Genital Herpes

HSV-1 is mainly spread by oral to oral contact to cause infection in or around the mouth (oral herpes). HSV-2 is almost exclusively sexually spread, through contact with genital surfaces, skin, sores or fluids of someone infected with the virus, causing infection in the genital or anal area (genital herpes). However, HSV-1 can also be spread to the genital area through oral-genital contact to cause genital herpes.

Herpes infections are most contagious when symptoms are present but can still be spread to others in the absence of symptoms. In rare circumstances, genital herpes can be spread from a mother to her infant during birth.

Genital herpes infections often have no symptoms, or only mild symptoms that go unrecognized. Most infected people are unaware that they have the infection. When symptoms do occur, it usually happens 4-7 days after sexual exposure and is characterized by one or more genital or anal blisters or open sores called ulcers. In addition to genital ulcers, symptoms of new genital herpes infections often include fever, body aches, and swollen lymph nodes.

After an initial genital herpes infection with HSV-2, recurring symptoms are common but often less severe than the first outbreak. The frequency of outbreaks lessens over time. People infected with HSV-2 may experience sensations of mild tingling or shooting pain in the legs, hips, and buttocks before the occurrence of genital ulcers. For people with genital herpes caused by HSV-1, symptoms might return, but genital herpes caused by HSV-1 often does not recur frequently.

Repeated symptoms of genital herpes may be painful, and the infection can lead to social stigma and emotional distress. These factors can have an important impact on quality of life and sexual relationships. However, with time, most people with herpes adjust to living with the infection.

Genital herpes increases the risk of getting HIV by about three times. In addition, people with both HIV and genital herpes are more likely to spread HIV to others. Between 60-90% of people living with HIV also have genital herpes caused by HSV-2. Infection with HSV-1 or HSV-2 in people living with HIV (and other individuals with weakened immune system) often has a more severe symptoms and more frequent returns.

Spread of HSV from mother to child during birth is a rare condition, happening in an estimated 10 out of every 100,000 births globally, but can lead to lasting disability or death. The risk for giving herpes to the infant is greatest when a mother gets an HSV infection for the first time in late pregnancy. Women who have genital herpes before they become pregnant are at very low risk of spreading HSV to their infants.

Genital herpes infection is often diagnosed clinically by a qualified health provider through physical examination. However, laboratory testing is required to differentiate between HSV-1 and HSV-2. When vesicles are not present, laboratory confirmation may also be needed to rule out other causes of genital ulcers. There have been major developments in the diagnosis of HSV-2 including using rapid molecular diagnostic tests, some prequalified by WHO.

Currently there is no cure or vaccines for herpes. Condoms help reduce the chances of infection but do not eliminate it completely, because outbreaks of genital herpes can occur in areas not covered by a condom. Condom use is still advisable as they can prevent other sexually transmitted infections and unplanned pregnancies.

Antiviral medications are the most effective medications available for people infected with genital herpes. These can help to reduce the severity and frequency of symptoms but cannot cure the infection. Both HSV-1 and HSV-2 infections are lifelong. For detailed information on recommended treatment, see WHO guidelines for the treatment of Genital Herpes Simplex Virus