I just had my first genital herpes outbreak. It finally cleared up, but my doctor said that there’s a chance it will come back. Why does this happen?
Even though your symptoms have cleared, the virus did not. Once you are infected it is for life. When you are not experiencing symptoms, the virus lives in the nerves of the area it has infected. Recurring symptoms happen when the virus is “triggered” or reactivated. Sometimes the virus travels a short distance (for example, from the genitals to the buttocks) but always remains within the same nerve region.
Some people feel the virus trying to reactivate by experiencing burning or sharp pains in the affected area. Sometimes these signs happen right before an outbreak, but sometimes they disappear with no further symptoms. This is a sign that your body has successfully prevented the virus from reactivating.
Yes. The virus will not be transmitted through your blood.
Probably not. Although 20-25% of pregnant women have genital herpes, less than .1% of babies contract the virus from their mothers. Most women with genital herpes have normal vaginal deliveries. However, if a woman is experiencing symptoms at the time of delivery, it is recommended that she do a C-section instead of a vaginal delivery.
Please note that a woman who contracts genital herpes in the third trimester of pregnancy are the exception. This can be dangerous for the infant because the mother’s body has not yet developed the proper antibodies to control the virus. A C-section is usually recommended for these women.
If an infant does contract herpes, the symptoms will show 2-3 weeks after birth. Medication can be used to keep the virus from becoming dangerous to the baby.
The greatest risk of contracting herpes for most infants is a kiss from a relative with a cold sore.
Currently, there is no drug that cures genital herpes, only treatments to control symptoms and manage outbreaks. The three antiviral drugs approved by the FDA are acyclovir, famciclovir, and valacyclovir. These drugs are taken orally and can help speed up recovery during an outbreak.
There is also the herbal Gene-Eden-VIR/Novirin. Clinical studies showed that Gene-Eden-VIR/Novirin is safer and more effective than the three leading drugs in the treatment of genital herpes.*†
I don’t have genital herpes, but my new partner just told me that he does. Is there any way I can avoid getting it?
The first rule is to avoid any sexual activity during outbreaks and as long as any signs of the virus remain since the virus is at its most contagious state. Sexual activity includes vaginal, anal, and oral sex. Recurring outbreaks are usually shorter than the original outbreak, and get less frequent as the years go on. You and your partner can research ways to help lessen his chance of future outbreaks.
However, it is important to remember that the virus can still be transmitted in between outbreaks. Having your partner use latex condoms for any genital-to-genital contact will reduce your risk of contracting the virus during this time. Condoms should also be used with any sex toy that the two of you share. Because condoms don’t completely protect from contracting herpes, you can ask your partner if he is currently taking any antiviral treatment. Studies showed that taking such treatment can reduce the risk of transmission. So combining these two methods of protection is more effective than either one method alone.
The most frequent adverse effects reported in the product insert for suppressive, or long term, treatment with the genital herpes drugs are the following: nausea, diarrhea, and headache for acyclovir; headache, nausea, and abdominal pain for valacyclovir; and headache, nausea, and dizziness for famciclovir.
In addition, the medical literature reports non-common side effects for the three drugs. For instance, one study reported that a 78-year-old female with normal baseline kidney function, and no other factors that can damage the kidney, developed irreversible kidney damage after oral treatment with acyclovir. Another study reported that a patient developed kidney failure and mental changes following treatment with high-dose acyclovir. A third study showed that ACV treatment can lead to neurological damage that may lead to confusion, hallucinations, seizures, and obtundation.
Another study analyzed 76,269 patients who received acyclovir or valacyclovir, and 84,646 who received famciclovir. The results showed that 0.27% of the patients who were treated with acyclovir or valacyclovir, and 0.28% of the patients who were treated with famciclovir were hospitalized due to acute kidney injury.
It varies greatly from person-to-person. Some people never get another outbreak, while others experience more than 12 outbreaks per year.
I know that HPV can lead to cervical cancer. Can having genital herpes increase my risk of getting cancer?
No. There was a time when scientists thought that there was a correlation between cervical cancer and herpes, but further research has shown that this is not true.
My older brother has genital herpes and says it’s not a big deal at all. Why do people care so much about getting it?
While it is true that many people live happy, fulfilling lives with genital herpes, there are still many reasons to try and avoid contracting the disease.
