Genital Herpes

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Images of Herpes Simplex Virus (HSV), Genital


Genital herpes is a sexually transmitted disease (STD) caused by infection with the herpes simplex virus (HSV). There are 2 major strains of this virus: herpes simplex virus type 1 (HSV-1) and herpes simple virus type 2 (HSV-2). In general, genital herpes is caused by HSV-2, and "fever blisters," or herpes on the face or lips, is caused by HSV-1.

HSV-2 can cause small, open, tender sores to develop on the genitals or in the buttocks. Though the virus is very contagious to others, only 20% of people who are infected will develop sores. The sores are usually described as an "outbreak," with the first outbreak occurring within weeks of exposure to the virus and subsequent outbreaks over a person's lifetime usually occurring less and less frequently. The sores themselves often crop up in the same place on the body. The sores are very contagious and are spread by skin-to-skin contact. Most people (up to 80%) never have an outbreak of sores, but they are still contagious and may spread the disease to others.

There is no cure for genital HSV. The only way to protect yourself is to know your sexual partners and to wear condoms. However, many people are unaware that they are infected with HSV. A doctor can check for HSV infection by doing a test on an open sore, or if there is no sore, by ordering a test on the blood. This is not a standard STD test, so make sure to ask your doctor if you have concerns. A pregnant woman with genital HSV can transmit the disease to her baby during delivery, which can be fatal for the baby. Make sure to discuss your sexual history with your doctor if you are pregnant. Your doctor can also help provide treatments to lessen the severity of outbreaks and may help you identify triggers (such as stress or illness) that may bring on outbreaks.

Who's at risk?

HSV infections can occur in anyone of any age, sex, or race. It is quite common, and up to 1 in 5 American teens and adults may be infected with HSV-2. Because it is easier for the disease to pass from men to women than from women to men, more women than men are infected. The 2 groups of people most commonly infected with HSV-2 are newborn babies, who are infected during childbirth, and sexually active teens and adults. Because only a minority of people who are infected will develop sores (approximately 20%), the majority of people who are infected are unaware of their status but are still contagious. Remember to always practice safe sex.

Signs and Symptoms

In females, the most common locations for HSV-2 infections include:

  • External genitalia
  • Labia majora and minora
  • Vagina
  • Cervix
  • Around the anus
In males, the most common locations for HSV-2 infections include:
  • Head and shaft of penis
  • Scrotum
  • Thighs
  • Buttocks
  • Around the anus
Shortly after exposure to the virus, a newly infected person may develop fluid-filled blisters (vesicles) or pus-filled bumps (pustules), occurring singly or in a group. These vesicles and pustules are usually quite fragile, so many people never notice them but instead see tiny (2–4 mm) ulcers. These painful ulcers subsequently become scabbed over. The scabs eventually fall off, leaving a red area that fades. The first (primary) outbreak typically lasts 1–3 weeks.

In mild cases of primary HSV infection, an individual may develop 1–2 lesions, or the newly infected person may notice no symptoms at all. The lymph nodes in the groin may or may not be swollen. In severe cases of primary HSV-2 infection, people may develop fever, headache, muscle pain, painful urination, and discharge from the vagina or urethra.

Repeat (recurrent) HSV infections are often milder than the primary infection, though they look alike. However, some people never develop the symptoms of a primary HSV infection and may mistake a recurrent infection for a primary infection. A recurrent infection typically lasts 7–10 days. People who are prone to recurrent outbreaks tend to get them 3–4 times per year, though some may have 10 or more outbreaks per year.

Many people with recurrent HSV infections report that the skin lesions are preceded by sensations of burning, itching, or tingling (prodrome). About 24 hours after the prodrome symptoms begin, the actual lesions appear as one or more small blisters or open sores, which eventually become scabbed over.

Triggers of recurrent HSV infections include:
  • Fever or illness
  • Sun exposure
  • Hormonal changes, such as those due to menstruation or pregnancy
  • Stress
  • Trauma, such as that caused by dental work or cuts from shaving
  • Surgery
  • Friction to the area, such as that caused by sexual intercourse or tight-fitting clothes

Self-Care Guidelines

Acetaminophen or ibuprofen may help reduce fever, muscle aches, and pain caused by the HSV sores. Applying cool compresses or ice packs may relieve some of the swelling and discomfort. Wear loose-fitting clothes that will not irritate your skin.

Because HSV infections are very contagious, it is important to take the following steps to prevent spread (transmission) of the virus during the prodrome phase (burning, tingling, or itching) and active phase (presence of blisters or sores) of HSV-2 infections:

  • Avoid sharing towels and other personal care items.
  • Wash your hands with soap and water if you touch an active lesion.
  • Avoid sexual contact (including oral, vaginal, and anal sex) during both the prodrome phase and the active phase.
Unfortunately, the virus can still be transmitted even when the affected person does not have active lesions. Therefore, safe sex practices, such as using a condom, should be used between outbreaks, even if no sores are present.

When to Seek Medical Care

If you develop tender, painful sores in or around the genitals, see a physician as soon as possible because treatment for HSV is much more effective if started early.

Recurrent outbreaks rarely require immediate medical attention. However, because some people have milder forms of genital HSV, you should also see a doctor for any recurring rash in the groin area, even if you think it is from bug bites, jock itch, or any other condition.

If you have an underlying medical condition such as cancer or HIV, if you have undergone organ transplantation, or if you are pregnant, you are at higher risk for more serious complications. Seek medical advice as soon as possible.

Treatments Your Physician May Prescribe

Most HSV infections are easy for physicians to diagnose. On occasion, however, a swab from the infected skin may be sent to the laboratory for viral culture, which takes a few days to grow. Blood tests may also be performed.

Untreated HSV infections will go away on their own, but medications can reduce the symptoms and shorten the duration of outbreaks. There is no cure for HSV infection.

Treatment for primary HSV infection includes the following oral antiviral medications:

  • Acyclovir pills
  • Valacyclovir pills
  • Famciclovir pills
These medications are usually taken for 7–14 days.

More severe primary HSV infections may require additional medications:
  • Oral antibiotic pills if the areas are also infected with bacteria
  • Oral antifungal pills if the areas are also infected with yeast
  • Topical anesthetic cream, such as lidocaine ointment, to reduce pain
Treatment for recurrent HSV infections includes the same oral antiviral medications:
  • Acyclovir pills
  • Valacyclovir pills
  • Famciclovir pills
People who experience early signs (prodromes) before recurrent infections may benefit from episodic treatment by starting to take medication after the onset of tingling and burning but before the appearance of blisters and sores.

Other people have recurrent infections that are frequent enough or severe enough to justify suppressive therapy, where medications are taken every day in order to decrease the frequency and severity of attacks.

Trusted Links

Clinical Information and Differential Diagnosis of Herpes Simplex Virus (HSV), Genital


Bolognia, Jean L., ed. Dermatology, pp.1099, 2062-2063, 2167. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1236-1239. New York: McGraw-Hill, 2003.