Frequently asked questions about genital herpes
How can you tell if you have genital herpes?
Genital herpes typically causes symptoms such as painful blisters in the genital area. These may affect the penis, foreskin and scrotum in men, and the labia, vagina and cervix in women. Less typical symptoms are also possible, such as blisters on the anus or thighs. During the very first outbreak, the lymph nodes in the groin often become swollen too.
In most cases, though, people who become infected with herpes viruses don’t develop any noticeable symptoms, or very mild symptoms. It can then easily be confused with minor skin injuries, ingrown hairs or a yeast infection (thrush). Some skin changes caused by herpes viruses are barely visible or affect parts of the body that are difficult to see. It is estimated that up to 90 out of 100 people who have genital herpes viruses in their body aren’t aware of it.
How are the viruses transmitted?
Herpes viruses are transmitted through skin-to-skin contact, so anyone who is sexually active can become infected. Genital herpes is mostly transmitted through sex, including oral and anal sex. It is also possible to become infected from shared sex toys.
Genital herpes is mainly caused by the type 2 herpes simplex virus (HSV-2). Cold sores on lips are caused by herpes viruses too, but usually by the type 1 virus (HSV-1). HSV-1 can also cause genital herpes, though. So it’s possible to get genital herpes from someone who has cold sores, for example through oral sex.
The virus can’t survive for long without skin contact. For this reason, you are highly unlikely to become infected through contact with toilets or other objects.
How long does it take for the disease to develop after becoming infected?
Genital herpes symptoms can already appear within a few days of being infected with the virus. But it can also take weeks, months, or even years before any symptoms occur. Most people who are infected with the virus will have no symptoms or hardly noticeable symptoms, though.
How long do herpes outbreaks last?
The first time people have genital herpes, the symptoms are often more severe and only go away after about 20 days. This varies from person to person, though. In later outbreaks, the symptoms are usually milder, and typically clear up after about 10 days.
Am I contagious if I don't have any symptoms?
The mucous membranes lining the genital area may still have herpes viruses on them during symptom-free phases, so the virus can still be transmitted. The risk is much lower than during an outbreak, though. But it’s still a good idea to use condoms during sex in the symptom-free phases. They can significantly lower the risk of infection and also prevent the spread of other sexually transmitted infections (STIs).
How high is the risk of becoming infected during sex?
In studies on couples in which one partner had genital herpes, it was found that the other partner became infected within one year in 5 to 10% of the couples. The people in these studies only rarely used condoms, though – and if they did, it was mostly during an outbreak. One of the studies showed that the infection was passed on in an estimated 1 out of 1,000 sexual acts. The likelihood of being infected with genital herpes during sex depends on various factors, including how often you have sex, whether and how frequently you use condoms, and how long the partner with herpes has already been infected. Someone who has had the virus for a long time is less contagious than someone who has just been infected. And women are more likely to become infected than men are.
I have genital herpes: How can I avoid spreading it to others?
There is no fail-safe way to stop the spread of genital herpes. But the risk of infection can be reduced significantly. People who have genital herpes are advised to avoid sex as soon as they notice signs that an outbreak is starting. This is because the risk of transmitting the virus is greatest during an outbreak.
Condoms can greatly reduce the risk of infection during symptom-free periods. People can still be contagious even if they don’t have symptoms at the time. But the risk of infection is much lower than during a herpes outbreak.
If you have genital herpes, it’s a good idea to talk about it with your partner. It’s also advisable for both of you to have a blood test to see whether you have antibodies to herpes. This allows you to find out whether just one or both of you have herpes viruses in your body, what type of herpes viruses they are – and whether there's a risk of infection. People who have genital herpes can somewhat lower the risk of infecting others by taking antiviral medication.
How likely is genital herpes to cause symptoms?
People who have had genital herpes outbreaks in the past will probably keep having outbreaks. The frequency of outbreaks depends on which type of herpes virus they have. About 20 to 50% of people who have herpes simplex type 1 (HSV-1) have further outbreaks in the first year after the initial outbreak.
About 70 to 90% of people who have herpes simplex type 2 (HSV-2) have further outbreaks within a year of their first outbreak. The symptom-free phases between outbreaks are also shorter in people who have HSV-2: They have an average of four further outbreaks within the first year. But the outbreaks usually become less frequent and less severe over time.
Can the virus spread to other parts of the body?
Genital herpes doesn’t always only occur in the genital area. It can also occur on other parts of the body, such as the bottom and inner thighs. But the skin in most other areas of the body is so thick that the viruses can’t get into it. In people who have other skin conditions such as eczema, the herpes virus sometimes affects larger areas of skin elsewhere on the body. This very rarely happens, though.
If your partner has genital herpes and you give them oral sex, you may get cold sores on your lips. But this doesn’t typically happen, either. The spread of viruses is more likely the other way round: If you have a cold sore on your lips and give your partner oral sex, they could get genital herpes.
What can trigger herpes outbreaks?
Some evidence suggests that constant emotional stress could make genital herpes outbreaks more likely. Other possible triggers are thought to include sunlight, common colds, physical exertion, skin injuries, menstruation, and wearing clothes that are tight or made from rough fabrics. There is hardly any research in this area, though.
Centers for Disease Control and Prevention (CDC). Seroprevalence of herpes simplex virus type 2 among persons aged 14-49 years - United States, 2005-2008. MMWR Morb Mortal Wkly Rep 2010; 59(15): 456-459.
Le Cleach L, Trinquart L, Do G, Maruani A, Lebrun-Vignes B, Ravaud P et al. Oral antiviral therapy for prevention of genital herpes outbreaks in immunocompetent and nonpregnant patients. Cochrane Database Syst Rev 2014; (8): CD009036.
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