Genital herpes is caused by one of the herpes simplex viruses (HSV). There are 2 types, HSV-1 and HSV-2. Both types can infect the genital and anal area (genital herpes), the mouth and nose (cold sores) and fingers and hands (whitlows).

The virus can enter the body through small cracks in the skin or through the moist soft linings (mucous membranes) of the mouth, vagina/front hole, rectum (back passage), urethra (tube you pee from) and under the foreskin.

After infection by the herpes simplex virus, some people will have an episode of genital herpes – see What are the signs and symptoms?

The virus then becomes dormant (inactive) but stays in the area of the body where you were infected. In some people the virus will become active again from time to time and cause further episodes of genital herpes, known as recurrent flare-ups – What are the signs and symptoms of recurrent genital herpes?.

Genital herpes can be passed on during sexual contact when the virus is active.

Anyone sexually active can get and pass on herpes simplex. It’s most likely to be passed on just before, during or straight after an episode of herpes.

Genital herpes can be passed on:

• from one person to another during vaginal/ frontal or anal sex, or by sharing sex toys
• by direct genital contact – you don’t need to have penetrative sex (vaginal/frontal or anal)
• by skin-to-skin contact with the affected area, if the virus is active on the skin
• if a person with an active herpes sore on the hand or finger touches a partner’s genitals or anal area.

It’s possible to get genital herpes if you get oral sex (going down, giving head) from someone who has a cold sore or is just about to get one.

Genital herpes can be passed to a partner’s mouth through oral sex, but this is rare.

If you’re pregnant it’s possible to pass the virus to the baby if you’re having your first episode at the time of giving birth – see What if I’m pregnant?

If you already have one type of herpes simplex virus it’s still possible to get the other type although you may not notice symptoms.

You can’t get genital herpes from hugging, sharing baths or towels, from clothing, from swimming pools, toilet seats or from sharing cups, plates or cutlery.

It’s very common not to have any visible signs or symptoms at all, or not to notice them.

Some people will get symptoms within 2 to 14 days of coming into contact with the virus. In others, the virus may be in the body for weeks, months or years before signs or symptoms appear. So, if you get symptoms it doesn’t necessarily mean you’ve only just got the virus.

If you do get signs or symptoms, they usually follow a pattern. You may feel generally unwell with flu-like symptoms. This may be followed by:

• stinging, tingling or itching around the genitals
• vaginal discharge that’s unusual for you
• discharge from the urethra (tube you pee from)
• small blisters around your genitals, anus, bottom or thighs; these burst after 1 to 2 days, leaving small, red sores which can be very painful
• pain when urinating (peeing)

Signs and symptoms of recurrent flare-ups are usually milder and clear up more quickly.

There’s often an early warning tingling sensation before a flare-up. The blisters and sores are usually fewer, smaller, less painful and heal more quickly.

In some people, virus is shed from the affected area for short periods of time without there being any signs or symptoms. This is called asymptomatic shedding.

During periods of asymptomatic shedding there may be enough virus to pass on to another person, but the chance is low. Shedding is higher in the first year after infection and in people with frequent flare-ups. When there’s a long gap between flare-ups, shedding is less likely.

You can only be certain you have genital herpes if you have a check-up when you’ve got signs or symptoms. You could have genital herpes even if a partner has never had an episode.

You can have a check-up as soon as you have visible symptoms.

There is no routine, reliable test for genital herpes if you don’t have visible symptoms.

In many cases, a doctor or nurse may diagnose genital herpes by looking at the affected skin. They will want to confirm this by taking a swab of fluid from the affected area, if they can.

A swab looks a bit like a cotton bud. It’s wiped over any blisters or sores for a few seconds. It may sting for a moment. The result will usually be known within 1 to 3 weeks. Some clinics may be able to give you the result after 1 to 2 days.

There’s a specific blood test that can check for antibodies to the herpes simplex virus, however this isn’t used as a routine test for genital herpes as it’s not reliable.

