What Is Genital Herpes? Everything You Need to Know About Its Symptoms and Treatment Methods

What is Genital Herpes?

Genital herpes refers to painful, fluid-filled blisters (anal area included) in the genital region, caused by the Herpes Simplex Virus (HSV). These fluid-filled blisters, known as vesicles, are commonly caused by HSV Type 2, though in rare cases, HSV Type 1 can also lead to genital infections.

HSV Type 1 typically causes oral herpes, which refers to cold sores around the mouth. So, do all cases of genital herpes stem from HSV Type 2? No, because it is also possible for HSV Type 1 to be transmitted to the genital area through oral-genital contact.

HSV is a double-stranded DNA virus. Once it infects the body, the herpes virus silently awaits in nerve ganglia, much like a covert agent. It reactivates during periods of weakened immune system function, after which symptoms begin to recur.

During periods when the immune system is weakened, the HSV, which lies dormant in the body, reactivates, and symptoms begin to recur.

According to two studies conducted in 2016 and 2020, HSV-2, the type of HSV that typically causes genital symptoms, is the most prevalent sexually transmitted infection globally. As of 2020, it is estimated that approximately one in every 13 individuals aged 15-49 has an HSV-2 infection. To learn more about HSV, click here.

Herpes simplex virus: global infection prevalence and incidence estimates, 2016. Bulletin of the World Health Organization, 98(5), 315–329.

James, C., Harfouche, M., Welton, N. J., Turner, K. M., Abu-Raddad, L. J., Gottlieb, S. L., & Looker, K. J.

Global and regional estimates of prevalent and incident herpes simplex virus type 1 infections in 2012. PLoS ONE, 10(10), e0140765.

Looker, K. J., Magaret, A. S., May, M. T., Turner, K. M. E., Vickerman, P., Gottlieb, S. L., & Newman, L. M.

Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students. Sexually Transmitted Diseases, 30(10), 797–800

Roberts, C. M., Pfister, J. R., & Spear, S. J.

What Causes Genital Herpes?

While HSV Type 2 is usually associated with genital herpes, HSV Type 1 can also rarely cause it. The primary cause of infection is the direct transmission of the virus through contact with mucosal membranes (such as the mouth and nose) and skin. Additionally, micro-fissures in the skin can facilitate the entry of the virus into the body. Transmission is not limited to individuals who show symptoms (i.e., those with visible cold sores); HSV can also be transmitted by individuals who carry the virus in their bodies but do not have active cold sores. For this reason, protected sexual intercourse and testing are crucial, even if your partner does not show signs of infection.

HSV infection begins when the virus breaches the skin, our largest organ, or the tissue layer called mucosa. The virus effectively uses microscopic cracks and lesions in the body as an entry point. After the primary (initial) infection, the virus travels along nerve endings and establishes itself in nerve ganglia. Once settled, the symptoms resolve, but the virus remains dormant. The dormant virus can be reactivated by triggers such as suppression of the immune system due to various reasons, stress, illnesses, high fever, and hormonal changes. This reactivation causes an asymptomatic infection to turn into a symptomatic infection in the patient.

According to current literature, HSV Type 2 is the most common cause of genital herpes. Additionally, a study conducted in 2013 showed an increasing frequency of HSV Type 1 infecting the genital area, particularly in young adults.

How Is Genital Herpes Transmitted? Can a cold sore in the mouth be transmitted to the genital area?

HSV is transmitted through direct contact with infected individuals. Even if an infected individual does not have active cold sores, transmission to a healthy individual can occur.

While HSV Type 2 is generally transmitted through genital contact (the most common way being sexual intercourse), HSV Type 1 is primarily transmitted through oral contact (such as kissing). If an individual with HSV Type 1 has their mouth area come into contact with a healthy person's genital region, it can lead to HSV Type 1 transmission to the genital area of the healthy individual.

Studies show that the rate of HSV-1 genital infection is also increasing. This indicates that cold sores in the mouth can indeed be transmitted to the genital area. Individuals with active herpes lesions (cold sores) are more likely to transmit the disease.

Cold sore on the lip

What are the symptoms of Genital Herpes? What does Genital Herpes look like? Does Genital Herpes cause pain and itching?

Genital herpes varies in appearance depending on whether the infection is occurring for the first time (primary) or is a recurring infection. Primary infections are generally more severe.

The primary symptom of HSV infection is the formation of cold sores. In addition, some symptoms include:

• Painful vesicles (painful blisters containing fluid)

• Open sores (ulcerations) formed when vesicles rupture

• Burning, itching, and tingling sensations

• Swelling of groin lymph nodes (lymphadenopathy)

• Painful urination (dysuria)

• Fatigue, headache, and fever (these symptoms are more pronounced, especially in primary infection)

These vesicles typically appear around the vulva (female external genitalia, the area that contacts underwear), vagina (the canal connecting the uterus to the outside world), cervix, penis, scrotum, anus, and thighs. They are usually 1-2 mm in diameter, numerous, clustered, and symmetrical. Within a few days of their formation, these vesicles ulcerate (turn into sores), then scab over, and heal within 2-3 weeks.

