Genital Herpes
Symptoms, Causes & Treatment
Understanding genital herpes: what causes it, how it is diagnosed, how to manage outbreaks, and how to protect partners while living well with herpes.
What Is Genital Herpes?
Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus (HSV). There are two types: HSV-1 (traditionally associated with cold sores on the mouth) and HSV-2 (traditionally associated with genital herpes), though both types can infect either area.
Genital herpes is extremely common. In the UK, approximately 1 in 8 people aged 25–45 carry HSV-2, and an increasing proportion of genital herpes cases are caused by HSV-1, transmitted through oral sex. Many people carry the virus without ever experiencing symptoms or knowing they are infected.
Genital herpes cannot be cured -- the virus remains dormant in the sacral nerve ganglia for life and can reactivate periodically, causing recurrent episodes. However, the condition is very manageable with antiviral treatment, and for most people, outbreaks become less frequent and less severe over time.
The emotional and psychological impact of a genital herpes diagnosis often exceeds the physical impact of the infection. Understanding the condition, its prevalence, and the effectiveness of treatment is an important part of managing it well.
What Are the Symptoms of Genital Herpes?
Herpes symptoms vary significantly between first outbreak and subsequent recurrences. The first outbreak is typically the most severe.
Primary outbreak: painful blisters or ulcers on genitals, buttocks, or thighs · Tingling, itching, or burning before blisters appear (prodrome) · Flu-like symptoms during first outbreak (fever, swollen glands) · Recurrent episodes: milder and shorter than primary
Severe urinary retention from perineal swelling · Herpes in a newborn (neonatal herpes) — emergency · Herpes encephalitis (confusion, fitting, severe headache) · Genital herpes during the third trimester of pregnancy — inform obstetric team
Seek urgent care for urinary retention from herpes swelling, suspected herpes encephalitis, herpes in a newborn, or genital herpes in the third trimester of pregnancy. These are medical emergencies requiring immediate specialist input.
What Causes Genital Herpes?
Genital herpes is caused by HSV-1 and HSV-2. Both establish lifelong latent infection and can reactivate at any time. Understanding viral shedding and latency helps with partner management and treatment decisions.
HSV-2 causes most genital herpes; HSV-1 (oral cold sores) is increasingly causing genital herpes through oral sex. Both establish lifelong latent infection in sensory ganglia.
After primary infection, HSV establishes latency in sacral dorsal root ganglia. Reactivation is triggered by stress, illness, menstruation, UV exposure, and immunosuppression, causing recurrent outbreaks.
Asymptomatic shedding occurs without any visible sores. During shedding, the virus is present on genital skin and can be transmitted to partners. Shedding is more frequent in HSV-2 than HSV-1.
STIs are transmitted through unprotected vaginal, anal, or oral sex. Some (herpes, HPV, syphilis) can spread through skin-to-skin contact even without penetration or visible symptoms.
Many STIs, particularly chlamydia, gonorrhoea, and early HIV, cause no symptoms at all. Regular testing is the only way to detect them — waiting for symptoms means delayed treatment and onward transmission.
Condoms reduce STI transmission by 85–98% when used consistently and correctly. They are less effective for infections spread by skin contact (herpes, HPV, syphilis) where lesions extend beyond the condom-covered area.
Key Risk Factors
How Is Genital Herpes Diagnosed?
Diagnosis is confirmed by PCR swab of an active lesion — the most sensitive test. Type-specific serology detects prior exposure when no active lesion is present. Clinical diagnosis alone is insufficient as many other conditions mimic herpes ulcers.
How Is Genital Herpes Treated?
Antivirals do not cure herpes but significantly reduce outbreak frequency, severity, duration, and viral shedding. Both episodic and suppressive regimens are effective.
Supportive Measures
During an outbreak, keep the area clean and dry. Loose cotton underwear reduces friction and pain. Saline baths ease ulcer discomfort. Urinating in warm water reduces dysuria. Topical lidocaine gel provides local analgesia. Antivirals are most effective when started at the first sign of prodromal symptoms (tingling, burning).
Managing Frequent Herpes Outbreaks
Recurrence frequency typically decreases over time. If recurrences remain frequent or distressing, long-term daily suppressive aciclovir or valaciclovir is highly effective. Dose adjustment is rarely needed and the medication is safe for years of continuous use. In pregnancy, suppressive therapy from 36 weeks reduces neonatal herpes risk from caesarean section transmission.
When Should You Seek Help for Herpes?
Complete urinary retention from genital herpes swelling · Suspected herpes encephalitis (severe headache, confusion, fitting) · Herpes in a newborn · Third-trimester herpes in pregnancy — inform obstetric team immediately.
You have a first herpes outbreak · You are pregnant with herpes · You have 6 or more outbreaks per year · You want to discuss suppressive therapy or partner protection · Your partner has disclosed herpes and you want testing.
How to Reduce Herpes Transmission
While herpes cannot be cured, transmission risk can be substantially reduced through evidence-based measures.
Daily suppressive valaciclovir therapy reduces herpes outbreaks by 70–80% and reduces viral shedding by 50%, significantly lowering transmission risk to partners.
Identify personal outbreak triggers (stress, illness, fatigue, UV, menstruation) and reduce their impact. Keeping a symptom diary helps predict outbreaks and enables timely antiviral use.
