Genital herpes is a common, lifelong viral infection caused by herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2) CDC. It spreads through skin and fluid contact, often with no visible sore. There's no cure, but antiviral medicines control outbreaks and lower the chance of passing it to a partner.
NAAT or culture
not a cure
USPSTF Grade D
| Item | Value |
|---|---|
| Most people | mild / none |
| Test | swab a sore — NAAT or culture |
| Antivirals | control — not a cure |
| Screening | not advised — USPSTF Grade D |
What genital herpes actually is
Genital herpes is an infection of the skin and mucous membranes around the genitals, rectum, or mouth caused by one of two closely related viruses: HSV-1 and HSV-2. After the first infection, the virus doesn't leave the body. It travels up the nerves and goes dormant in the nerve roots, sitting quietly until something reactivates it. Herpes is lifelong because antivirals can't reach the latent virus or change how often it wakes up once you stop the drug.
Historically HSV-2 was the genital virus and HSV-1 the oral (cold-sore) one, but that line has blurred. In one US young-adult cohort, the share of new genital herpes caused by HSV-1 climbed from 31% to 78% HSV-1 cohort study, largely through oral sex. Type changes the course. Genital HSV-1 tends to recur only about once in the first year, while genital HSV-2 recurs around four times a year and sheds virus far more often.
A new diagnosis can land hard emotionally. In practice it behaves like a manageable skin condition. Most people have few outbreaks over the years, and daily medicine can make them rare while lowering the odds of transmission.
Symptoms — and the silent reality
Most people with HSV-2 don't know they carry it, and most genital herpes infections go undiagnosed. Symptoms are often absent or so mild they're mistaken for an ingrown hair or a yeast infection.
When symptoms do show up, the first outbreak is usually the worst. Small blisters appear on or around the genitals, rectum, or mouth, then break open into painful sores that take a week or more to heal. The first episode can also bring flu-like symptoms — fever, body aches, and swollen glands — as the body mounts its initial immune response. Repeat outbreaks are shorter and less severe, and many people get a warning prodrome beforehand: a tingling, itching, or burning in the area a day or two before a sore appears.
Presentation can differ by anatomy and is easy to miss internally; for a fuller rundown see genital herpes symptoms in women.
How genital herpes spreads
Herpes passes through direct contact with a herpes sore, with saliva (for oral infection), or with genital fluids. You can catch it from a partner who has no visible sore at all, and oral HSV-1 can be carried to the genitals through oral sex.
It spreads so quietly because of asymptomatic shedding — the virus surfaces on the skin and is contagious without causing a sore. People with HSV-2 shed virus on roughly 10% of days even when they never have outbreaks, and most of that shedding leaves nothing visible JAMA shedding study. Most transmission happens from someone who doesn't know they're infected or has no symptoms at the moment.
The most common mistake is assuming "no sore means no risk." That assumption is why honest disclosure to partners and, for some, daily suppressive therapy matter.
How genital herpes is tested
The right test depends on whether you have a sore. With an active lesion, swab the sore for type-specific virologic testing — a NAAT or viral culture CDC testing. Swab-based tests work best, so go in while the sore is fresh; once it crusts over, the test is less likely to catch the virus.
Without a sore, a type-specific blood (serologic) test can help. But timing matters: it can take up to sixteen weeks or more for these antibody tests to turn positive after infection, so an early test can miss a recent exposure — see when to test after exposure.
Routine blood screening for herpes in people without symptoms is not recommended. The CDC advises against it in most situations, and the USPSTF gives it a Grade D recommendation against routine serologic screening for asymptomatic adolescents, adults, and pregnant people USPSTF 2023. The blood tests have high false-positive rates, and a wrong positive causes real anxiety and relationship strain with little benefit. If you want a clear plan, you can get tested for the full STI panel and compare testing providers.
Treatment: controlling, not curing
There are three FDA-approved antivirals — acyclovir, valacyclovir, and famciclovir CDC STI Tx Guidelines. They control symptoms but don't cure the infection or clear the latent virus. They're inexpensive generics, and a clinic visit during an outbreak gets you both the most reliable diagnosis and a prescription.
There are two ways to use them:
- Episodic therapy — pills taken at the first sign of an outbreak to shorten it and ease symptoms.
- Suppressive therapy — a daily pill that reduces recurrences by about 70%–80% in people who get frequent outbreaks, and also lowers the chance of passing HSV-2 to a partner.
In a randomized trial of couples where one partner had HSV-2 and the other didn't, daily suppressive valacyclovir cut the risk of transmission by about 48% Corey et al.. That trial is the evidence behind taking a daily pill partly for a partner's sake. Some people also ask about non-drug options — see alternative herpes treatments.
| Approach | How it's taken | Best for |
|---|---|---|
| Episodic therapy | Pills started at the first symptom of an outbreak | Infrequent or mild recurrences |
| Suppressive therapy | A pill taken every day | Frequent outbreaks, or to lower transmission risk to a partner |
Complications if it's left unmanaged
For most healthy adults, herpes is uncomfortable but not dangerous. A few situations need more attention:
- HIV risk — having HSV-2 increases the chance of acquiring HIV by two- to three-fold, because herpes sores and inflammation give HIV an easier entry point; co-infection also raises onward HIV spread.
- Pregnancy and the newborn — herpes infection during pregnancy can lead to miscarriage or preterm delivery, and neonatal herpes (the baby catching the virus around birth) is a potentially deadly infection. Women with recurrent lesions at the start of labor are advised to have a cesarean to reduce that risk, and antiviral late in pregnancy can lower the chance of an outbreak at delivery — more on the medication's role in is valtrex treatment effective in reducing hsv-2 transmission to infant during birth?
How to lower your risk
- Use condoms — they decrease HSV-2 transmission but don't eliminate it, since they may not cover all the affected skin.
- Avoid sexual contact when a sore or prodrome is present.
- If you have HSV-2, daily suppressive antiviral makes passing it to a partner less likely.
- Tell partners before sex — disclosure lets you both make informed choices, and it's strongly advised.
When to see a clinician
See a clinician if you have a new genital sore, blister, or unexplained burning or tingling in the area — ideally while a sore is fresh so it can be swabbed. Also reach out if you're pregnant and have a herpes history, if outbreaks are frequent or severe and you want to discuss daily suppression, or if you simply want to understand your status and protect a partner. A first visit during an active outbreak gives the most reliable answer.