Pain in the area where fluid-filled blisters appear is particularly noticeable during the ulceration stage. Itching, however, can be experienced both before the infection and during the healing period.

While pain in the area where vesicles form is frequently observed, especially during the ulceration stage, itching is prominent in the pre-infection period and during the healing process.

While primary infections are much more severe, recurrent attacks are generally milder and shorter-lived.

Asymptomatic progression is also possible. Some individuals may carry the virus but show no symptoms. These individuals can still transmit HSV infection to healthy individuals. This is especially true for HSV Type 2. Patients should not assume they have completely cleared the virus from their bodies simply because their symptoms and cold sores have healed. This is a significant factor that increases the risk of transmission.

Genital Herpes vs. Warts: What's the difference?

Both are viral and sexually transmitted infections.

However, they are completely different diseases in terms of clinical appearance, the viruses that cause them, and treatment approaches.

The causative virus for genital warts is the Human Papillomavirus (HPV). Low-risk types like HPV Type 6 and 11 cause genital warts, while high-risk oncogenic types like HPV Type 16 and 18 usually do not cause warts but are associated with cervical cancer. For detailed information about genital warts, click here.

Genital warts are usually painless compared to cold sores. They appear as rough, cauliflower-like growths on the skin.

Where does Genital Herpes appear? Genital herpes in the vagina and on the penis

Genital herpes manifests as vesicles and ulcers that appear particularly in the genital and perianal regions. HSV Type 2 typically affects the lower genital area, while HSV Type 1 affects the oral region. Both types can infect both sexes.

In women, the infection typically progresses as follows:

• The vulva, vagina, cervix, perineum, and perianal area are the most commonly affected regions.

• Lesions typically begin as clustered vesicles at the vaginal entrance or on the vulva (external genital area).

• Lesions eventually ulcerate and form sores.

• Cervical infections can often be asymptomatic, which may delay diagnosis.

In men:

• The shaft of the penis, glans, foreskin, and scrotum are the most commonly affected areas.

• Additionally, the perianal area (around the anus) and inner thighs can also be affected by the infection.

• In men, lesions being more distinct and symptomatic are factors that facilitate diagnosis.

Lesions typically depend on the mode of transmission, micro-cracks and microtraumas in the skin and mucosa, and the individual's immune status. Primary infections tend to spread widely, while recurrent infections are more likely to affect limited areas.

When HSV infection appears around the rectum and anus, it can cause proctitis. Proctitis is an inflammation of the rectum, the lower end of the large intestine, and can lead to rectal pain, diarrhea, and bleeding.

How is Genital Herpes diagnosed?

If you suspect you are showing symptoms of HSV, you should consult your doctor immediately.

After conducting the necessary physical examinations, your doctor may request several laboratory tests.

These tests are as follows:

1. PCR Test (Polymerase Chain Reaction Test): Used to detect HSV DNA and differentiate between HSV Type 1 and Type 2 from a swab sample taken from the lesion.

2. Viral Culture: Applied to open and fresh lesions, especially during initial outbreaks.

3. Serological Tests (IgG/IgM): Determines past or active infection by measuring HSV Type 1 and HSV Type 2 specific antibodies; these are type-specific tests.

4. Direct Fluorescent Antibody (DFA) Test: Used to identify HSV antigen.

So, when should we get tested?

If:

• You notice herpes-like lesions in your genital area for the first time.

• You have recurrent genital sores (ulcers).

• Evaluation for HSV is necessary during pregnancy.

• Your partner has been diagnosed with HSV.

Which doctor should I see for genital herpes? Which department handles genital herpes?

If you suspect you or your sexual partner has genital herpes, you should consult your family doctor or a specialist as soon as possible.

Your family doctor may refer you to, or you can schedule an appointment with, departments such as Dermatology, Urology, Gynecology (Obstetrics and Gynecology), or Infectious Diseases.

If you suspect or are pregnant, you must consult your gynecologist (obstetrics and gynecology specialist) without delay. Due to the risk of HSV infection during pregnancy, your doctor will plan the most appropriate delivery method and timing for you.

Early diagnosis and treatment are crucial for the course of the disease and the prevention of transmission. Additionally, the World Health Organization (WHO) emphasizes that individuals diagnosed with HSV infection should also be screened for other sexually transmitted infections (HIV, syphilis, gonorrhea, etc.).

Genital Herpes in Pregnancy - What is Neonatal Herpes?

Genital herpes experienced during pregnancy can be very dangerous for both the mother and the baby. Especially primary infections, meaning those experienced for the first time, carry much greater risks. If you are pregnant and suspect genital herpes, you should consult your doctor immediately.

The risk of neonatal herpes is highest in those who contract a primary HSV infection during pregnancy. This is because antibodies that have not yet formed in the mother cannot be transferred to the baby via the placenta. In this case, the baby will not have received these new, first-time antibodies formed in the mother by the placenta.

However, if the mother was diagnosed with HSV before pregnancy, meaning she is experiencing a recurrent HSV infection (outbreak) during pregnancy, the existing HSV antibodies in the mother can partially protect the baby from the infection. This protection reduces the risk of neonatal infection.

