Symptoms

The majority of people who've been infected with HSV never know they have the disease, because they have no signs or symptoms. The signs and symptoms of HSV can be so mild that they go unnoticed.

When present, the initial symptom of genital herpes usually is pain or itching, beginning within a few weeks after exposure to an infected sexual partner. After several days, small red bumps or tiny white blisters may appear. They then rupture, becoming ulcers that ooze or bleed. Eventually, scabs form and the ulcers heal.

In women, sores can erupt in the vaginal area, external genitals, buttocks, anus or cervix. In men, sores can appear on the penis, scrotum, buttocks, anus or thighs or inside the urethra, the channel inside the penis leading to the bladder.

While you have ulcers, it may be painful to urinate. You may also experience pain and tenderness in your genital area until the infection clears. During an initial outbreak, you may have flu-like signs and symptoms, such as headache, muscle aches and fever, as well as swollen lymph nodes in your groin.

Recurrences are common 
Genital herpes is different for each person. The signs and symptoms may recur, off and on, for years. Some people experience numerous episodes each year. For many people, however, the outbreaks are less frequent as time passes.

Various factors may trigger outbreaks, including:

• Stress
• Fatigue
• Illness
• Surgery
• Menstruation

When to see a doctor 
If you suspect you have genital herpes — or any other sexually transmitted infection — see your doctor.

Causes

Two types of herpes simplex virus infections can cause genital herpes:

• HSV-1. This is the type that usually causes cold sores or fever blisters around your mouth, though it can be spread to your genital area during oral sex.
• HSV-2. This is the type that commonly causes genital herpes. The virus spreads through sexual contact and skin-to-skin contact. HSV-2 is very common and highly contagious, whether or not you have an open sore.

Because the virus dies quickly outside of the body, it's nearly impossible to get the infection through contact with toilets, towels or other objects used by an infected person.

Risk factors

Your risk of becoming infected with genital herpes may be increased if you:

• Are a woman. Women are more likely to have genital herpes than are men. The virus is sexually transmitted more easily from men to women than it is from women to men.
• Have many sexual partners. Each additional sexual partner broadens your opportunity for being exposed to the virus that causes genital herpes.

Complications

Complications associated with genital herpes may include:

• Other sexually transmitted infections. Having genital sores increases your risk of transmitting or contracting other sexually transmitted infections, including the AIDS virus.
• Newborn infection. Babies born to infected mothers can be exposed to the virus during the birthing process. This may result in brain damage, blindness or death for the newborn.
• Bladder problems. In some cases, the sores associated with genital herpes can cause inflammation around the urethra, the tube that delivers urine from your bladder to the outside world. The swelling can close the urethra for several days, requiring the insertion of a catheter to drain your bladder.
• Meningitis. In rare instances, HSV infection leads to inflammation of the membranes and cerebrospinal fluid surrounding your brain and spinal cord.
• Rectal inflammation (proctitis). Genital herpes can lead to inflammation of the lining of the rectum, particularly in men who have sex with men.

Preparing for your appointment

If you think you have a sexually transmitted illness, such as genital herpes, make an appointment to see your family doctor or gynecologist.

What you can do 
Before your appointment, you might want to write a list that answers the following questions:

• What are your symptoms? When did they start?
• Do you have a new sexual partner or multiple partners?
• Have you ever been diagnosed with a sexually transmitted infection?
• Do you regularly use condoms?
• What medications or supplements do you take regularly?

Some basic questions to ask your doctor include:

• What kinds of tests do I need?
• Should I be tested for other sexually transmitted infections?
• Should my partner be tested?
• Do I need to abstain from sexual activity during treatment?
• How can I avoid infecting my partner?

What to expect from your doctor 
Your doctor is likely to ask you a number of questions, such as:

• Are you experiencing any pelvic pain?
• Do you have any pain while urinating?
• Do you have any sores or unusual discharge?

Tests and diagnosis

Your doctor usually can diagnose genital herpes based on a physical exam and the results of certain laboratory tests:

• DNA test. A sample of your blood, sore tissue or spinal fluid can be tested to establish the presence of HSV and determine which type of HSV you have.
• Blood test. This test analyzes a sample of your blood for the presence of HSV antibodies to detect a past herpes infection.
• Viral culture. This test involves taking a tissue sample or scraping of the sores for examination in the laboratory.

Treatment and drugs

There's no cure for genital herpes. Treatment with prescription antiviral medications may:

• Help sores heal sooner during an initial outbreak
• Lessen the severity and duration of symptoms in recurrent outbreaks
• Reduce the frequency of recurrence
• Minimize the chance of transmitting the herpes virus to another

Antiviral medications used for genital herpes include:

• Acyclovir (Zovirax)
• Famciclovir (Famvir)
• Valacyclovir (Valtrex)

Your doctor may recommend that you take the medicine only when you're experiencing symptoms of an outbreak. Or your doctor may recommend that you take a medicine daily, even when you're not experiencing any signs of an outbreak, to minimize your chances of recurrent outbreaks.

People who are experiencing severe complications may need to be hospitalized, so they can receive antiviral medication intravenously.

Coping and support

Finding out that you have genital herpes may be quite distressing. Among the tumult of emotions, you might feel shock, shame or anger. You may be suspicious or resentful of your partner if you think he or she "gave" you the disease. Or you might be fearful of rejection by your current partner or future partners.

What you're feeling is normal and perfectly valid. But you can cope with your diagnosis of genital herpes in a healthy and effective way. Here's how:

• Communicate with your partner. Be open and honest about your feelings. Trust your partner and believe what he or she tells you. Don't be too quick to assign blame. Genital herpes can lie dormant in your body for years, so it's often difficult to determine exactly when you became infected.
• Educate yourself. Talk with your doctor or a counselor to learn how to live with the condition and minimize your chances of infecting future partners. Learn about your treatment options so you understand how to best manage outbreaks.
• Join a support group. Look for a group in your area or online so that you can talk about your feelings and learn from others' experiences.

Prevention

The suggestions for preventing genital herpes are the same as those for preventing other sexually transmitted infections. The key is to avoid being infected with HSV, which is highly contagious while lesions are present. The best way to prevent infection is to abstain from sexual activity or to limit sexual contact to only one person who is infection-free. Short of that, you can:

• Use, or have your partner use, a latex condom during each sexual contact
• Limit the number of sex partners
• Avoid intercourse if either partner has an outbreak of herpes in the genital area or anywhere else

Pregnancy precautions 
If you're pregnant, be sure to tell your doctor that you have genital herpes or, if you're unsure, ask to be tested for it. Your doctor may recommend that you start taking herpes antiviral medications late in pregnancy to try to prevent an outbreak from occurring around the time of delivery. If you're having an outbreak when you go into labor, your doctor will probably suggest a cesarean section to reduce the risk of passing the virus to your baby.