Having genital sores increases the risk of contracting HIV, the virus that causes AIDS. This is because the open sores make it easier for HIV to enter the body. In addition, having herpes can aggravate HIV and make the condition worse. In return, having HIV can aggravate genital herpes and cause the symptoms to be worse as well.
Contracting herpes near the end of pregnancy can increase the risk of a woman transmitting the virus to her baby. 30% of women who are infected in their third trimester pass the virus to their babies. Herpes can be a life-threatening disease for infants and can cause long term damage.
Once you contract genital herpes, there is no cure and you are stuck with it for life. Living with this condition often forces you to make inconvenient changes in your life, particularly in your sex life which can be painful and uncomfortable. Outbreaks can be painful and scare away potential partners. It is preferable not to contract the disease.
No. The virus does not travel through the body. If you have a genital infection, you cannot transmit it to her orally.
No. The virus requires skin-to-skin contact to be transmitted. The virus dies once it is away from the infected skin. You also can’t get herpes from a toilet seat, despite what many people will claim.
However, it is never a good idea to share underwear with anyone, as you are at risk of contracting other parasites, like pubic lice.
I had unprotected sex with a stranger a few weeks ago and now I’m worried he might have given me genital herpes. What are the earliest signs?
Most people who experience symptoms will first notice them 1-2 weeks after exposure. The earliest signs include flu-like symptoms, nausea, muscle aches, and for women, vaginal discharge and painful urination. In addition, there might be tingling, burning or itching sensations in the area where blisters will appear. Soon after, most people will find a small cluster of blisters in the infected area.
It depends on your gender. For women, HSV-2 may limit how often you can have sex, which means conceiving may take longer. However, there is no direct link between herpes and a woman’s fertility. Men’s fertility, on the other hand, can be impacted by the HSV virus. Studies showed that even inactive viruses in the body can lead to lower sperm count and impaired reproductive functions.
Yes. Research showed that alcohol can weaken the immune system, which in turn, leaves your body vulnerable to an attack from the HSV virus. The stronger your immune system is, the better it can defend you against viruses like HSV.
Although pimples and herpes sores can look similar, it is usually possible to tell the difference. Pimples can hurt when you touch them, but a sore might also tingle, burn, or itch. Pimples often have a single whitehead or blackhead, herpes sores are usually a cluster of small blisters. Pimples can be filled with white pus, while herpes sores generally contain clear liquid.
If none of these help, you can simply wait and see what happens. Herpes occurs in cycles, with sores returning to the same area of the lower lip, while pimples often occur anywhere on the face.
I had a full STI check before my girlfriend and I started having sex. Now, she’s claiming that I gave her herpes. How can this be possible?
It’s very possible because STI checks won’t detect herpes. The most common way to test for herpes is through swabs taken from active sores while the infected person is experiencing symptoms.
I have oral herpes, can I infect my own genitals if I touch my mouth and then my penis without washing my hands?
Incredibly unlikely. If you have the virus in one part of your body, your immune system has probably already developed antibodies to protect other parts of the body. This does not mean, however, that you cannot catch genital herpes from someone else.
Although laser therapy does not cure herpes, it can help heal sores faster. It has also been shown to help increase the time between breakouts, by up to 17 months according to one study.
Yes. Herpes is the most common cause of viral encephalitis, which means swelling in the brain. This swelling occurs when the virus travels to the brain, instead of causing outbreaks in the skin. This brain swelling can cause seizures, mental changes, comas, and even death. If you have any of the symptoms of encephalitis, you should contact your doctor. The symptoms include high fever, confusion, personality changes, lethargy, and weakness in an area of the body, confusion, and seizures.
Is it true that having herpes means that I am more likely to develop Alzheimer's in the future? What if I had herpes once but never have outbreaks anymore?
Possibly. Although the connection is still being researched, studies are showing that the presence of HSV can increase the likelihood of developing dementia-inducing diseases like Alzheimer’s by up to 50%. Once you contract herpes, you have it for life. Even if the virus is inactive, or your immune system is successful in repressing it, it still remains in your body. A change in the body, like the weakening of the immune system that comes with old age, can reactivate the virus. Once reactivated, the virus can travel to the brain and cause damage.
Yes. Studies show that being circumcised can reduce the risk of contracting HSV by 30%.
I get bouts of depression occasionally and have found that almost every time I get depressed I also get a herpes outbreak. Can depression actually cause herpes outbreaks?
