Herpes Is Common and Manageable

Herpes is a sexually transmitted infection (STI) that causes painful blisters or sores in your genitals or mouth. Although it’s incurable, it’s often not as bad as most people think. Herpes doesn't usually cause serious health issues or keep people from having relationships. Antiviral medication can also help manage herpes outbreaks and reduce your risk of spreading the infection. 

There is still a lot of fear and social stigma surrounding herpes. Here's why herpes may not be as bad as you think and what to know about transmission, prevention, and treatment. 

How Common Is Herpes?

Genital herpes is caused by two different herpes simplex viruses: HSV-1 and HSV-2. HSV-1 infections often cause oral herpes (known as cold sores or fever blisters), but the infection can spread to the genitals. Genital herpes is usually caused by HSV-2.

About 11.9% of people under 50 have an HSV-2 infection in the U.S., according to the Centers for Disease Control and Prevention. Based on 2018 data, the CDC also estimates about 572,000 new genital herpes infections occur per year. HSV-2 is also more common in people with a vagina, at about 15.9% compared to 8.2% in people with a penis.   

According to the World Health Organization, about 3.7 billion people under 50 (67% of the global population) have an oral or genital HSV-1 disease. 

Most people with herpes are also asymptomatic (or don't show symptoms) and have no clue they have the disease. In the U.S., the CDC estimates about 87.4% of people under 50 are unaware they have genital herpes. 

Symptoms

People with herpes usually have no symptoms or only have mild symptoms. Common symptoms typically appear between 2-21 days after exposure to the herpes virus, but some might not start until months or years later. 

Symptoms of genital herpes include:

• Small blisters or bumps on the genitals, rectum, or mouth
• Painful ulcers that bleed or ooze
• Fever and chills
• Headache
• Pain in the joints
• Swollen lymph nodes
• Pain while urinating
• Unusual discharge with a foul odor

In rare cases, herpes can cause severe health issues if you are immunocompromised and have a weakened immune system. Severe herpes complications can include:

• Encephalitis (inflammation of the brain)
• Meningitis (inflammation of the meninges)
• Keratitis (eye infection)
• Hearing loss

If you are pregnant, genital herpes can also spread to your baby. However, most birth parents with herpes do not pass the infection onto their children during pregnancy and birth. If your baby does get a herpes infection, known as neonatal herpes, it can cause life-threatening complications like:

• Infected organs (especially the lungs and liver)
• Central nervous system disease and damage
• Skin, eyes, and/or mouth infections 

How Is Herpes Spread?

Genital herpes spreads through direct skin-to-skin contact. Body fluids can also carry the virus if a person has an active infection, even if they don’t have symptoms. Many people unknowingly spread the virus to non-infected people due to viral shedding (when a person releases copies of a virus from their bodies) and cause an infection without herpes sores being present. 

Different ways you can get genital herpes include:

• Cold sores touching your skin or genitals during oral sex
• Genital herpes sores touching your skin or genitals during sex or close contact
• Saliva touching your skin or genitals during oral sex if your partner has oral herpes
• Exchanging genital fluids during sex if your partner has genital herpes
• Oral area skin touching your genitals if your partner has oral herpes 
• Genital area skin touching your genitals if your partner has genital herpes

Infants are at greater risk of getting neonatal herpes if the birth parent gets herpes later in pregnancy or has an active outbreak during delivery. However, if you contract herpes before or during the early stages of your pregnancy — and don’t have sores — it’s rare to pass the infection to your newborn during delivery (less than 2% chance).

How to Prevent Spreading Herpes

Medication and other preventative measures can help you reduce your risk of spreading herpes to your partner, including: 

• Antiviral medication: Antivirals like acyclovir, famciclovir, and valacyclovir reduce the amount of virus in your body. This helps lower your risk of outbreaks and passing the virus to another person.
• Avoid touching your herpes sores: Touching herpes sores or fluids can pass the virus to other body parts you touch. Always wash your hands with soap and water if you touch a sore.
• Avoid direct skin-to-skin contact during outbreaks: You are most contagious when you have sores and can easily pass the virus to your partner. When you have an outbreak, avoid any sexual activity — even with a condom.
• Don't have sex until your sores have healed: The presence of herpes sores means you have an active infection and are contagious.
• Use the appropriate protection during outbreaks: Condoms or dental dams do not completely eliminate the risk of passing herpes to your partner. However, barrier methods can significantly lower the risk of contracting the infection during sex.
• Talk to your healthcare provider if you’re pregnant: Monitoring a herpes infection and taking antivirals during pregnancy can help prevent spreading herpes to your baby. Your provider may also suggest a C-section if you have an active outbreak or new infection. 

A Quick Review

Genital herpes is a common STI caused by HSV-1 (oral herpes) and HSV-2 (genital herpes). It is spread primarily through direct skin-to-skin contact through vaginal sex, anal sex, or oral sex. However, most people with herpes do not know they have it and are asymptomatic. If you experience any symptoms, it's important to get tested and rule out other conditions.

While the infection remains highly stigmatized and is often feared, having herpes is usually not as bad as most people think. Antiviral medication can help you avoid outbreaks and reduce your risk of spreading it to your partner. Avoiding intimacy during an outbreak will also reduce your risk of spreading the virus.   

It's rare for herpes to cause severe disease or spread to infants if the birth parent has herpes. Most people will not face life-threatening complications from genital herpes, and they can continue to have romantic and sexual relationships.