Frequently asked questions about genital herpes

A painful rash with blisters on the genitals is typical of genital herpes. These may affect the penis, foreskin and scrotum in men, and the labia, vagina and cervix in women. Symptoms in other areas such as the perineum, the anus and the thighs are also possible, though. 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. Some skin changes caused by herpes viruses are barely visible or affect parts of the body that are difficult to see. Less severe problems easily be confused with minor skin injuries, ingrown hairs or a yeast infection (thrush). It is estimated that up to 90 out of 100 people who have genital herpes viruses in their body aren’t aware of it.

Genital herpes is mainly transmitted through skin-to-skin contact during sex. That is why every sexually active person can become infected. It is also possible to become infected from shared sex toys.

Genital herpes is mainly caused by the type 2 herpes simplex virus, while cold sores are usually caused by the type 1 virus (HSV-1). HSV-1 can also cause genital herpes, though. This can happen if somebody has cold sores and touches another person's genitals with their mouth during 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.

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.

The first time people have genital herpes, the symptoms are often more severe and only go away after about 20 days. In later outbreaks, the symptoms are usually milder, and clear up after about 10 days.

It can't be ruled out that people without symptoms may pass the viruses on to other people. The risk is much lower than during an outbreak, though. But it still makes sense to use condoms during sex. They can significantly lower the risk of infection and also prevent the spread of other sexually transmitted infections (STIs).

Studies on heterosexual couples in which one partner had genital herpes 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 found that the couples had to have sex with each other around 1,000 times for an infection to be passed on.

It is not possible to make a general statement about sex outside of long-term relationships: It can depend on how often and with how many different sexual partners you have sex, whether you use condoms, and how long one of the people involved has had the infection. 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.

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, femidoms and dental dams can significantly reduce the risk of infection during symptom-free phases. 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 are in a long-term relationship or have regular sexual partners, you can discuss whether a blood test for herpes antibodies might be a good idea. 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.

Herpes viruses stay in people's body for the rest of their lives once infected. If the infection then triggers an outbreak of genital herpes, recurring outbreaks have to be expected. The frequency of outbreaks depends on which type of herpes virus they have. The symptoms come back within one year of the first outbreak

• in 20 to 50% of people with herpes simplex virus type 1 (HSV-1), and
• in 70 to 90% of people with herpes simplex virus type 2 (HSV-2).

The time between the outbreaks is shorter with type 2 viruses. People with type 2 have an average of four more outbreaks within the first year. But in most people the outbreaks become less frequent and less severe over time.

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 skin conditions such as eczema, the herpes virus sometimes affects larger areas of skin elsewhere on the body. This very rarely happens, though.

Rarely, the viruses can also attack the brain or cause infections in the entire body, most commonly in newborn babies or people with a weakened immune system.

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.