Yes. Studies show that depression can damage the immune system, which can leave an individual more vulnerable to a herpes attack. Boosting your immune system during times of depression (or just in general) can go a long way to increase the time between herpes outbreaks.
Yes. When the HSV virus occurs in the eye, it can cause scarring on the cornea which can result in blindness. A herpes infection in the eye is known as keratitis.You should see a doctor if you experience eye pain accompanied by a loss of vision, painful eye movement, loss of eye movement, or a severe headache.
No. If you have herpes and are wondering where you contracted it from, the answer is most likely not your tattoo parlor. However, unclean needles can transmit serious diseases like HIV and Hepatitis B and C, so it is always important to make sure your tattoo artist follows all sanitary guidelines.
I heard someone mention that certain birth controls can make herpes outbreaks worse. Is this true? I have genital herpes, are there any contraceptives that are safe to use?
Most likely, your friend was referring to the hormone progesterone. Progesterone is a female hormone which appears, in synthetic form, in many forms of female birth control. It also makes up an injectable form of birth control called Depo-Provera, which is essentially a shot of progesterone. Taken 4 times a year, this injection has proven to be very effective at preventing pregnancy. However, evidence exists that consistent use of the hormone might increase a woman’s risk of contracting genital herpes.
A 2015 study examined Ugandan women in stable, heterosexual relationships. It found that the consistent use of Depo-Provera may lead to an increased risk of contracting HSV-2. A more recent 2016 study of sex workers in Vancouver showed that exposure the Depo-Provera injection was associated with a four times higher risk of being infected with HSV-2.
Why does synthetic progesterone cause women to be more susceptible to contracting the HSV-2 virus? Can this make women who are already infected with the virus more vulnerable to flare-ups?
We found an animal study which showed that female mice in heat have a natural protection against the HSV virus. This is because a thick lining in the vagina forms a protective barrier during this time. However, the use of progesterone in these mice have been shown to make this lining thinner, and more penetrable by the virus.
Other data has indicated that hormone therapy (like the administration of progesterone) can affect the immune system. This is based on evidence that the level of certain antibodies become significantly lower after a Depo-Provera treatment. These antibodies might be important in the protecting against HSV-2. When the immune system is weak, people are more vulnerable to infection and outbreaks.
 Mary K Grabowski, Ronald H Gray, Fred Makumbi, Joseph Kagaayi, Andrew D Redd, Godfrey Kigozi, Steven J Reynolds, Fred Nalugoda, Tom Lutalo, Maria J Wawer, David Serwadda, Thomas C Quinn, Aaron A R Tobian.Use of injectable hormonal contraception and women’s risk of herpes simplex virus type 2 acquisition: a prospective study of couples in Rakai, Uganda.Lancet Glob Health 2015; 3: e478–86.
M Eugenia Socías,1,2 Putu Duff,1 Jean Shoveller,1,3 Julio S G Montaner,1,2
Paul Nguyen,1 Gina Ogilvie,3 Kate Shannon.Use of injectable hormonal contraception and HSV-2 acquisition in a cohort of female sex workers in Vancouver, Canada. STI Online First, published on November 7, 2016 as 10.1136/sextrans-2016-052838
Gallichan WS1, Rosenthal KL.Effects of the estrous cycle on local humoral immune responses and protection of intranasally immunized female mice against herpes simplex virus type 2 infection in the genital tract.Virology. 1996 Oct 15;224(2):487-97.
Charu Kaushic, Ali A. Ashkar, Lesley A. Reid, and Kenneth L. Rosenthal.Progesterone Increases Susceptibility and Decreases Immune Responses to Genital Herpes Infection.J Virol. 2003 Apr; 77(8): 4558–4565. doi: 10.1128/JVI.77.8.4558-4565.2003.
I just got through my first outbreak, and it was pretty horrible. I know any recurrences probably won’t be as bad, but I was wondering how often people with genital herpes experience new outbreaks? How long do they last?
It depends on a few factors. The first factor is your immune system. If your immune system can successfully fight the virus, you won’t experience outbreaks. Symptoms occur when there is a weakness in the immune system. Eating a balanced diet, getting enough sleep, and reducing stress all keep your immune system strong. Some people find that taking measures to boost the immune system helps reduce the frequency of breakouts. These measures include special diets, supplements, and stress reduction techniques. People with compromised immune systems, like children, burn victims, or HIV patients tend to experience more frequent, more severe recurrences.
