Genital herpes: infection and treatment (2024)

• Genital herpes is caused by an infection with herpes simplex viruses (HSV).
• These are transmitted through skin contact. Many people become infected during sex.
• Once people have been infected with herpes viruses, they remain carriers for life.
• An HSV infection does not usually lead to illness. Up to 90 percent of infected people have no symptoms or only very mild symptoms.
• If symptoms occur, they can sometimes be painful and cause psychological stress.
• Treatments are available that can alleviate the symptoms and shorten an outbreak.

Genital herpes is caused by herpes simplex viruses (HSV) and is one of the most common sexually transmitted infections (STI). Once people have been infected with herpes viruses, they remain carriers for life.

Many people remain asymptomatic despite having an HSV infection. If the herpes breaks out, however, the symptoms can be distressing – a painful rash appears in the genital area, often accompanied by a high temperature and general feeling of malaise. The symptoms usually go away on their own after 1 to 2 weeks.

However, there are also treatments that accelerate recovery and alleviate the symptoms.

Once the virus has become active, further herpes outbreaks can be expected. Over time, the outbreaks become milder and less frequent.

A diagnosis of genital herpes is very unpleasant for many people. It raises questions such as who infected me? Have I infected anyone else? How do I talk to my partner about this? Who should I tell about my diagnosis? Can the infection be transmitted to a fetus during pregnancy?

The typical symptoms of genital herpes are painfully inflamed skin and small blisters. The blisters appear in small clusters. They can burst and ooze. They develop a crust during the healing process. The skin can also itch and burn.

In women, the labia, vagin* and cervix are often affected. In men, the condition usually affects the penis, scrotum and foreskin. However, blisters can also appear on the perineum, in the anal region, on the buttocks and on the inside of the thighs.

Some people experience tingling in the sexual organs or pain in the buttocks, hips or legs prior to an outbreak. Women often also experience pain during urination.

Symptoms are often particularly pronounced during the initial genital herpes outbreak. In addition to the symptoms mentioned above, fever, headache, fatigue, and muscle pain can occur. Swollen lymph nodes in the groin are also common.

Subsequent outbreaks are usually milder.

Genital herpes is caused by an infection with herpes simplex viruses. There are two different types:

• herpes simplex virus type 1 (HSV-1)
• herpes simplex virus type 2 (HSV-2)

HSV-2 is primarily responsible for genital herpes, whereas HSV-1 usually causes oral herpes (cold sores). However, a person experiencing an oral herpes outbreak can transmit the virus to the genital area of another person during oral sex. This person can then contract genital herpes through type 1 herpes simplex viruses.

Once a person has become infected, the herpes viruses remain in the body forever, nesting in the ganglia at the lower end of the spine. From there, they can multiply, travel along the nerve fibers into the outer layers of the skin and trigger genital herpes.

Herpes viruses are transmitted by skin contact. Most people become infected during unprotected sex. However, herpes viruses can also be transmitted by sharing sex toys. On the other hand, it is very unlikely that people will become infected by sharing towels, bed linen or toilet seats.

Since infections with herpes simplex viruses (HSV) are usually asymptomatic, carriers of the viruses often unknowingly transmit them to others. Women are generally thought to be more susceptible to HSV infection than men.

Frequently changing sexual partners increases the likelihood of contact with someone who is contagious. Using condoms can reduce the risk of infection.

It is not yet known why some people are asymptomatic and others are not. There is only minimal research regarding possible triggers for recurrent outbreaks. A persistent state of stress seems to increase the risk of outbreaks. Sunlight, the common cold, physical exertion, injuries to the skin, rough or tight clothing and menstruation in women all appear to be capable of activating herpes viruses.

Genital herpes is usually caused by an infection with type 2 herpes simplex viruses (HSV-2).

Approximately 10 to 15 percent of people in Germany are HSV-2 carriers. About 10 to 30 percent of these are also symptomatic. Women are affected by genital herpes slightly more often than men.

Months or even years can pass between infection and the initial genital herpes outbreak. The initial outbreak takes on average 20 days to heal without treatment. Subsequent outbreaks are less severe and heal within an average of 10 days. People who have had an initial outbreak of genital herpes can typically expect to experience subsequent outbreaks.

The frequency of further genital herpes outbreaks depends on whether the person has been infected with type 1 herpes simplex viruses (HSV-1) or type 2 herpes simplex viruses (HSV-2):

• On average, HSV-1 results in a further outbreak within a year in approximately 20 to 50 percent of those infected.
• HSV-2 results in at least one but on average four additional outbreaks within a year in 70 to 90 percent of those infected.

