Genital Herpes

Symptoms

The first outbreak is usually more severe. Symptoms:

• Painful, fluid-filled blisters on the genital area, around the anus or on the buttocks
• Blisters breaking open and turning into ulcers
• Burning, itching or tingling (prodrome)
• Pain when urinating
• Swollen lymph nodes in the groin
• Fever, fatigue, headache (especially in the first outbreak)

Recurrent outbreaks are usually milder and shorter. With HSV-2 there are on average 4–5 recurrences in the first year; genital HSV-1 infection recurs less often. Many people have no symptoms at all or only mild ones. Having no symptoms does not remove infectiousness.

Diagnosis

If there is an active sore or blister, type-specific NAAT (PCR) is the most reliable method. The sample is taken from the lesion. Culture may also be used but is less sensitive than PCR.

Type-specific serology (HSV-2 antibody test) can help in some situations: recurrent or atypical lesions, negative PCR but high clinical suspicion, a partner with genital herpes. Routine screening is not recommended; the USPSTF does not recommend serological screening in people without symptoms. An HSV-1 antibody test cannot distinguish between oral and genital infection.

Other STIs that cause ulcers (syphilis, chlamydia LGV, chancroid) are considered in the differential diagnosis. If pregnancy is suspected, a pregnancy test is done first.

Treatment

Antiviral treatment is recommended for the first outbreak. Options according to CDC 2021:

• Aciclovir 400 mg three times daily, 7–10 days
• Valaciclovir 1 g twice daily, 7–10 days
• Famciclovir 250 mg three times daily, 7–10 days

If healing is not complete, the course can be extended. Severe cases may need intravenous treatment.

For recurrent outbreaks, episodic treatment is more effective when started as soon as symptoms begin (within the first 24 hours). For frequent recurrences (6 or more a year) or when quality of life is affected, suppressive (continuous) treatment is discussed:

• Aciclovir 400 mg twice daily
• Valaciclovir 500 mg or 1 g once daily
• Famciclovir 250 mg twice daily

Suppressive treatment reduces the number of outbreaks and viral shedding. It can also lower the risk of transmission to a partner. The length of treatment is decided individually; it is usually reassessed after 6–12 months.

Pregnancy and the newborn

Getting genital herpes for the first time in the last trimester of pregnancy increases the risk of transmission to the newborn (about 30–50%). With recurrent infection the risk is low (< 1%) if there is no active lesion. If there is an active genital lesion at delivery, a caesarean section is recommended.

In pregnant women with a history of recurrent genital herpes, suppressive antiviral treatment (aciclovir or valaciclovir) from week 36 reduces the risk of lesions at delivery. Routine screening in pregnancy is not recommended. New-onset or severe genital herpes in pregnancy is managed jointly by obstetrics and infectious diseases.

Complications and risks

• Frequent recurrences and reduced quality of life
• Urinary retention (in a severe first outbreak)
• Meningitis or encephalitis (rare)
• Increased risk of HIV transmission (due to ulcers and inflammation)
• Neonatal herpes (can be serious)

The psychological impact matters. After diagnosis, communication with the partner and the risk of transmission should be discussed.

Prevention

• Avoiding sex while there is an active lesion
• Using condoms (reduces the risk, does not eliminate it)
• Informing the partner
• Suppressive treatment (reduces shedding)
• Assessment before planning a pregnancy

Having had genital herpes once does not give immunity. Reinfection and reactivation are possible.

Our approach at SoftCare

At SoftCare Clinic, genital herpes assessment begins with a gynaecological history and examination. If there is an active lesion, a swab is taken for type-specific NAAT (PCR) and run at a partner laboratory. Tests for other STIs can be planned at the same time.

For a first outbreak, antiviral treatment is started. For recurrent outbreaks, episodic or suppressive treatment options are discussed. If pregnancy is suspected or confirmed, management is adjusted accordingly; the delivery plan is coordinated with obstetrics. In case of a severe course, suspected meningitis or a first outbreak late in pregnancy, an urgent referral is made. HIV treatment is not provided at the clinic; a referral is arranged if needed.

Appointments: +90 212 241 30 10 · softcareclinic.com

References

• 1. Centers for Disease Control and Prevention (CDC). Genital Herpes. STI Treatment Guidelines, 2021. https://www.cdc.gov/std/treatment-guidelines/herpes.htm
• 2. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1–187.
• 3. Johnston C. Diagnosis and Management of Genital Herpes: Key Questions and Review of the Evidence for the 2021 CDC STI Treatment Guidelines. Clin Infect Dis. 2022;74(Suppl 2):S134–S143.
• 4. U.S. Preventive Services Task Force (USPSTF). Serologic Screening for Genital Herpes Infection. Recommendation statement (Grade D, routine screening not recommended).
• 5. World Health Organization (WHO). Herpes simplex virus. Fact sheet.
• 6. American College of Obstetricians and Gynecologists (ACOG). Management of Genital Herpes in Pregnancy.
• 7. British Association for Sexual Health and HIV (BASHH) / RCOG. Management of HSV in Pregnancy and the Neonate (2024 update).
• 8. Merck Manual Professional Edition. Genital Herpes.
• Note: Treatment doses, management in pregnancy and screening decisions are updated by the physician according to current national and international guidelines. This reference list is for information only.

Listing a source does not mean SoftCare wrote that text.

Medically reviewed by Op. Dr. Şükrü Sanus, Obstetrician & Gynecologist · Last medical review: 2 October 2026