Genital Herpes: Symptoms, Causes & Treatment

Genital herpes is an infection caused by the herpes simplex virus, a highly contagious virus that lodges in nerve cells. There are two types: HSV1 and HSV2. It was originally believed that HSV1 mainly causes cold sores around the mouth and HSV2 is responsible for genital infections, but this separation is less clear than thought. Today, HSV1 causes nearly thirty percent of genital herpes infections, while HSV2 is responsible for just over sixty percent.

The special thing about the herpes simplex virus is that it stays permanently in your body after an initial infection. After the initial infection, the virus withdraws into nerve cells near the spinal cord, where it remains in a dormant state. This means that you are a lifelong carrier of the virus, even if you have no visible symptoms. This dormant presence explains why the infection can flare up again at various points in your life.

The spread mainly occurs during sexual contact, where the virus is transmitted via direct skin-to-skin contact. What makes genital herpes extra complicated is that about half of the transmissions are by people who don't know they're carrying the virus. This is because many people have no or very mild symptoms that they do not recognize as herpes, but can transmit the virus to their partner. This high spread, combined with the lack of awareness among many carriers, makes genital herpes an important sexually transmitted infection that deserves serious attention.

The infection with the herpes simplex virus occurs through direct contact with contaminated body fluids or skin during sexual intercourse. The virus can easily invade intact mucous membranes, although there is debate about intact skin.

The highest contagiousness occurs when active lesions are present. At these times, the moisture in and around the blisters or sores contains huge amounts of virus particles. Any contact with these areas poses a direct risk of transmission, not only during sexual intercourse but also with other forms of sexual contact involving genital zones.

What many people don't realize is that the virus can be transmitted even when there are no visible symptoms. This phenomenon is called asymptomatic viral shedding and is common among people with genital herpes. During these periods, the virus actively produces new particles that can be released through the skin without blisters or other visible signs.

The risk of contamination is influenced by various factors. Newly formed lesions are more contagious than old, healing ones. The viral load varies between people and can fluctuate over time. People who have recently become infected often secrete more virus than people who have been carriers for years and have built up a strong immune response. Your immune system plays a role in susceptibility to infection. A weakened immune system due to illness, stress or medication makes you more vulnerable to the virus. Existing damage or inflammation in the genital area facilitate access for the virus.

Partners who are intimate for a long time are at increasing risk of transmission. With each sexual encounter, the cumulative risk of infection increases, especially if protective measures are not taken during periods of viral shedding. This makes open communication about the infection essential in any relationship where either partner carries the virus.

The first genital herpes infection, also known as the primary flare-up, is often the most pronounced episode you'll experience. This occurs approximately four to fourteen days after the infection. What starts as a vague, stinging and tingling sensation in the genital area quickly develops into visible skin changes.

The skin gradually becomes redder and more sensitive. This stage passes into the formation of small blisters that are filled with clear fluid. These blisters can occur individually or stick together in groups. They are characteristically painful and sensitive when touched. The number and size varies widely between people, from a few small blisters to extensive clusters.

After a few days, the blisters burst, releasing the virus-rich fluid. This leaves small sores that become covered with a scab. This phase is often the most painful and can cause significant discomfort in daily activities. Urination, in particular, can cause a burning sensation when urine comes into contact with the open sores.

The first flare-up is sometimes accompanied by general symptoms such as fever, headache and muscle pain. Swollen glands in the groin occur regularly, which indicates that your body is actively fighting the infection. In women, sores can also form on the cervix, which are only visible during gynecological examinations. The full first episode usually takes two to three weeks before all injuries are fully healed. Fortunately, the skin recovers without permanent scarring.

After the first infection, the virus can become active again, resulting in recurrent outbreaks. These episodes are usually milder than the first. Around eighty percent of people experience a new surge at some point. The frequency varies enormously, from multiple times a year to sporadic episodes with years in between. The blisters often occur on only one side of the genitals. In women, they are often confined to the labia. General signs of illness are rare in these later episodes and healing takes approximately seven days.

The location of herpes lesions is determined by the site of the initial infection and the nerve tracts that the virus inhabits. In men, the lesions usually appear on the penis, often around the glans or on the shaft. The foreskin may be affected, which can lead to temporary difficulties in retracting it due to swelling and pain in some men.

Among women, the distribution pattern is often more extensive. The outer and inner labia are common locations, but the vaginal opening and the surroundings of the urethra can also be affected. This scattered localization can make it difficult to sit, walk or urinate comfortably during an active surge.

The area around the anus forms another important location, independent of gender. These perianal lesions can be caused by direct infection during sexual contact or by spreading the virus via nerve tracts. They are particularly sensitive and can cause pain when defecating. The buttocks and upper thighs can also be affected because the virus follows nerve tracts that radiate to these areas.

In the case of recurring outbursts, the pattern is often predictable. The virus travels along the same nerve tracts, so the lesions usually appear in the same location as in previous episodes. This consistency helps to recognize a new surge.

Genital herpes treatment focuses on several goals: alleviating acute symptoms, shortening outbreaks and reducing the frequency with which the virus becomes active again. Complete healing is not possible because the virus has permanently lodged in nerve cells, but modern treatments can significantly limit the impact.