Subsequent outbreaks are less severe and occur less frequently. Complications are also very rare with subsequent outbreaks.

Important: The first genital herpes outbreak in particular can result in complications. These can include a vagin*l yeast infection, bladder problems with difficulty urinating or, in rare cases, meningitis. In very rare cases, larger skin rashes or eye infections can occur. People with a weakened immune system are at a higher risk of such complications.

What are the consequences of an HSV infection during pregnancy?

Pregnant women can transmit herpes simplex viruses (HSV) to their baby during the birth. This can be dangerous for the baby but is a rare occurrence. If a pregnant woman experiences a genital herpes outbreak shortly before giving birth, a cesarean section is often recommended to minimize the risk of infection and protect the child.

More information about genital herpes in pregnancy can be found at gesundheitsinformation.de.

Many people are carriers of herpes simplex viruses. Anyone who is sexually active can become infected with the pathogens of genital herpes. However, there are measures that can be taken to reduce the risk of infection.

If a sexual partner shows symptoms of a herpes outbreak, a temporary abstention from sexual intercourse and oral sex is recommended. The risk of infecting someone else is greatest during an outbreak.

A condom can significantly reduce the risk of infection as well as provide protection against other STIs. There are also condoms for women (femidoms) and dental dams for oral sex.

Important: It is helpful for people who know they have been infected with genital herpes to talk openly about it. This enables all sexual partners to be tested. A blood test to check for antibodies shows whether people are carriers of type 1 (HSV-1) or type 2 (HSV-2) herpes simplex viruses. This makes it possible to determine if there is a risk of infection – for example, people with HSV-1 can still become infected with HSV-2.

Taking an antiviral is likely to reduce the risk of infecting others to some extent. Medications with the active ingredient aciclovir, famciclovir, or valaciclovir can be used for this purpose. However, they must be taken daily and longterm. Use as a cream or ointment does not provide any protection. It is unclear whether the medications further reduce the risk of infection when people with genital herpes use condoms.

It is often impossible to clearly diagnose genital herpes based on the changes to the skin and discomfort alone, as these can have various causes. People not always present with typical symptoms and, in addition, genital herpes can also occur alongside other skin disorders and sexually transmitted infections.

For example, an infection with fungi or chlamydia and other skin diseases like psoriasis can result in similar symptoms. To make a definitive diagnosis, doctors will therefore take a sample from an affected area and have it tested in a lab. Depending on the situation, the virus type can also be determined.

If there are no symptoms, it is more difficult to detect a herpes virus infection. A blood test can be used to indirectly determine the existence of the virus by testing for antibodies. However, these tests do not provide any information about the duration of the infection. If no antibodies are present in the blood during the initial genital herpes outbreak, it is likely that the virus was contracted recently.

The initial outbreak of genital herpes can have severe symptoms and even lead to complications.

In such cases, doctors usually prescribe antiviral medication with the active ingredient aciclovir, famciclovir or valaciclovir. These tablets can alleviate symptoms and shorten their duration by several days. Creams and ointments with antiviral ingredients are not effective against genital herpes.

Symptoms are usually less severe in later outbreaks and it is not absolutely necessary to treat the symptoms. If a subsequent outbreak is treated, medication can be taken for a shorter period of time. It is important to begin treatment within the first 24 hours: ideally at the onset of the first symptoms.

In the case of severe or frequent outbreaks, preventative therapy with medication is possible. In this case, medication is taken longterm, i.e. also in symptom-free phases, thereby significantly reducing the risk for outbreaks.

If genital herpes causes significant pain, painkillers can help. Many women who experience pain during urination due to genital herpes find relief from sitz baths.

At present, other treatments like laser or local heat treatment have hardly been studied. It is not clear whether they are actually effective.

More detailed information on the treatment of genital herpes can be found at gesundheitsinformation.de.

Having genital herpes can be a source of significant psychological strain. Many people find it difficult to talk about – especially if in a long-standing relationship and it leads to discussions about topics such as sexual activity before or outside the relationship. Other people worry about whether their partner may have infected them. But even in the early stages of a relationship or if people only have a casual sexual relationship, it can be difficult to talk about a genital herpes infection.

However, it is very important to be open about this. It is often not possible to determine when and how infection occurred. This is because many people are carriers of herpes simplex viruses – the pathogens of genital herpes – and anyone who is sexually active runs the risk of infecting other people. In addition, people can often be infected with the viruses months or even years before the initial genital herpes outbreak.

Tips on how to start and continue talking about sexually transmitted infections can be found at https://www.liebesleben.de/en/ – a website of the Federal Center for Health Education (BZgA).

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen – IQWiG).

As at: 11/17/2021