The number of outbreaks also depend on the amount of time the virus has been in your body.
HSV 1: Most people with HSV-1 were infected as children, so their body has had a long time to build up defenses (called antibodies) against the virus. Therefore, most adults with the virus experience infrequent, mild outbreaks.
HSV 2: Because most people become infected as teenagers/adults their body has not had time to build up defenses (called antibodies) against the virus. This means that in the beginning, breakouts can be severe and frequent. However, once the body gets used to fighting the virus, outbreaks will be less painful and further apart. In fact, some people never experience a breakout after the initial one. Others rarely experience breakouts except when triggered by stress, a poor diet, lack of sleep, or menstruation (all things which are said to weaken the immune system).
The next factor is the type of virus that you’re infected with, and where that infection is located. HSV-1 usually affects places above the waist, typically the mouth. However, the CDC (U.S. Centers for Disease Control) have stated that as many as 50% of first-episode cases of genital herpes are now caused by HSV-1. When HSV-1 affects areas below the waist, like the genitals, you can expect a weaker infection, and many fewer recurrent outbreaks. The same is true of HSV-2 in the mouth. In fact, a SOURCE study showed that HSV-2 in the genitals causes physical symptoms 10 times more than HSV-2 in the mouth.
Ok, now I understand how recurrences work, overall. But, how many recurrences do people get on average?
After the first year of infection, people with oral HSV-1 or genital HSV-2 experience 4-5 outbreaks a year (on average). If a person experiences an outbreak more than 5 times a year, his herpes is considered chronic. The symptoms of these outbreaks usually last about half the amount of time that the original outbreak lasted. Those with genital HSV-1 experience an average of 1 outbreak per year. Those who have experienced an oral infection of HSV-2, very rarely experience a recurrence.
A recurrence can occur months or even years after the primary breakout, and is usually triggered by a weakness in the immune system. This weakness can be caused by stress, a poor diet, lack of sleep, surgery, hormonal changes, a disease, or certain medications.
Stage 1: Inflammation. Also called viral shedding, the infected area can swell, burn, or become tender, red, or itchy. Sometimes the outbreak is successfully stopped by the body at this stage, and no blisters appear. However, you are still contagious at this stage, even if are no blisters.
Swelling, tenderness, burning and redness may appear before the actual outbreak, and may include itching and sensitivity. For some people, the inflammation may not progress past this stage, or form into blisters.
Stage 2: Blisters
At this stage one or several liquid filled blisters/bumps may form. In genital herpes a rash resembling small paper cuts may form around the anus. This is the most contagious stage of the disease, because the liquid in the blisters contain high concentrations of the virus.
Stage 3: Ulcers
Ulcers form when the surface skin of the blister breaks. The ulcer is usually small, round, and wet looking. It may leak a cloudy fluid.
Stage 4: Crusts and Ulcers
Within a few days, the blisters usually begin the healing phase. Blisters on the skin, like around the lips and groin, will generally crust over and form scabs. Sores on mucous membranes, like the inside of the mouth or vagina, don’t usually crust over. Instead, they form ulcers, or shallow craters in the skin. Both crusts and ulcers can be itchy and/or painful. You may still be contagious at this point.
Stage 5: Healing
During a primary outbreak, it may take as long as six weeks to get to this stage. In recurrent outbreaks, this stage might begin within a week of the beginning of the flare-up. At this point, new skin forms. The virus has left the surface of the skin, so it becomes safe to touch the area. There shouldn’t be any scar after the sore heals. If there is a remaining mark, you can try dabbing some Aloe Vera or vitamin E to repair the skin.
Some people find that the friction of sex can cause flare ups. Using proper lubricant, and having less vigorous sex, can help keep sexual intercourse from triggering an outbreaks.
Not much longer! Most primary outbreaks can last anywhere between 3-6 weeks. You’ve most likely gotten through the worst of it, as any outbreaks after this will probably be much shorter and less painful.
During an active outbreak (when a sore is present) the rate is very high. However, when a person is not experiencing an outbreak the rate of transmission is 4-10%, depending on several factors.
According to some studies done by the manufacturer of the antiviral drug Valtrex, the rates of transmission per year of regular sex are as follows.
Partners who completely avoid sex during breakouts: 8% risk of a female contracting it from a male, 4% risk of a male contracting it from a female.