Cervical screening (smear) tests and routine blood tests don’t detect herpes simplex.

It’s possible to have more than one sexually transmitted infection (STI) at the same time. A check-up for other STIs is also advised if:

• you or a partner have a new diagnosis of genital herpes or any other STI
• you or a partner have, or think you might have, any other symptoms
• you’ve recently had sex without a condom with a new partner
• you or a partner have had sex without a condom with other partners
• a sexual partner tells you they have an STI
• you’re pregnant or planning a pregnancy.

No tests are 100% accurate.

It’s easier to diagnose genital herpes at the beginning of an episode before blisters or sores heal. An accurate diagnosis will depend on the amount of virus on the skin, the stage of the blisters or sores and the type of test used. The doctor or nurse will talk to you about how accurate your test result might be.

There are different services you can go to. Choose the one you feel most comfortable with.

Important: Check-ups and tests for genital herpes can only be done when you have visible symptoms on the skin.

Check-ups and tests can be done at:

• a sexual health clinic or genitourinary medicine (GUM) clinic
• some GP surgeries
• some contraception clinics and young people’s services

Free online testing services are available in many areas. They can test for some common sexually transmitted infections and in some areas they may offer an online check for genital herpes.

All check-ups, tests and treatment are free through NHS services.

The aim of the treatment is to ease any pain and prevent the virus from multiplying.

• Treatment is usually started within 5 days of the start of the first episode and while new blisters or sores are still forming. You take antiviral tablets, usually 2 or 3 times a day, for 5 days
• Some people find it helpful to take antiviral treatment when they get another flare-up. You may be given tablets to take at home. These need to be started as soon as the flare-up begins and are usually taken for 1 to 3 days
• People who have repeated flare-ups (usually at least 6 in a year) may be given a long course of the tablets to reduce the number of flare-ups.This is known as suppressive therapy. It also reduces asymptomatic shedding – see Can I pass the virus to a partner when I have no signs or symptoms? – and for most people it stops flare-ups completely, while you’re taking the tablets
• If you’re pregnant, or trying to get pregnant, tell the doctor or nurse. If you have a flare-up of herpes in pregnancy it can be treated safely – see What if I’m pregnant?
• As genital herpes is caused by a virus and not bacteria, antibiotics won’t help
• The treatment you can buy for cold sores on the face isn’t suitable for genital herpes

There are several things you can do to ease the discomfort and speed up the healing process.

• Apply a local anaesthetic ointment such as lidocaine. This will help relieve the pain. You can buy it from a pharmacy
• Gently bathe the area using cotton wool and a warm salt water solution (1 teaspoon of salt to half a litre of water)
• Apply petroleum jelly. Be aware that this can damage latex (rubber) condoms, diaphragms or caps, making them less effective
• Put ice cubes in a plastic bag, wrap in a clean towel or flannel and hold on the sores for up to an hour. Don’t put ice directly onto the skin
• Take a cool shower to soothe the sores
• Avoid washing too often. After washing, dab the affected area gently to dry it
• If urinating (peeing) is painful, urinate in a warm bath or shower
• Wash your hands before touching the blisters or sores. This helps to avoid an infection which may delay the healing process
• Drink extra fluids, such as water
• Wear loose clothing
• Use painkillers, if you need to

It’s different for each person and will depend on your general state of health and whether this is the first episode or a recurrent flare-up. The first episode may last from 2 to 4 weeks in total.

• Flu-like symptoms usually last for about a week
• Individual sores take around 5 to 10 days to heal. Once the sores start healing they’re less painful
• Pain and irritation can last up to 2 weeks or sometimes longer

A recurrent flare-up usually lasts for a shorter time than the first episode.

Flare-ups can be triggered by different things in different people.