Annual STI testing is recommended for all sexually active people. Those with multiple partners should test every 3 months. Free NHS testing is available at sexual health clinics, online via SHGM/SH:24, and from GP surgeries.
Use condoms consistently for vaginal, anal, and oral sex with new or casual partners. Dental dams reduce transmission during oral-vulval contact. Lube reduces condom breakage and anal mucosal trauma.
Notify all recent sexual partners when diagnosed with an STI so they can be tested and treated. Partner notification can be done directly or anonymously through the sexual health clinic (contact tracing service).
HPV vaccination prevents 90% of cervical cancer and most genital warts. Hepatitis B vaccine is recommended for all MSM, PWID, and sexual health clinic attendees not previously vaccinated.
Speak to a Clinician About Genital Herpes
Through The GP Service, a licensed clinician can assess herpes symptoms, prescribe antivirals, and advise on suppressive therapy, disclosure, and pregnancy management.
Expert clinical advice, when you need it.
Genital Herpes FAQs
Yes, but safely. With modern antiviral suppression, the risk of transmitting herpes to a partner is substantially reduced. Daily suppressive valaciclovir reduces transmission risk by approximately 50%, combined with condom use. Disclosing herpes to a new partner is an important conversation — most people with herpes have had it from a previous partner without knowing. Your sexual health clinician can help with disclosure conversations and partner testing. Most people with herpes continue to have satisfying, loving relationships. Herpes is extremely common — HSV-2 affects around 1 in 6 adults — and carries significant social stigma disproportionate to its medical impact.
STI testing is recommended annually for all sexually active people. Those with new or multiple partners should test every 3 months. Testing is free at NHS sexual health clinics and from online services (SH:24, SHGM). You do not need symptoms to be tested — most STIs cause no symptoms. A full STI screen covers chlamydia, gonorrhoea, syphilis, HIV, hepatitis B, and hepatitis C. Specific sites tested (urine, swabs, blood) depend on your sexual practices. Results are usually available within 1–2 weeks. Positive results trigger automatic partner notification advice.
Not all STIs are curable, but all are treatable. Bacterial STIs — chlamydia, gonorrhoea, and syphilis — are fully curable with antibiotics when diagnosed promptly. Viral STIs — HIV, herpes, HPV, and hepatitis B — cannot be cured but can be effectively managed. HIV is controlled with ART to the point of undetectability. Herpes is managed with antivirals that suppress outbreaks. HPV often clears naturally within 1–2 years in people with healthy immune systems. Genital warts can be treated and removed, though the underlying HPV virus may persist. The key message: all STIs are manageable with prompt diagnosis and treatment.
Without treatment, chlamydia can persist silently for months or years, causing progressive damage to the reproductive tract. In women, untreated chlamydia causes pelvic inflammatory disease (PID) in 10–15% of cases, leading to tubal factor infertility, chronic pelvic pain, and ectopic pregnancy risk increased 6–10-fold. In men, chlamydia causes epididymo-orchitis, which can impair sperm production and quality. Reactive arthritis (formerly Reiter's syndrome) — involving joint inflammation, eye inflammation, and urethritis — is a rare but recognised complication. These complications are entirely preventable with prompt diagnosis and a simple 7-day course of doxycycline.
Gonorrhoea is increasingly difficult to treat due to rising antibiotic resistance. The current UK first-line treatment is a single intramuscular injection of ceftriaxone 1g. A test of cure is required 2 weeks later to confirm eradication. Azithromycin is no longer recommended routinely due to resistance. Multidrug-resistant gonorrhoea has been identified in multiple countries, including the UK. If you have been treated for gonorrhoea and symptoms persist, return to the clinic immediately — do not take additional antibiotics without guidance. Treatment of all recent sexual partners is essential to prevent reinfection.
Syphilis in pregnancy can cause miscarriage, stillbirth, premature birth, and severe congenital syphilis in the newborn (causing bone, liver, brain, and skin disease). All pregnant women in the UK are offered a syphilis blood test at their first antenatal appointment. Treatment with benzathine penicillin G during pregnancy is safe and highly effective at preventing mother-to-child transmission. If you are pregnant and believe you may have been exposed to syphilis, seek urgent testing and treatment. Contact tracing of all recent partners is mandatory. Untreated syphilis in pregnancy is one of the most preventable causes of neonatal death.
PE affects approximately 20–30% of men at some point — making it the most common male sexual dysfunction. Many men suffer in silence due to embarrassment, assuming it is shameful or untreatable. In reality, PE is a well-recognised medical condition with highly effective treatments. Dapoxetine (a short-acting SSRI licensed specifically for PE) can more than triple ejaculatory latency time in clinical trials. Behavioural techniques (stop-start, squeeze) are effective for lifelong PE. Combining medication with psychological or couples therapy produces the best outcomes. Most men with PE who seek treatment experience significant improvement.
Yes. HIV is now a manageable chronic condition, not a death sentence. With antiretroviral therapy (ART), people with HIV can live long, healthy lives with a normal life expectancy. ART suppresses the virus to undetectable levels in the blood, meaning it cannot be transmitted sexually (Undetectable = Untransmittable, or U=U). Most people on modern ART take a single tablet daily and experience minimal side effects. HIV does not prevent you from having children, working, or having a fulfilling life. In the UK, HIV care is excellent and free on the NHS. The biggest barrier to good outcomes is late diagnosis — testing early is life-saving.