If partners avoid sex during outbreaks and also use condoms OR take daily antiviral medication: 4% risk of a female contracting it from a male, 2% risk of a male contracting it from a female.
If partners use condoms AND antivirals: 2% male to female risk, 1% female to male risk.
There are several options for testing. If you suspect you have herpes, it is important to get tested because health care providers misdiagnose skin lesions as herpes in about 20% of the time. So if you have a skin lesion or ulcer, it’s recommended to insist on a lab test along with a clinical examination.
There are a few ways to diagnose herpes. The first is a viral culture. In a viral culture, cells or fluid from a fresh sore are collected and examined. The sample should be taken early, preferably within the first 3 days from the time the blister appeared. This is because the results are most accurate when the lesion is in the clear, blister stage. However, this type of test is known to deliver false negative results (that is, it fails to find the virus even when it is present). A study showed that 76% of viral culture tests came back negative when the PCR (see below) test indicated the presence of herpes.If you test positive for herpes with this test, it is very likely that you have the virus. If you test negative, yet experience herpes-like symptoms, it is still possible that you have the virus. An alternative to the viral culture is an antigen detection test. This test also examines cell samples. An antigen is any foreign substance in the body. The test looks for signs of herpes antigen in cells collected from an individual.
Another possible test is called the Polymerase Chain Reaction (PCR) test. This test detects the presence of DNA material from the HSV virus. It can tell the difference between HSV-1 and 2, and it is done on certain bodily fluids. This test is not usually used to diagnose skin sores, but rather to examine spinal fluid to determine the presence of a herpes infection in and around the brain. It is up to 4 times more sensitive than the viral culture, and recommended for babies and those who are not getting a clear result from antibody tests.
Tzank smears, also called the Tzanck preparations, are used for a quick and initial diagnosis. Your doctor might recommend it while you are waiting for the results of a PCR test. When read by an experienced lab person, the Tzanck test is useful. However, it picks up only about 30% of herpes cases. So testing negative does not mean you do not have the virus. The Tzanck test is known to display false positive results as well, because the presence of other forms of herpes that remain in the body (like chicken pox) are also detected by the test.
Antibody tests can tell if your body has encountered the HSV virus. These tests are also called serologic tests. They are best done 12-14 days after contracting the virus. The test examines the blood for specific antibodies produced to combat the virus. The test cannot tell the difference between a current herpes infection, and a herpes infection that has occurred in the past. They also cannot usually tell the cause of a specific sore or ulcer. In addition, if you have been recently infected with HSV, you may not test positive for the virus. This is because it takes the body time to develop the HSV antibodies that appear in the blood. In addition, taking antivirals like acyclovir, famciclovir, ganciclovir, or valacyclovir can make it more difficult to detect HSV through a blood test.
Ok, one more question on testing: is it important to know which strain of herpes I have? Why or why not?
Determining the strain can help your doctor predict how long your outbreaks will last and how often they will occur. In addition, it may help him prescribe more effective treatment.
Yes. The following conditions are often mistaken for genital herpes: Yeast infections, genital warts, shingles, molluscum, scabies, syphilis, and certain cancers. Occasionally, genital herpes may not produce skin lesions. In this case, it can be confused with a urinary tract infection, or cystitis.
You’re right, we do have less state-by-state statistics on herpes. Certain STD’s are classified as “notifiable” in the U.S. A notifiable disease means that healthcare providers in all 50 states are required to file a report every time it’s diagnosed. Herpes is not considered “notifiable,” so the only population data that exists is derived from national surveys.
Ok, interesting. But why is herpes not considered notifiable?
The Council of State and Territorial Epidemiologists works with the CDC to determine if a disease should be considered notifiable. The decision is based on the following public health considerations.
- Is the disease treatable?
- Is the disease preventable?
- How common is the disease?
- Does the disease require a public health response?
- Is there a good source of information on how common the disease is?
- Does the disease represent a public health threat?
Based on these factors, and the fact that national surveys are able to get herpes statistics, herpes was not categorized as a notifiable disease.
Yes, if they are herpes sores. Many women experience pain and sores during breastfeeding, which are not usually associated with HSV. However, sometimes herpes outbreaks do occur on the nipple, so it is important to rule this out before continuing breastfeed. Herpes can be a life-threatening condition in newborns, so it is important to avoid transmitting the virus to your infant.
Yes. When you share saliva or other bodily fluids with other people, you increase your risk of acquiring the virus.
What about waxing?