If you notice a pattern, you might be able to make changes to help stop flare-ups. Some people find that these are triggers:

• being ill, run down, tired or stressed
• different times in the menstrual cycle
• friction from sex or masturbation; using a lubricant can help
• ultraviolet light on the affected skin area (such as from sunbathing or using sunbeds)
• tight clothing and nylon or lycra underwear
• drinking alcohol or smoking

Flare-ups can eventually stop altogether. This can often be within 18 to 24 months, but may also take much longer. Suppressive therapy can help – see How can I ease the discomfort?

Not necessarily. If testing for other sexually transmitted infections is advised, you may be asked to go back when the episode is over. Contact the clinic if you have any questions or are troubled by recurrent flare-ups in the future.

It’s not essential to have treatment as genital herpes will clear up by itself. However, prompt treatment at the start of an episode can reduce the time it lasts, help the healing process and reduce the chance of you passing the virus on.

Having genital herpes may mean you’re more likely to get HIV from a sexual partner who’s living with HIV and has a detectable viral load. It’s important to know that effective HIV treatment can suppress HIV in the body. This is known as having an undetectable viral load and means HIV can’t be passed on to a sexual partner. Also see our guide to HIV.

Don’t have vaginal/frontal, anal or oral sex if you know a flare-up is coming, while you have symptoms, and for a week after the symptoms have gone.

This helps stop you passing on the virus to a partner. Having sex while you have blisters or sores can also delay them healing.

If a partner is pregnant, it’s important to use condoms or dams (latex or soft plastic squares) during sex and avoid sex for the last 6 weeks of pregnancy. This reduces the likelihood of passing on the virus to your partner and the baby.

A genital herpes test can’t tell you how long you’ve had the virus for.

If you feel upset or angry about having genital herpes and find it difficult to talk to a partner or friends, don’t be afraid to discuss how you feel with the staff at the clinic or GP surgery.

If you have genital herpes, it isn’t usually recommended that a partner has a check-up unless they have signs or symptoms.

You’ll be advised to tell your sexual partner(s) but it’s not compulsory. The staff at the clinic or GP surgery can discuss with you how to do this.

The Herpes Viruses Association has helpful advice on talking to a sexual partner about herpes.

If a partner is pregnant it’s important to reduce the likelihood of passing on the virus to them and the baby – see What if I’m pregnant?

Genital herpes can be treated safely during pregnancy. The chance of passing the virus to the baby during the birth is usually very low because your immune system produces antibodies which help protect the baby.

If you first had genital herpes before you were pregnant, even if you have flare-ups during pregnancy, or if you get genital herpes for the first time earlier than 6 weeks before your due date, the chance of passing it on to your baby during the birth is very low. You’ll usually be able to have a vaginal delivery.

It’s important to tell your midwife or obstetrician that you have genital herpes. You may be offered antiviral treatment at the time of any episode or flare-up, and from 36 weeks of pregnancy to birth. If the first episode is at 28 weeks or later, you may be offered antiviral treatment until the birth.

If you get your very first episode of genital herpes within 6 weeks of your due date, your immune system won’t have time to make antibodies to protect your baby. This can mean the virus could be passed to the baby during vaginal delivery. You’ll be offered antiviral treatment until the birth and should be offered a planned caesarean delivery.

You can get more information on genital herpes in pregnancy from RCOG.org.uk

No. Your fertility won’t be affected by having the herpes simplex virus.

No. Genital herpes doesn’t cause cervical cancer.

For more information about herpes – see Herpes Viruses Association.

Genital herpes blisters and sores are highly infectious. If you or a partner have cold sores or genital herpes:

• don’t kiss or give oral sex if you have cold sores around the mouth
• don’t receive oral sex if you have an episode or flare-up of genital herpes
• if you have sores or blisters in the genital or anal area, avoid anyone having contact with that area from the time an episode or flare-up starts until it’s completely gone

And to protect yourself from other sexually transmitted infections:

The Herpes Viruses Association provides confidential advice and information about genital herpes. Call 0845 123 2305 (Monday to Friday, 11am-8pm) or visit herpes.org.uk