Genital herpes
What is genital herpes?
Genital herpes is a sexually transmitted infection (STI) caused by herpes simplex viruses – HSV-1 and HSV-2. Both types can cause genital infection.
HSV-1 is most often transmitted in childhood through contact with saliva or skin, for example through kissing or sharing personal hygiene items. It usually causes oral herpes (cold sores on or around the lips, mouth, or nose). Many people infected with HSV-1 have no symptoms, but the virus remains in the body in an inactive form and can reactivate repeatedly throughout life. In people who have not previously encountered the virus, HSV-1 can also be transmitted during sexual contact, especially oral sex, and cause genital herpes. In recent years, the number of genital infections caused by HSV-1 has been increasing, because fewer people acquire oral HSV-1 in childhood due to improved hygiene and lower levels of close contact.
HSV-2 is transmitted almost exclusively through sexual contact (vaginal, anal, or oral) and is the main cause of genital herpes. This type of virus causes more frequent and more pronounced outbreaks (recurrent episodes with blisters and sores) than HSV-1 and is responsible for approximately 90% of symptomatic episodes (cases in which the infection presents with visible or painful symptoms such as blisters and sores). After infection, the virus remains permanently in the body and can reactivate repeatedly over time. HSV-2 infection also increases the risk of acquiring HIV approximately two- to three-fold, because herpes lesions (sores or blisters on the skin or mucosa) make it easier for HIV to enter the body. According to estimates by the World Health Organization, around 520 million people aged 15–49 were living with HSV-2 infection in 2020. There is currently no cure, but antiviral medication can shorten the duration and severity of symptoms and reduce the risk of transmission.
Symptoms
Genital herpes often occurs without visible symptoms, which is why many people are unaware they are infected. Even without symptoms, the virus remains in the body and can be transmitted to a sexual partner.
In people with symptomatic infection, the following symptoms may occur:
- burning, itching, or tingling in the genital area, anus, or thighs,
- small blisters or bumps that rupture and form painful sores or ulcers (lesions),
- redness, swelling, and pain in the affected area,
- painful urination or unusual discharge,
- itching or burning when the skin comes into contact,
- sometimes swollen lymph nodes, fever, headache, and general fatigue – especially during the first outbreak.
Sores usually appear in areas that were in contact with a partner during sex. In people with a vulva, they most often appear on the vulva, the outer part of the clitoris, the vaginal opening, or around the anus. In people with a penis, they commonly appear on the penis, scrotum, buttocks, or inner thighs.
The first episode of genital herpes is usually the most intense and longest, lasting 2 to 4 weeks, and is often accompanied by flu-like symptoms. After symptoms subside, the virus remains inactive in the body but can reactivate at any time. Recurrent outbreaks are usually milder, shorter, and less frequent than the first episode. Triggers may include weakened immunity, stress, fatigue, or other illnesses.
Testing
Diagnosing genital herpes can be challenging because most infected people have no visible symptoms or only very mild signs that are often mistaken for other skin conditions.
If blisters or sores (lesions) are present, a doctor will take a swab from the affected area. This sample is then tested in a laboratory for the presence of the virus using molecular NAAT or PCR tests, which are among the most sensitive and reliable diagnostic methods. The sample has the highest diagnostic value if collected within 4 days of blister or sore formation.
If no sores are present, the diagnosis can be confirmed with a blood test that detects antibodies against HSV-1 or HSV-2. These tests help determine whether a person has ever been infected and which type of virus caused the infection. However, blood tests cannot determine the exact time of infection or the source, and in recent infections the result may still be negative. In some cases, repeat testing after 12 weeks is recommended.
The diagnosis of genital herpes should be confirmed by a healthcare professional experienced in sexually transmitted infections. In many countries, testing is carried out in dermatovenerology or sexual health clinics.
Treatment
Genital herpes is a chronic viral infection that cannot be completely cured, because the virus remains in the body in an inactive form. The goal of treatment is to relieve symptoms, shorten the duration of outbreaks, and reduce the risk of transmission to sexual partners.
During the first outbreak, symptoms are usually the most severe and may last 2 to 4 weeks. Antiviral treatment for 7 to 10 days is recommended, as it helps shorten the duration of the infection and reduce pain. If sores do not heal within 10 days, treatment may be extended. In severe or widespread cases, for example if the infection affects the nervous system, antivirals may be administered intravenously.
In addition to antiviral medication, simple supportive measures can help:
- gently washing the affected area with clean or saline water,
- wearing loose, breathable clothing,
- applying petroleum jelly or a numbing ointment to relieve pain,
- urinating while sitting or in a warm bath if urination is painful,
- using common pain relievers (e.g., ibuprofen, paracetamol).
Although antivirals reduce the risk of transmission, the virus can still be spread even when no symptoms are present. To further reduce risk, it is recommended to:
- avoid sexual contact during outbreaks or when early warning signs appear,
- use condoms or dental dams during every sexual encounter,
- inform sexual partners about the infection,
- consider long-term suppressive therapy in cases of frequent recurrences.
Conclusion
Genital herpes is a common, chronic viral infection that can range from completely asymptomatic to painful outbreaks. Although it cannot be fully cured, modern treatment can effectively suppress symptoms, shorten the duration of episodes, and reduce the risk of transmission.
It is important that people with this infection do not hesitate to seek professional help. Early diagnosis, antiviral treatment, and simple supportive measures can significantly improve quality of life. Genital herpes does not mean the end of intimacy or relationships – with open communication, protective measures, and proper treatment, it is possible to have a fulfilling and lower-risk sex life.
Support and information are key. The more we know about herpes, the better we can protect ourselves and our partners.
Sources:
https://www.nhs.uk/conditions/genital-herpes
https://www.cdc.gov/herpes/about/index.html
https://www.healthdirect.gov.au/genital-herpes
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