Yes. You can contract HSV-1 if your technician is infected. To minimize your risk, make sure your technician wears gloves.
Yes. In most states, someone with an STD can be sued for engaging in sexual activity without informing his partner of his condition. In some states, you can also be sued even if you don’t transmit the infection! In August of 2017, singer Usher paid a woman $1.1 million after she sued him for giving her herpes.
 Public Health Law Research, Temple University.State Statutes Explicitly Related to Sexually Transmitted Diseases in the United States, 2013. www.cdc.gov/std/program/final-std-statutesall-states-5june-2014.pdf.
Meningitis is a swelling of the brain which can lead to memory problems, hearing loss, loss of limbs, vision loss, seizures, coordination problems, etc. This inflammation can be caused by the HSV virus, among other things.
I have been having a tingling sensation in my genital area. My doctor said this could be prodrome. What is prodrome?
Prodrome is the early phase of an outbreak. During this phase you may experience an itching, tingling or painful feeling in the area where you get lesions. Other possible symptoms include numbness, aches, or other sensations in the lower back, buttocks, or thighs. You can think of prodrome like warning symptoms that generally come a day or two before your lesions appear. During this time you should assume that the virus is active and avoid direct skin-to-skin contact. The risk of transmission of the virus during this period is high. 
 Beauman JG. Genital herpes: a review. Am Fam Physician. 2005 Oct 15;72(8):1527-34.
I have just recently started my period and now I have a herpes outbreak. I feel like I have more outbreaks when I have my period. Is this true?
Many women say that they have a tendency to be more susceptible to outbreaks around their periods. A study of 104 student nurses looked at the frequency of recurrent herpes within the menstrual cycle. The results showed that eight days before the onset of menstruation there were more episodes of herpes lesions.   
 Segal AL, Katcher AH, Brightman VJ, Miller MF. Recurrent herpes labialis, recurrent aphthous ulcers, and the menstrual cycle. J Dent Res. 1974 Jul-Aug;53(4):797-803.
During the initial stages of a herpes outbreak, you may experience a tingling, itchy or burning feeling. As the outbreak progresses the feeling of itchiness tends to lessen and the blisters tend to become painful.  
 Jaishankar D, Shukla D. Genital Herpes: Insights into Sexually Transmitted Infectious Disease. Microb Cell. 2016 Jun 27;3(9):438-450.
Genital herpes sores can come out on your anus. This is more likely to happen if the virus is transmitted during anal sex. The symptoms of anal herpes tend to be red bumps or blisters around your anus. Other symptoms include pain, discharge and constipation.  
 Jacobs E. Anal infections caused by herpes simplex virus. Dis Colon Rectum. 1976 Mar;19(2):151-7.
 Goulart A, Pinto J, Leão P. Anal herpes. BMJ Case Rep. 2017 Jun 29;2017. pii: bcr-2017-220856.
You may have a herpes outbreak that consists of a single sore. Genital herpes outbreaks can differ greatly in severity. You may have many painful blisters, or you may experience just a single sore. Sometimes your symptoms may be so mild that they go unnoticed. 
Herpes and HIV are caused by different viruses. However, if you have herpes, you are more likely to get HIV. The herpes sores provide a place for the HIV virus to enter the body. If you have HIV and get genital herpes, the herpes infection is probably going to be more severe. 
 Mary Jo Groves, Genital Herpes: A Review, American Family Physician June 1, 2016 Volume 93, Number 11.
Shingles is also known as herpes zoster. It is caused by a virus (varicella zoster virus (VZV)) that also causes chickenpox in early life. Like herpes, the varicella zoster virus can become latent (hidden) in the sensory nerve roots. The virus can reappear later in life, after a period of latency. Shingles is typically characterized by the appearance of vesicles and blister lesions. It is a painful skin rash and most common among older adults and people who have a weak immune system. Shingles is not a sexually transmitted infection. 
 Nair PA, Bhimji SS. Herpes, Zoster (Shingles). SourceStatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017-.2017 Jun 26.
If you have HSV-1, you are susceptible to becoming infected with HSV-2; the common cause of genital herpes. If you have cold sores, you are still able to contract genital herpes from HSV-2. 
