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Genital Herpes

Understanding Herpes Simplex Virus (HSV-1 & HSV-2)

Herpes is extremely common - most people don't know they have it. While incurable, effective treatments control symptoms and reduce transmission. Get accurate diagnosis and expert support.

What is Herpes (HSV)?

Genital herpes is caused by herpes simplex virus (HSV), either type 1 (HSV-1, traditionally causing cold sores) or type 2 (HSV-2, traditionally genital). Both types can infect either location. Herpes is extremely common - around 1 in 6 adults have genital herpes, though most are unaware. While there's no cure, antiviral treatments effectively manage symptoms and reduce transmission risk.

Symptoms

  • Many people have no symptoms or very mild ones
  • Tingling, itching, or burning before outbreak
  • Small painful blisters on genitals, buttocks, or thighs
  • Blisters break to form shallow painful ulcers
  • Flu-like symptoms during first outbreak (fever, body aches)
  • Swollen lymph nodes in groin
  • Painful urination if urine touches sores
  • First outbreak usually most severe, lasting 2-4 weeks
  • Recurrent outbreaks usually milder and shorter

Causes

  • Herpes simplex virus type 1 (HSV-1) - increasingly common cause of genital herpes
  • Herpes simplex virus type 2 (HSV-2) - traditional cause of genital herpes
  • Direct skin-to-skin contact with infected area
  • Transmission can occur even without visible sores
  • Oral sex can transmit HSV-1 to genitals
  • Vaginal, anal, or oral sex with infected partner
  • The virus remains dormant in nerve cells for life

Who Is at Risk?

  • Sexually active individuals
  • People with multiple sexual partners
  • Those not using barrier protection
  • Partners of people with known herpes
  • People who have received oral sex (HSV-1 transmission)
  • Immunocompromised individuals (more severe/frequent outbreaks)

Potential Complications

  • Recurrent outbreaks (frequency varies greatly)
  • Psychological impact and relationship concerns
  • Neonatal herpes if transmitted during childbirth (rare but serious)
  • Increased risk of HIV acquisition
  • Rarely, herpes meningitis or encephalitis
  • Eye infections if virus spreads to eyes

How We Diagnose

Herpes is best diagnosed by PCR swab testing during an active outbreak - this identifies the virus and determines whether it's HSV-1 or HSV-2. Blood tests (IgG antibody testing) can detect past infection but may miss recent infections (takes 12-16 weeks for antibodies to develop). A positive blood test indicates you carry the virus but doesn't tell you where.

Treatment Options

Antiviral medications (aciclovir, valaciclovir) are highly effective. They can be used as episodic treatment (taken at start of outbreak to shorten duration) or as suppressive therapy (daily dosing to prevent outbreaks and reduce transmission). Suppressive therapy can reduce outbreaks by 70-80% and transmission risk by about 50%. Treatment is safe for long-term use.

Prevention

Condoms reduce but don't eliminate transmission (virus sheds from uncovered areas)
Avoid sex during outbreaks and prodromal symptoms
Daily suppressive antiviral therapy reduces transmission
Open communication with partners about herpes status
Consider testing before new relationships
Avoid touching sores and wash hands if contact occurs

Frequently Asked Questions

Can herpes be cured?

There's currently no cure - once infected, the virus remains in your body for life. However, antiviral medications very effectively control symptoms and reduce outbreaks. Many people on suppressive therapy have no outbreaks at all. Research into herpes vaccines and curative treatments continues.

How did I get herpes if my partner shows no symptoms?

Most people with herpes don't know they have it - up to 80% are undiagnosed. The virus can be transmitted even without visible symptoms (asymptomatic shedding). Your partner may have been infected years ago and never had obvious symptoms. This is very common.

Will I have outbreaks forever?

Outbreak frequency varies greatly between individuals. Many people have fewer and milder outbreaks over time as the immune system controls the virus better. Some people have one outbreak and never again; others have several per year. Suppressive therapy dramatically reduces outbreak frequency.

Can I still have a normal sex life with herpes?

Absolutely. Herpes is very common and manageable. With proper precautions (avoiding sex during outbreaks, using condoms, considering suppressive therapy), transmission risk is low. Honest communication with partners is important. Many people in serodiscordant relationships (one partner has herpes, one doesn't) successfully prevent transmission.

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