What are the Symptoms of Herpes

Genital herpes

What is genital herpes?

Genital herpes or herpes genitalis is a common, sexually transmitted viral disease, in which, among other things, unpleasant blisters can appear on the genitals. It is widespread and can affect both men and women. The disease is usually caused by the herpes simplex virus 2 (HSV-2) and sometimes by the herpes simplex virus 1 (HSV-1). Genital herpes is contagious and can appear quickly after sexual contact with new intimate partners.

Not every infected person will experience symptoms. If symptoms occur, they vary from a slight tingling sensation and burning sensation to painful blistering or recurring wounds. Fever, fatigue, or swelling of the lymph nodes in the groin can also be associated with the infection.

Treatment includes antiviral drugs that can be applied as a cream or taken as a tablet. Even after successful treatment, the virus remains dormant in the nerve cells of those affected and can cause another outbreak. Symptoms can return, especially during periods when the person feels weak or stressed.[1],[2]

What are the causes of genital herpes?

Genital herpes is caused by the herpes simplex virus (HSV), usually HSV-2 virus type, sometimes HSV-1. However, both types of virus can also be present at the same time. Genital herpes is contagious. The virus is transmitted from person to person in the following ways:[3]

  • through vaginal, oral, or anal sex;
  • by sharing sex toys;
  • through direct genital contact; it does not have to come to penetration;
  • through direct skin contact: if the other person has a cold sore in another part of the body, which then touches the genital area of ​​the intimate partner.

Symptoms can appear a short time after sexual contact with new intimate partners. The transmission can also take place at times when the affected sexual partner does not show any symptoms.

Most people become infected when they begin sexual activity in puberty or young adulthood. However, infection is possible at any age. More women than men suffer from genital herpes, as the virus is more easily transmitted from men to women than vice versa.

It is estimated that every fifth woman and every ninth man between the ages of 14 and 49 has an HSV-2 infection.[4],[2]

Factors that further increase the risk of becoming infected are:

  • Early time of first sexual intercourse;
  • Number of sexual partners; both currently and throughout life;
  • History of other sexually transmitted diseases (STDs);
  • Sexual contact with prostitutes;
  • Presence of an immunodeficiency;
  • Existing infection with HIV;
  • Unprotected sexual intercourse;
  • Sharing sex toys without condoms.[1],[4],[5],[6],[3]

Reactivation and recurrence of symptoms:

The infection persists even after the symptoms have subsided. The virus now rests in the nerve cells of the person affected, can be reactivated and thus cause another outbreak. A reactivation can be triggered by:[1],[7],[2]

  • Stress,
  • Diseases that weaken the immune system,
  • Operations or major injuries,
  • Extreme heat or cold,
  • Menstruation,
  • Fever.

What are the symptoms of genital herpes?

Not every infected person will experience symptoms. If symptoms occur, they vary from person to person. Men and women can have the same symptoms.[2]

The typical symptoms of genital herpes are:[4],[5],[6],[8],[3]

  • Tingling, itching, or light stinging; often before skin symptoms are visible.
  • small, fluid-filled, painful blisters.
  • encrusted wounds can develop from the vesicles.

These symptoms can affect the following parts of the body:[5],[3]

  • penis
  • labia minora
  • vagina
  • buttocks
  • Thigh

Symptoms can last up to two weeks. When genital herpes appears for the first time, the symptoms can last longer and be more pronounced overall. The vesicles are therefore sometimes very painful.

Other possible symptoms are:

  • Fever,
  • A headache,
  • Tiredness, general malaise and fatigue,
  • Painful urination,
  • Muscle pain,
  • Swelling of the lymph nodes in the groin.

If you have already had genital herpes once, you have to expect a recurrence of the symptoms after phases of complete freedom from symptoms.

Recurring outbreaks:[2],[9]

  • vary greatly from person to person.
  • symptoms may vary from time to time.
  • are more common in HSV-2 than in HSV-1 infections.
  • can occur several times a year.
  • depend on the severity and duration of the first episode.
  • depend on the immune system of the person affected.
  • occur even after successfully treating the first outbreak.
  • decrease in frequency and severity over time.

Good to know: Around two thirds of all people infected with genital herpes show no symptoms, but can still transmit the virus to their intimate partners.[7]

If you are unsure whether these symptoms apply to you, start a symptom analysis.

How is the diagnosis of genital herpes made?

A doctor will first ask the person concerned about the typical symptoms and their history. With the help of a physical examination, possible skin changes can be assessed directly. In addition, a laboratory test is necessary to establish the diagnosis, which can confirm or rule out an HSV infection.

One of four methods is used for this:[2]

  • Polymerase chain reaction (PCR); Detection of the virus genome;
  • Immunofluorescence; Use of an antibody labeled with fluorescent dyes;
  • Testing for the body's own antibodies against the herpes simplex virus;
  • Virus culture; Growing the virus on a culture medium.

If the affected person currently has genital herpes, either a PCR or a virus culture is usually used.

Good to know: Genital herpes cannot be diagnosed with a gynecological Pap smear or routine blood tests. The Tzanck test, which was frequently used in the past, has lost its importance compared to the other test methods.[6],[3],[2]

Who should be tested for genital herpes?

