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Learn How to Live With and Manage Genital Herpes

What are the keys to keeping yourself safe from the STI or managing it if you do contract it?

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Illustration by Brandon Cornwell

Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus—HSV-1 or HSV-2—and spread by skin-to-skin contact. It can create lesions on the skin around the genital area that can flare up in people who carry the infection.

Genital symptoms can include red or white bumps, itching, pain, sores or blisters, small scabs and painful urination. However, herpes can show no symptoms at all, so some carriers aren't aware they have it. The virus can be diagnosed using a swab of an active sore or a blood test.

Genital herpes is not curable but is treatable. It has been found to be less contagious when it has been in the body for a long time, but keeping yourself and others informed about the herpes virus is still important because herpes can be contagious even when someone is asymptomatic.

Genital herpes and reproductive health

It may be possible for genital herpes to harm your reproductive health. A Taiwanese nationwide population-based study found a possible relationship between herpes and erectile dysfunction (ED), but more research is needed.

However, unlike sexually transmitted infections such as chlamydia and trichomoniasis, herpes does not affect fertility.

"Genital herpes can affect pregnancies, as pregnant women fall into an immunocompromised group," said Jane Leonard, M.B.Ch.B., a general practitioner and cosmetic doctor with clinics in London.

This means pregnant women are more susceptible to catching herpes and at a greater risk of a flare-up or becoming symptomatic when the virus has previously been dormant, she explained.

There is a small risk of transmitting herpes to a newborn. It won't happen during pregnancy, but it can happen during delivery if you have an active infection at that time, according to Peter Leone, M.D., a professor of medicine in the division of infectious diseases at the University of North Carolina School of Medicine in Chapel Hill.

Leone outlined these ways to significantly reduce the risk of transmission during labor and delivery:

Ensure your obstetrician or midwife knows you have genital herpes.
Let your provider know if you have any signs of an outbreak, such as itching, tingling or pain during labor.
If you do have an active outbreak at this time, a C-section may be the safest course of action.
Ask your provider not to use a fetal scalp monitor (scalp electrodes), a vacuum cup (ventouse) or forceps during delivery, or break the bag of water (amniotic sac) around the baby unless medically necessary.

"These instruments may allow herpes virus to enter, and the bag of water may help protect the baby against any virus in the birth canal," Leone explained.

According to research, neonatal herpes infection affects 1 in 1,700 to 1 in 8,200 newborns during birth in the United States.

Though nonspecific, some signs and symptoms that a newborn has been exposed to the herpes virus include the following:

Irritability
Sores or blisters on the body
Grunting or rapid breathing
Periods of no breathing or turning blue
Jaundice
Bleeding easily

A neonatal team can administer immediate antiviral treatment to an infant who is exposed to the virus and shows these symptoms.

Living with genital herpes

One of the main problems associated with living with genital herpes is the stigma surrounding it, despite its prevalence.

According to statistics from the World Health Organization (WHO), about 3.7 billion people younger than age 50 have an HSV-1 infection. More than 490 million 15- to 49-year-olds worldwide have HSV-2.

Only 10 percent to 20 percent of people with HSV-2 develop genital herpes.

"Many people struggle with shame, guilt and vulnerability, but remember that a herpes diagnosis does not define one's worth," said Lisa Lawless, Ph.D., a psychotherapist and the CEO of Holistic Wisdom in Bend, Oregon. "You may also wish to seek out the support of trusted friends and family, seek therapy or join a support group in person or online."

If you need to manage your herpes outbreaks, your doctor can prescribe an antiviral medication such as valacyclovir or acyclovir and come up with a care plan to follow.

Dating while living with genital herpes

Avoid sex when herpes lesions are active since you are more likely to spread the virus during this time. Even when they're not present, you still need to inform your partner of your STI status.

"When a person with herpes is not having an active outbreak, they can still shed viral particles that can transmit the virus to others," said Emily Rymland, D.N.P., F.N.P.-C., a certified HIV specialist in Tahoe City, California, who works for telehealth provider Nurx.

"Discussing STD testing can feel intimidating, but expressing it as a mutual concern for each other's well-being can create a shared sense of responsibility for protecting one another," Lawless said.

She recommended taking the following steps to make the conversation easier:

Discuss STD/STI status before any possible exposure.
Provide the partner with factual information about herpes.
Review how herpes can be managed and prevented.
Approach the conversation with a positive and understanding attitude.
Reassure your partner that a herpes diagnosis does not have to be a barrier to intimacy.
The key to healthy communication is to remain open, honest and empathetic.
Creating a safe space for an open exchange can help reduce the tension of such a conversation.

Managing and preventing herpes

If you are symptomatic or have been in contact with someone with an active infection, you can get tested for herpes, but it isn't always recommended since the virus is prevalent around the world and doesn't always cause problems to the carrier. Additionally, if a person gets a blood test too soon after an infection, the result could be wrong.

Herpes symptoms can be similar to those of other STIs, so get tested for other common infections at the same time if you show any signs. If you are not sure, speak to your provider or someone at a sexual health clinic who will be able to advise you.

Leone recommended the following ways to prevent and manage herpes:

Know your status and your partner's status (blood tests for herpes are available).
Avoid sex during outbreaks.
Use condoms or other barrier techniques, such as a dental dam for oral sex.
Take daily oral therapy with antiviral medication, such as valacyclovir, if you are infected.

It is important to know that condoms are not 100 percent effective at preventing STIs. This is especially true for herpes, which can be transmitted by bodily skin contact. A full understanding of this misunderstood virus is useful for anyone who is sexually active in order to protect themselves and others.

Resources for patients and caregivers

The following organizations are available as resources for people who want or need to learn more about the herpes virus:

Don't allow shame or fear of unwarranted stigma to keep you from protecting yourself and others if you suspect you've been exposed to or might have HSV-1 or HSV-2. Medical management and a couple of lifestyle modifications allow people with genital herpes to live their life as usual, knowing they'll need to make adjustments during outbreaks.