organization.Herpes simplex virus.World Health Organization.Massive proportion of world’s population are living with herpes infection.Centers for Disease Control and Prevention.About genital herpes.American College of Obstetricians and Gynecologists.Why does herpes cause repeated outbreaks?Centers for Disease Control and Prevention.About Genital Herpes.Schiffer JT, Mayer BT, Fong Y, Swam DA, Wald A.Herpes simplex virus-2 transmission probability estimates based on quantity of viral shedding.J R Soc Interface.2014 Jun 6;11(95):20140160. doi:10.1098/rsif.2014.0160Government of Canada.Genital herpes guide: risk factors and clinical manifestations.Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz L.Trends in seroprevalence of herpes simplex virus type 2 among non-Hispanic blacks and non-Hispanic whites aged 14 to 49 years–United States, 1988 to 2010.Sex Transm Dis, 2013;40(11):860-4. doi:10.1097/OLQ.0000000000000043Looker KJ, Elmes JAR, Gottlieb SL, et al.Effect of HSV-2 infection on subsequent HIV acquisition: an updated systematic review and meta-analysis.Lancet Infect Dis. 2017 Dec;17(12):1303–6. doi:10.1016/S1473-3099(17)30405-XNational Organization of Rare Diseases.Herpes, neonatal.Planned Parenthood.What does genital herpes look like?Mospan CM, Cluck D.Prevention and management of genital herpes.US Pharm.2016;41(4):30-33.Anderson NW, Buchan BW, Ledeboer NA.Light microscopy, culture, molecular, and serologic methods for detection of herpes simplex virus.J Clin Microbiol. 2014 Jan;52(1):2-8. doi:10.1128/JCM.01966-13Centers for Disease Control and Prevention.Screening for genital herpes.Centers for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021: genital herpes.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Sauerbrei A.Herpes genitalis: diagnosis, treatment and prevention.Geburtshilfe Frauenheilkd.2016 Dec;76(12):1310–7, doi:10.1055/s-0042-116494World Health Organization.Herpes simplex virus.World Health Organization.Massive proportion of world’s population are living with herpes infection.Centers for Disease Control and Prevention.About genital herpes.American College of Obstetricians and Gynecologists.Why does herpes cause repeated outbreaks?Centers for Disease Control and Prevention.About Genital Herpes.Schiffer JT, Mayer BT, Fong Y, Swam DA, Wald A.Herpes simplex virus-2 transmission probability estimates based on quantity of viral shedding.J R Soc Interface.2014 Jun 6;11(95):20140160. doi:10.1098/rsif.2014.0160Government of Canada.Genital herpes guide: risk factors and clinical manifestations.Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz L.Trends in seroprevalence of herpes simplex virus type 2 among non-Hispanic blacks and non-Hispanic whites aged 14 to 49 years–United States, 1988 to 2010.Sex Transm Dis, 2013;40(11):860-4. doi:10.1097/OLQ.0000000000000043Looker KJ, Elmes JAR, Gottlieb SL, et al.Effect of HSV-2 infection on subsequent HIV acquisition: an updated systematic review and meta-analysis.Lancet Infect Dis. 2017 Dec;17(12):1303–6. doi:10.1016/S1473-3099(17)30405-XNational Organization of Rare Diseases.Herpes, neonatal.Planned Parenthood.What does genital herpes look like?Mospan CM, Cluck D.Prevention and management of genital herpes.US Pharm.2016;41(4):30-33.Anderson NW, Buchan BW, Ledeboer NA.Light microscopy, culture, molecular, and serologic methods for detection of herpes simplex virus.J Clin Microbiol. 2014 Jan;52(1):2-8. doi:10.1128/JCM.01966-13Centers for Disease Control and Prevention.Screening for genital herpes.Centers for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021: genital herpes.
Sauerbrei A.Herpes genitalis: diagnosis, treatment and prevention.Geburtshilfe Frauenheilkd.2016 Dec;76(12):1310–7, doi:10.1055/s-0042-116494
World Health Organization.Herpes simplex virus.
World Health Organization.Massive proportion of world’s population are living with herpes infection.
Centers for Disease Control and Prevention.About genital herpes.
American College of Obstetricians and Gynecologists.Why does herpes cause repeated outbreaks?
Centers for Disease Control and Prevention.About Genital Herpes.
Schiffer JT, Mayer BT, Fong Y, Swam DA, Wald A.Herpes simplex virus-2 transmission probability estimates based on quantity of viral shedding.J R Soc Interface.2014 Jun 6;11(95):20140160. doi:10.1098/rsif.2014.0160
Government of Canada.Genital herpes guide: risk factors and clinical manifestations.
Fanfair RN, Zaidi A, Taylor LD, Xu F, Gottlieb S, Markowitz L.Trends in seroprevalence of herpes simplex virus type 2 among non-Hispanic blacks and non-Hispanic whites aged 14 to 49 years–United States, 1988 to 2010.Sex Transm Dis, 2013;40(11):860-4. doi:10.1097/OLQ.0000000000000043
Looker KJ, Elmes JAR, Gottlieb SL, et al.Effect of HSV-2 infection on subsequent HIV acquisition: an updated systematic review and meta-analysis.Lancet Infect Dis. 2017 Dec;17(12):1303–6. doi:10.1016/S1473-3099(17)30405-X
National Organization of Rare Diseases.Herpes, neonatal.
Planned Parenthood.What does genital herpes look like?
Mospan CM, Cluck D.Prevention and management of genital herpes.US Pharm.2016;41(4):30-33.
Anderson NW, Buchan BW, Ledeboer NA.Light microscopy, culture, molecular, and serologic methods for detection of herpes simplex virus.J Clin Microbiol. 2014 Jan;52(1):2-8. doi:10.1128/JCM.01966-13
Centers for Disease Control and Prevention.Screening for genital herpes.
Centers for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021: genital herpes.
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