How to Know If You Have Herpes

We tend to talk about herpes in hushed tones, as if having the condition is somehow a badge of shame. But this viral infection is incredibly common and can be effectively managed.

With that out of the way, let's talk about just how many people live with it. Worldwide, in 2016, 491 million people aged 15–49 had HSV-2, the virus that usually causes genital herpes, according to the World Health Organization (WHO). And 3.7 billion people under the age of 50 had HSV-1. HSV-1 is the virus that usually causes cold sores on the mouth and lips, but both types of herpes can infect either the mouth, genitals, or anus.

"Herpes has such a negative stigma around it, and many people get very upset at a diagnosis," said Taraneh Shirazian, MD, OB-GYN at NYU Langone in New York City. Part of the reason for this is that this sexually transmitted infection (STI) is episodic—meaning that after an outbreak clears up, it lives dormant in your nervous system until something triggers the virus to cause another outbreak. (Not everyone who has herpes will experience subsequent outbreaks, however.)

Another reason a herpes diagnosis is so upsetting is because people think it means the end of their sex life. But Dr. Shirazian would tell patients that herpes can be managed—decreasing the risk of passing it to others as well as reducing or even preventing future outbreaks for yourself.

Numerous signs indicate that you may have contracted herpes. The infection is usually diagnosed when certain symptoms appear, with the virus confirmed by testing. These are the six signs to watch for and how to know if you should go to a healthcare provider.

Blisters on Your Genitals or Anus

Who hasn't seen a wayward bump on their genitals and automatically panicked? But there is a difference between bumps (like ingrown hairs, for example, or skin irritation) and sores from herpes. "What I tell women is that herpes lesions are ulcerated," said Dr. Shirazian. (Ulcerated means that they will have a small little crater or clearing in the center.)

While you may have any number them, herpes blisters tend to appear in a tiny cluster of one to three lesions, said Dr. Shirazian. They may appear on the vagina, vulva, penis, perineum, anus, butt, and upper thighs.

Pain and/or Itching in or Around the Blisters

Lesions are usually painful to touch—especially during the first herpes outbreak, which tends to be more severe. "The main thing that brings women into the office with herpes is pain," said Dr. Shirazian.

Bumps that you find just by chance when sudsing up in the shower or toweling off probably aren't herpes. "Herpes lesions will make themselves known and felt," said Dr. Shirazian. They can also itch, especially as they begin to scab over and heal.

Burning When You Pee

Herpes lesions can cause a lot of pain and burning when you pee, if your urine stream runs over any open sores on your vulva or outside your vagina near your urethra. A urinary tract infection (UTI) also causes burning, said Jee Shim, MD, an OB-GYN at Long Island Jewish Forest Hills in Queens, New York.

Flu-Like Symptoms

Herpes is caused by a virus, and some people can have a flu-like response to an infection, including fever, headache, and enlarged lymph nodes in the groin, said Donna Neale, MD, assistant professor of gynecology and obstetrics at Johns Hopkins Medicine in Maryland.

These flu-like symptoms often happen with just the first episode, said Dr. Shim. While the initial outbreak can be painful and tough to get through, it does get better. "With recurrent episodes, the symptoms tend to be less severe and shorter in duration than primary episodes. You can still—but rarely—develop (flu-like) symptoms, but most people will only develop painful lesions."

Tingling or Pain Before Blisters Form

If you know you've been exposed to herpes, you may want to watch for prodromal (early stage) symptoms. "About 50% of people will have symptoms such as itching, tingling, or pain on genital skin before blisters or sores appear," said Dr. Shim. Usually you'll experience an outbreak later, but it's possible to have this tingling or itching and have no sores emerge.

No Symptoms at All

You can be infected with the virus, but it may not cause any symptoms, said Dr. Neale. "Herpes is not always straightforward with painful red ulcers. Not everyone has symptoms the first time, and some people find out later in life they were exposed to herpes. If you're diagnosed, it doesn't mean it's a new and primary infection," she said. Keep in mind that even if you are asymptomatic, you can still pass the virus onto a partner.

Cold Sores Around the Lips and Mouth

Just like genital herpes, oral herpes may come with no symptoms, according to the National Library of Medicine MedlinePlus resource. But some people do get cold sore outbreaks, which may recur. Although they can't be cured, cold sores can be treated, typically with antiviral medicines.

How Herpes Is Diagnosed

Your first step is to make an appointment with your healthcare provider if you have a lesion on your genitals or believe you were exposed to herpes. "Google really can't tell you if you have genital herpes or not," said Dr. Shim. A diagnosis of herpes can be made with an exam, but your healthcare provider will also order a culture swab from the sore to confirm the virus and rule out other possibilities.

Your healthcare provider can give you advice on easing symptoms, shortening their duration, and preventing outbreaks in the future. Taking a daily dose of the antiviral drug Valtrex (valacyclovir) can decrease transmission to a noninfected partner, said Dr. Shirazian. It can also prevent recurrent outbreaks for the person with the infection. Maintaining general healthful habits—eating nutritious foods, staying active, and getting enough sleep—go a long way to keeping your immune system able to minimize outbreaks.