Genital Herpes: Signs, What It Looks Like, and How It Is Transmitted

Genital herpes is a sexually transmitted infection; it is caused by the herpes simplex virus. Typical signs are blisters and sores in the genital area, anus, buttocks, and thighs. Below is what is known about symptoms, routes of transmission, and diagnosis.

What genital herpes is and which virus causes it

This is a sexually transmitted infection caused by the herpes simplex virus (HSV). Type 2 virus (HSV-2) is transmitted almost exclusively sexually and manifests in the genital or anal area. It is neurotropic: after infection it migrates to the nervous system and remains in the body for life, causing blisters in the same location.

The infection is more widespread than it seems: in different countries, the proportion of adults with antibodies to herpes simplex virus type 1 and/or type 2 is 60–95%, and in the United States 16.2% of the population is infected with HSV-2. Only 10–20% of those infected with HSV-2 report a previously established diagnosis — the rest are often unaware of it.

How genital herpes is transmitted

The virus is transmitted through skin-to-skin contact with an affected area, including during vaginal, anal, and oral sex. Infection can also occur without visible blisters: the virus is shed from the moment of the first tingling or itching at the onset of a flare-up until the sores have completely healed, as well as during asymptomatic infection.

The risk of transmission is higher in the first 6 months after infection and is rare after 2 years. Other routes include touching a "cold sore" on the lips to the genitals, transferring the infection from the fingers, and sharing sex toys. You cannot become infected through towels, swimming pools, saunas, or toilet seats: there is no skin-to-skin contact there. A condom reduces the risk but does not eliminate it if it does not cover the affected area.

What herpes looks like on the genitals, pubic area, and buttocks

First, tingling, burning, or itching appears; with HSV-2 there may also be shooting pain in the legs, thighs, and buttocks before the rash. Then small blisters form, which burst, leaving red open sores around the genitals, anus, thighs, or buttocks. On brown and black skin, the sores may be less red.

A blister may appear on the vagina, a cluster of blisters on the penis, and rashes also occur on the buttocks. In the intimate area this is accompanied by pain during urination and unusual discharge. Recurrent episodes are usually milder than the first, become less frequent over time, and in some people do not recur at all.

Genital herpes in men and women: specific features

Pregnancy is a separate scenario: women with herpes before pregnancy usually give birth to a healthy child vaginally, but a flare-up during labor or a primary infection during pregnancy creates a risk of neonatal herpes. This disease can result in death, although most children recover with treatment; from 32 weeks of pregnancy, prophylaxis is offered to reduce this risk.

How it is diagnosed and why genital herpes is dangerous

The diagnosis is confirmed by a swab: a small cotton swab is used to take fluid from a blister or sore. Testing is not performed in the absence of visible lesions, and it does not show how long a person has been infected or from whom they became infected — symptoms may appear weeks or years after infection.

The infection is more dangerous with weakened immunity (HIV, the period after organ transplantation) and for newborns. Flare-ups are triggered by ultraviolet light on the affected area, friction (sex, tight clothing), smoking, alcohol, malaise, stress, the menstrual cycle, and surgery.

When to see a doctor

If rashes or sores appear in the intimate area, see a doctor as soon as possible — even if there has been no sexual contact for a long time. The doctor will ask about symptoms and partners and take a swab from a rash lesion.

• blisters and sores on the genitals, around the anus, on the buttocks, or thighs;
• tingling, burning, or itching in the intimate area;
• pain during urination together with a rash;
• unusual discharge.

A rash in the intimate area by itself is not a reason to call an ambulance. 103/112 — for life-threatening conditions, for example when a person is in a serious condition and needs urgent help.

This material is for informational purposes and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer