Herpes is a very common virus that causes sores to develop, either on the mouth or in the genital region. The virus is so common that well over half of Americans have one of two strains of the virus, with 1 in 6 having genital herpes.
While the virus can’t be cured, medications are available that can reduce the frequency and intensity of outbreaks of sores in the body. Learn more about what herpes is, how it affects the body and how it can be prevented.
In This Section
- Herpes Symptoms
- Herpes Transmission
- Herpes Prevalence
- At-Risk Groups
- Herpes Complications
- Herpes & Pregnancy
- Herpes Testing
- Herpes Treatment
- Herpes Prevention
Many people who contract either type of the herpes virus show no obvious symptoms, but for those who do, a herpes infection can be quite obvious — sores appearing on the genitals or mouth.
Two types of herpes virus can cause genital herpes, herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2), though HSV-2 is more closely related to genital herpes, while HSV-1 prefers to infect the mouth area.
For people who develop an HSV-2 infection of the genitals, in addition to sores, they may also develop flu-like symptoms, such as a fever, chills, headache and swollen glands in the throat, underarms or pelvic area.
Other symptoms of genital herpes include:
- Pain around the genitals
- Burning or painful urination
- Difficulty urinating
Both males and females can experience similar symptoms of genital herpes, though the specific area of the body affected will depend on their exposure. For instance, if genital herpes is contracted in the anus, painful blisters may show up there, while for others, the blisters may be limited to the inside of their thighs.
For people who do show signs of the infection, this typically begins within a couple of days after infection, though it could take up to a few weeks for the initial outbreak to begin. This first outbreak usually lasts a couple of weeks but can remain for a month or more, and while the blisters will subside, the virus does not leave the body and repeated outbreaks are common for many people with herpes.
Symptoms of oral herpes are similar — painful blisters, often called cold sores, but oral herpes typically does not cause any flu-like symptoms, and the sores generally are less painful than genital herpes sores.
Herpes is transmitted via direct skin-to-skin contact with the virus, including in active sores or oral or genital secretions. Even if a person does not appear to have any active sores, it’s still possible to transmit either HSV-1 or HSV-2.
For the most part, it’s only possible to get a genital HSV-2 infection through genital contact with someone who has an HSV-2 genital infection, but it is sometimes possible to get an oral HSV-1 infection by receiving oral sex from someone who has an HSV-1 genital infection.
Herpes can be spread during many types of sex, including vaginal, oral and anal sex, and it’s possible to spread the virus even if fully penetrative sex does not occur or sex does not happen to completion.
While herpes is at its most contagious when there’s an open sore present, it’s also possible to spread oral herpes through kissing, and a person who has herpes can even spread it to other parts of their own body if they touch a sore and then touch an uninfected part of the body without washing their hands. However, the virus dies quickly outside the body, so it’s not possible to spread the virus through casual contact like holding hands or hugging.
More than 750,000 people are newly infected with genital herpes in the U.S. in a typical year, and oral herpes is much more common than genital herpes, though about 12% of people 14 49 years old have genital herpes. Oral HSV-1 is usually acquired in childhood, but declining rates of oral HSV-1 could make people more susceptible to contracting genital herpes through exposure to HSV-1.
HSV-2 infection is more prevalent in women than in men, possibly due to genital infection passing more easily from men to women during vaginal sex than from women to men. The vast majority of people 14-49 who have HSV-2 — more than 85% — have not been diagnosed with the virus.
Prevalence of both types of herpes virus have fallen in recent years, with HSV-1 prevalence dropping by about 20% and HSV-2 prevalence falling by nearly one-third between 2000 and 2016.
Herpes simplex prevalence by year and virus type
Because herpes is so common, anybody who has intimate contact with another person could potentially be at risk of contracting herpes sexually. However, the virus is more common in women than in men, and having multiple sexual partners and engaging in unprotected sex elevates a person’s risk.
As many as 87% of people who are infected with genital HSV-2 don’t know they are infected, so they are far more likely to spread the virus because they don’t know they have it. Rates of both types of the virus have fallen in recent years, so, unlike with the majority of sexually transmitted diseases, infection rates for both types of herpes virus peak in older age groups than in younger ones.
Herpes simplex prevalence by age and virus type
Along racial and ethnic lines, Hispanics are more likely to have HSV-1, while African-Americans are more likely to have HSV-2.
Herpes simplex prevalence by race/ethnicity and virus type
Genital herpes can be quite painful, causing ulcers that are severe and persistent, particularly in people who have suppressed immune systems, such as HIV-positive individuals or those with other immune disorders. In addition to the strain and anxiety caused by outbreaks of herpes sores, several other potential complications can result from either HSV-1 or HSV-2, including:
- Other STDs: Genital herpes has been linked to higher rates of many other sexually transmitted diseases and infections, including HIV. Those with genital herpes have as much as four times the risk of contracting HIV if exposed to it genitally.
- Meningitis: Though it’s quite rare, it’s possible for the herpes virus to cause inflammation of the membranes and fluid surrounding the spinal cord and brain, causing meningitis.
- Pregnancy: Genital herpes can lead to a very serious issue for newborns — neonatal herpes. Infants who are exposed to genital herpes during pregnancy or through childbirth can develop a potentially fatal herpes infection.