The correct diagnosis of genital herpes is usually made by gynecologists, urologists or centers specializing in sexual health. The following people should be tested for genital herpes:[5],[6]

  • People who have symptoms;
  • Persons whose partner is affected;
  • People with changing sexual partners;
  • Anyone who has recently had unprotected oral, anal, or vaginal intercourse with a new partner;
  • People who are HIV positive;
  • Men who have sex with men;
  • People who have other sexually transmitted diseases (STDs);
  • Women who are either pregnant or planning to become pregnant.

What is the treatment for genital herpes?

Treatment includes antiviral drugs, which are usually taken as tablets.

If there are signs of genital herpes appearing for the first time, antiviral therapy can significantly shorten the duration of the symptoms. Even after successful treatment, the virus remains dormant in the nerve cells of those affected and can cause another outbreak. Accordingly, the symptoms can keep recurring.

The further episodes are either treated individually each time or a continuous antiviral suppression is carried out, which should prevent further outbreaks.[1],[8],[9],[10]

Treatment for the first appearance of herpes in the genital area

Ideally, antiviral therapy should be started as soon as possible after the skin lesions appear and within 72 hours. But even after that, it makes sense to start therapy.[9]

First time affected:

  • are usually treated with oral therapy in the form of tablets.
  • should only receive intravenous therapy, i.e. directly into the blood, if the course of the disease is complicated.
  • usually do not receive any local therapy in the form of creams, as these are of little use when genital herpes first occurs.

Treatment should be carried out for 7 to 10 days. If new lesions continue to appear after this, the treatment can be extended.

People who experience moderate to severe local pain in the affected skin areas may also be given pain medication. Furthermore, Sitz baths can help alleviate the symptoms of some sufferers.[1],[9]

Treatment for recurring outbreaks

If there are seldom new outbreaks and if they are mild, there is an option to forego antiviral treatment. This can also be considered in people who are not sexually active.[1],[8],[9],[10]

The following options are available for treatment:

Episodic treatment

  • Those affected can immediately start antiviral treatment themselves if there are signs of a new outbreak (tingling, itching).
  • this takes the form of oral therapy in the form of tablets.
  • this will shorten the duration of the symptoms.

Continuous antiviral suppression:

  • Sufferers take an antiviral drug every day.
  • this is done as oral therapy in the form of tablets.
  • best suited for:
    • Affected with very frequent / severe outbreaks.
    • Affected people who want to reduce the risk of transmission to their uninfected sexual partner.
  • reduces the risk of reactivation and the risk of transmission.

Good to know: Local therapy in the form of creams is not recommended, as these are of little use in genital herpes.

Can you prevent genital herpes?

Preventive measures can significantly reduce the risk of transmission. The most important are:[11]

Avoiding any sexual activityif there are currently symptoms of genital herpes.

Use of condomsif there are currently no symptoms of genital herpes.

  • Around two thirds of all people infected with genital herpes show no symptoms, but can still transmit the virus to their intimate partners.
  • Consistent use of condoms can reduce the risk of HSV-2 transmission to an uninfected partner by up to 96 percent.

Continuous antiviral suppression: Recommended for people with recurrent genital herpes and a non-infected partner.

Good to know: There is currently no vaccine that protects against genital herpes.

What is the prognosis for genital herpes?

Genital herpes is a chronic viral infection with a very variable course. Some people may have frequent and severe outbreaks of the disease, while others remain completely asymptomatic or only rarely and slightly affected by the disease.[1]

Repeated outbreaks of genital herpes are generally less severe and shorter than the initial episode. With adequate episodic treatment or suppression treatment, there are effective ways to positively influence the course.[9]

What are the possible complications of genital herpes?

The main complications of genital herpes are:[2]

Neurological

  • Meningitis; severe inflammation of the meninges.
  • Voiding disorders; caused by an attack on the associated nerve root.

Proctitis Inflammation of the anus region, especially if you have had anal sex before.


  1. BMJ. "Herpes simplex virus infection." - As of August 7, 2019 ↩↩↩↩↩↩↩

  2. UpToDate. “Epidemiology, clinical manifestations, and diagnosis of genital herpes simplex virus infection” - as of August 7, 2019 ↩↩↩↩↩↩↩↩

  3. FPA.org. "Genital herpes" - as of August 7, 2019 ↩↩↩↩↩

  4. CATIE. "Genital Herpes" - as of August 7, 2019 ↩↩↩

  5. American Family Physician. "Diagnosis and Management of Genital Ulcers" - as of August 7, 2019 ↩↩↩↩

  6. Centers for Disease Control and Prevention. "Genital Herpes - CDC Fact Sheet (Detailed)" - As of August 7, 2019 ↩↩↩↩

  7. STDCheck.com. "Genital Herpes Symptoms in Men" - As of August 7, 2019 ↩↩

  8. Medscape. "Herpes simplex" - as of August 7, 2019 ↩↩↩

  9. UpToDate. “Treatment of genital herpes simplex virus infection” - as of August 7, 2019 ↩↩↩↩↩↩

  10. Anvil. "Herpes simplex virus infections." - As of August 7, 2019 ↩↩

  11. UpToDate. “Prevention of genital herpes virus infections” - as of August 7, 2019 ↩