Antiviral medications are the cornerstone of medical treatment. These medicines inhibit the multiplication of the virus, so that flares last less long and are less severe. In the event of a first infection, a course of five to ten days is usually prescribed. It is essential to start this treatment as soon as possible after the onset of symptoms for the best effect.

In case of serious first infections, hospitalization may be necessary. This occurs with a high fever, inability to urinate due to pain, or very extensive injuries. The antiviral medication can then be administered via an infusion, which provides a faster and more powerful effect. Fortunately, this is rare, but offers a solution for the most problematic cases.

For recurrent flare-ups, a short course of antiviral medication can be started as soon as you feel the first signs. Many people recognize the characteristic tingling sensation that heralds a new surge. By starting medication at this time, the symptoms can sometimes be completely suppressed or significantly reduced.

In people with frequent and burdensome flares, for example more than six per year, long-term suppressive therapy may be considered. This means taking antiviral medication daily, regardless of whether there are symptoms. This approach drastically reduces the number of outbreaks and also reduces the risk of transmission to partners. Suppressive therapy may be followed for periods of six months to years.

Symptomatic care helps to reduce discomfort during a flare-up. Cleansing and keeping injuries dry promotes healing and prevents secondary infections. Some people find relief by gently dabbing the sores with a dilute disinfectant solution. Pain management is another important aspect. Common pain relievers can help make the discomfort more bearable. In case of severe pain when urinating, it can help to pour lukewarm water over the genital area while urinating, which reduces the burning sensation.

There are many misunderstandings surrounding the treatment of genital herpes. A common misconception is that the virus can be “eradicated” with sufficient medication or natural remedies. The reality is that the virus remains permanently in nerve cells and cannot be removed with current therapies. Treatments focus on control, not cure.

Home remedies such as applying vinegar, lemon juice or tea tree oil directly to the lesions are not effective and may even be harmful. These agents further irritate sensitive tissue and may delay healing. While they may have a temporary narcotic effect, they do not treat the viral infection and may cause chemical burns.

The idea that avoiding treatment makes your immune system “stronger” is wrong. While untreated herpes often heals on its own, this is associated with unnecessary suffering and an increased risk of transmission to partners. Modern antiviral medications support your natural defenses without weakening them.

Many people think that condoms offer complete protection against genital herpes. Although condoms certainly reduce the risk, they do not offer absolute protection because the virus can also be transmitted through skin contact outside the area covered by the condom. After all, the lesions can be anywhere on the genitals, including areas that are not covered by a condom.

Ignoring the emotional impact is also a form of ineffective treatment. This disorder can cause feelings of shame, anxiety, and isolation. Psychological support and education are essential for dealing with the diagnosis. After all, hiding your status from partners solves nothing and is even ethically problematic. Honest communication about your infection before having sexual contact is not only morally right but also practically sensible.

Can genital herpes completely heal?

No, genital herpes cannot heal completely. Once you are infected, the virus remains dormant in nerve cells for life. There is currently no treatment that can completely remove the virus from your body. However, medication and lifestyle changes can ensure that your symptoms are minimal and seizures become rare.

What are the chances of infecting my partner?

The risk of transmission varies. With visible injuries, the chances are very high and you should avoid all sexual contact. Without symptoms, there is still a risk from asymptomatic viral shedding, although it is lower. Daily suppressive medication can reduce this residual risk by about half. Combined with condom use and avoiding contact during flare-ups, you can significantly reduce the risk.

How often do recurring flare-ups occur?

This varies enormously from person to person. Some people have only one or two flare-ups in their lives, while others suffer several times a year. On average, the frequency decreases the longer you are infected. Stress, illness, menstruation and exhaustion can trigger new outbreaks, but they can occur even without a clear trigger.

Is Genital Herpes Dangerous During Pregnancy?

A first infection during pregnancy is the highest risk, with a thirty to fifty percent chance of transmission to the baby in the event of active injuries. In the case of long-standing infections with a recurrent outbreak during childbirth, this risk is much lower, around one to three percent. It is crucial to inform your healthcare provider about your herpes infection so that appropriate measures can be taken, such as cesarean delivery for active injuries around the birth.

Can I get genital herpes from someone with cold sores?

Yes, this is possible. The HSV1 virus that usually causes cold sores can be transmitted to the genital area through oral sex. More and more genital herpes infections are caused by HSV1. Conversely, HSV2 can also cause oral herpes, although this is less common. Safe sex remains important, even when it comes to oral sexual contact.

Do I always have to take treatment?

Not necessarily. In case of mild and rare flare-ups, you can choose to only treat symptomatically with pain relief and care. Antiviral medication is particularly useful for frequent or severe flare-ups, or when you want to minimize the risk of transmission to a partner. Talk to your doctor about what's best for your situation.

1. Skindr dermatologists
2. Health and Science: Genital Herpes
3. EBPNet: Evidence-based guidelines for GPs
4. Sensoa: Center for Sexual Health
5. Home doctor: Genital herpes