Genital herpes can occur during pregnancy.

So, how should delivery occur?

In the presence of active lesions or prodromal symptoms (such as tingling or burning sensations experienced days before cold sores appear), vaginal delivery is not recommended. In these situations, a C-section delivery significantly reduces the risk of infection transmission to the baby, as it minimizes contact between active lesions and the baby. The most common route of transmission for neonatal herpes caused by HSV is through the birth canal.

Regular doctor follow-up is very important for pregnant women with genital herpes or suspected cases.

How long does Genital Herpes last? How many days does Genital Herpes take to heal? Does Genital Herpes go away on its own?

The healing time for genital herpes symptoms varies depending on whether the infection is primary (first time) or recurrent (recurring).

Primary genital herpes:

• Typically lasts 2-4 weeks.

• Are painful.

• When lesions first appear, they are small and fluid-filled, later turning into sores (ulcerating) and then scabbing over to heal.

• Fever, headache, and muscle pain are commonly observed.

Recurrent genital herpes, however:

• Presents with a milder clinical picture.

• Typically heals on its own within 7-10 days.

• Systemic symptoms like fever, headache, and muscle pain are either absent or mild.

• Itching, tingling, and burning sensations may be experienced a few hours to days before the lesion appears (prodromal period).

So, do genital herpes go away on their own?

For individuals with a normal immune system, the answer to this question is yes. However, not consulting your doctor and not receiving treatment can lead to prolonged symptoms, much more severe pain, and an increased risk of transmission.

Therefore, consulting your doctor as soon as you notice symptoms will be the best decision.

How to treat Genital Herpes at home? What helps Genital Herpes? Natural and herbal Genital Herpes treatment

You can use supportive methods to complement your genital herpes treatment, which should be supervised by a doctor. However, it is very important that these supportive methods are implemented under the supervision of a physician and pharmacist.

Keeping lesions clean and dry, applying cold compresses, opting for cotton and loose-fitting underwear, and reducing stress can help alleviate the severity of symptoms.

In addition, some standardized and proven effective topical gels and sprays that you can use after consulting your pharmacist can also be supportive for your treatment.

In vitro studies have shown that glycyrrhizinic acid, found in gel and spray forms and derived from licorice root, prevents the entry and reproduction of HSV in the body due to its strong antiviral effect against HSV Type 1 and Type 2. Current literature indicates that Glycyrrhizinic Acid is frequently prescribed for protection against both HSV and other viral infectious diseases, and for reducing the frequency and severity of attacks. These preparations, available in pharmacies, can be easily used by patients.

Source: Antiviral effects of Glycyrrhiza species. Phytotherapy Research, 22(2), 141–148

Fiore, C., Eisenhut, M., Krausse, R., Ragazzi, E., Pellati, D., Armanini, D., & Bielenberg, J

Glycyrrhizic acid inhibits virus growth and inactivates virus particles. Nature, 281(5733), 689–690

Pompei, R., Flore, O., Marccialis, M. A., Pani, A., & Loddo, B

Some studies have also indicated that the plant Melissa officinalis shows an antiviral effect against HSV Type 2 when applied to the skin. Similarly, some studies have noted that propolis can be effective in topical use due to its antiviral and anti-inflammatory phenolic compounds. Moreover, zinc sulfate solutions have been the subject of studies focusing on their ability to accelerate the healing of genital herpes and prevent viral proliferation. However, it is crucial to remember that the correct use of these substances does not involve homemade preparations, but rather standardized products approved by ministries and sold in pharmacies, meaning products where the same active ingredient is proven to be present in the same dose across all items. Otherwise, these home-applied treatments can significantly negatively affect patient health.

Source: Antiviral activity of the essential oil of Melissa officinalis against herpes simplex virus type 2. Phytomedicine, 11(7–8), 657–661.

Allahverdiyev, A. M., Duran, N., Ozguven, M., & Koltas, S. (2004)

Herpes genitalis - topical zinc sulfate: An alternative therapeutic and modality. Indian Journal of Sexually Transmitted Diseases and AIDS, 34(1), 32

Singh, R., Mahajan, B., & Dhawan, M.

A comparative multi-centre study of the efficacy of propolis, acyclovir and placebo in the treatment of genital herpes (HSV). Phytomedicine, 7(1), 1–6

Vynograd, N., Vynograd, I., & Sosnowski, Z. 

If you notice genital herpes or similar lesions on your body, consult your family doctor without delay.

Frequently Asked Questions

Are genital herpes only caused by HSV Type 2?

No, while genital herpes is most commonly caused by HSV Type 2, HSV Type 1 can also cause genital infection through oral-genital contact.

Can the virus be transmitted even when there are no active sores?

Yes, the virus can be transmitted to another person (silent shedding) even when it is latent in the body and shows no symptoms of herpes.

What is the main difference between genital herpes and genital warts?

Genital herpes are painful, fluid-filled blisters and sores caused by HSV; genital warts are painless, bumpy, cauliflower-like growths caused by HPV.

This article was written by Pharmacist Nil Eker from the Primum Pharma team.