- Rectal swelling: Inflammation of the rectum, also called proctitis, is possible, especially among gay and bisexual men.
- Bladder issues: The sores that result from a genital herpes infection can cause inflammation around the urethra, and in some cases, this swelling can last for days, preventing a person from urinating.
The biggest risk of genital herpes for pregnant women is the danger of passing the virus to their unborn babies, whether during pregnancy or through birth. Neonatal herpes can be incredibly dangerous, as it can cause an infection that results in lasting, even fatal damage to an infant’s central nervous system.
However, this is exceedingly rare, impacting only about 0.1% of babies despite a much larger percentage of women having genital herpes. The risk of transmitting genital herpes to babies in utero or during birth is highest for women who contract genital herpes late in their pregnancies before their bodies have a chance to produce antibodies.
Women with genital herpes who become pregnant should take several precautions to avoid transmitting the virus to their babies, such as avoiding the use of fetal scalp electrodes during labor or the scheduling of a C-section to avoid vaginal delivery. Women who are pregnant but don’t have genital herpes should avoid having sex with herpes-positive partners, especially during the third trimester.
As we’ve discussed, most people who have herpes aren’t aware of it, but the majority of the population is infected with at least one type of the virus. For most people, it’s impossible to tell whether they have herpes by looking at them, and even for people with active outbreaks, herpes sores are easily mistaken for other skin issues, such as ingrown hairs or acne.
Despite this, herpes screening is not generally recommended for most people unless they meet certain qualifications based on their lifestyle, sexual activity or HIV status:
Here are the federal recommendations for herpes testing:
- Everyone: People who are getting tested for other STDs should be screened for herpes, particularly if they have multiple sexual partners and/or regularly engage in unprotected sex.
- Pregnant women: Pregnant women who don’t have any symptoms of herpes generally do not need to be screened for HSV-2, though women who at a higher risk of contracting STDs may need screening or additional counseling to prevent contracting the virus during their pregnancies.
- Gay and bisexual men: Screenings should be considered for men who have sex with men if their infection status is unknown and they had a previously undiagnosed infection of the genital tract or for those who are at elevated risk of contracting HIV.
- HIV-positive individuals: People with HIV should be screened for herpes if their infection status is unknown at the time they are diagnosed with HIV.
Even if a person is currently in the midst of an oral or genital herpes outbreak, it’s not possible to diagnose with 100% certainty without a medical test. The good news is that many options exist for easy, confidential tests for herpes and other STIs, including:
- Planned Parenthood
- Doctor’s office
- Pharmacy clinic
- Campus health clinic
- Community health clinics
- At-home test kits
- Urgent care center
No cure exists for any type of herpes virus, there are two types of medications to consider for combating genital herpes: episodic therapy and suppressive therapy.
These drugs are taken at the first sign of an outbreak and are continued for several days until the outbreak is over. In many people, episodic treatment can reduce the severity of the outbreak as well as shortening it by a day or two.
These drugs are taken every day to lower the chances of outbreaks beginning in the first place as well as to lower the overall viral load and decrease the risk of spreading the virus. For some people, suppressive therapy can reduce by at least 75% the number of outbreaks.
Many people with herpes have found success in reducing outbreaks and their severity through certain alternative therapies, such as changing their diets or exercising regularly. For those who have herpes, it’s important for them to closely monitor their bodies so they can understand what triggers outbreaks, as this is incredibly specific to each person. In some cases, stress can induce outbreaks, while other people have had outbreaks after surgeries or prolonged exposure to the sun.
The only way to completely eliminate the risk of contracting genital herpes is by abstaining from sex. But remember that it’s possible to contract genital herpes through non-penetrative sex, including oral sex.
Since the majority of people have at least one type of herpes, the best way to protect yourself and still have a health sex life is to use condoms or dental every time you have sex and to have sex with only mutually exclusive partners who do not have herpes.
Additionally, individuals who have herpes should avoid sex while they’re experiencing an outbreak, as the virus is at its most transmittable during outbreaks, but it still can be spread when no sores are present, so safer sex practices are crucial.
Herpes is incredibly common and easily spread, and while it can’t be completely cured, it is rarely dangerous. Still, once you get herpes, you’ll have it forever, so it’s best for anybody who is sexually active, especially those with multiple partners, to find out their herpes status and engage in safer sex practices every time.
- Centers for Disease Control and Prevention, Genital Herpes. (2019.) Retrieved from https://www.cdc.gov/std/herpes/default.htm
- Centers for Disease Control and Prevention, 2015 STD Treatment Guidelines, Screening Recommendations and Considerations Referenced in Treatment Guidelines and Original Sources. (2015.) Retrieved from https://www.cdc.gov/std/tg2015/screening-recommendations.htm
- Centers for Disease Control and Prevention, Genital Herpes - CDC Fact Sheet (Detailed). (2019.) Retrieved from https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm
- American Sexual Health Association, Herpes treatment. (Undated.) Retrieved from http://www.ashasexualhealth.org/stdsstis/herpes/herpes-treatment/
- Centers for Disease Control and Prevention, Sexually Transmitted Disease Surveillance 2017, Other STDs. (2018.) Retrieved from https://www.cdc.gov/std/stats17/other.htm#herpes