Herpes can be mistaken for hemorrhoids,  anal fissures, an allergic reaction, heat rash, a yeast infection, ingrown hair follicles, or the like. Anal herpes, like hemorrhoids, can cause a knife-like pain during and directly after bowel movement. Anal herpes can also cause bleeding and blood can appear on the toilet paper or on the stool. Herpes that appear around the anus often forms a small crack or fissure. The real way to differentiate anal herpes from hemorrhoids is that anal herpes is an infection, and as such is often accompanied by symptoms such as swollen lymph nodes, fever, headache, muscle ache, burning sensation in the infected area, and lower back pain. Before an outbreak of herpes, the infected area will probably itch, burn or tingle.  
 Dinesh Jaishankar and Deepak Shukla Genital Herpes: Insights into Sexually Transmitted Infectious Disease. Microb Cell. 2016 Sep 5; 3(9): 438–450. Published online 2016 Jun 27.
Psoriasis is an inherited autoimmune disease. Herpes is a sexually transmitted virus. Psoriasis can be mild or severe. Psoriasis causes higher than normal cell replication in the skin. This causes cells to collect on the skin’s surface. The cells then create areas of thickening and irritation. Psoriasis can form on the genitals; and most commonly on the folds of the skin. This kind of psoriasis is called inverse psoriasis. It may look like smooth, dry red lesions. 
Because of the way the neural pathways are created, herpes outbreaks can appear in different places. They will, however, remain in the same general area. The sores may migrate a few inches in the genital area, or can show up on the upper thigh or buttocks. 
 Dinesh Jaishankar and Deepak Shukla. Genital Herpes: Insights into Sexually Transmitted Infectious Disease. Microb Cell. 2016 Sep 5; 3(9): 438–450.
A heat rash forms when your sweat ducts are clogged and the sweat gets trapped underneath the skin. The result is a rash on your skin. You can generally treat a heat rash at home. A heat rash can be mild or more severe. Mild heat rash symptoms include redness and small fluid filled blisters. More severe symptoms may include pus filled blisters, and firm lesions on the skin’s surface. The herpes virus is contagious and is considered a sexually transmitted disease. The symptoms of genital herpes include blisters, burning with urination, itching and swelling.
I am going through my first outbreak. Will the pain during urination also happen during future outbreaks?
It is common for women with herpes to experience pain when urinating. The first outbreak is usually the most severe, however, pain during urination can occur in subsequent outbreaks. If you experience burning during urination, you should try to drink plenty of fluids to dilute the urine. It can help reduce the pain and stinging.
It is common for woman to have outbreaks that can be triggered by menstruation. The location of your outbreak should determine whether you chose to use tampons or pads. You should try to avoid contact with the symptoms of your outbreak so as not to further spread the infection. Pads are generally preferable, but it is okay to use tampons as long as the outbreak doesn’t come in contact with the tampon when being inserted. I f the lesions are located internally, it is typically not recommended to use tampons.
I have recently had an herpes outbreak. During the outbreak, I felt itchy and noticed a discharge. Is it possible to have a yeast infection during an outbreak?
Yes, it is possible to have a secondary yeast infection during a herpes outbreak. Having herpes can sometimes make you more prone to bacterial or yeast infections, which can cause a discharge. Medications and natural therapies are available to help secondary infections such as thrush, yeast, or candida. You should consult with your doctor to know exactly what you are treating, and what the best treatment is. 
I have been experiencing abdominal cramps and pain. Is it possible to have internal herpes outbreaks?
Yes. Some women experience internal lesions, which can be hard to detect. Some things you can look for if you have genital herpes, and suspect you have internal outbreaks, are: watery, white or off-colored discharge; irritation during intercourse; a burning sensation when you urinate; and a burning sensation inside the cervix. If you think you may have internal lesions, you should visit your doctor. 
Is it possible to get herpes without having sexual intercourse? Can you get herpes even if you have never had sex with someone?
Herpes can be transmitted through sexual intimacy, or through contact with someone who is actively shedding the herpes virus. Viral shedding is contagious. T he virus can be actively shedding itself at the site of infection without displaying any visible signs or symptoms. This is called “Asymptomatic Viral Shedding.” If you have oral herpes, the shedding can take place through the mouth, or a cold sore. T his means that you can get herpes through kissing or sharing a drink. Genital herpes can be transmitted while sharing sex toys, or participating in grinding. It can be transmitted from one individual to another through skin-to-skin or mucosal contact. Mucosal refers to tissues that produce mucus, such as the digestive and genital tracts.  
 Elizabeth Tronstein, et. al. Genital Shedding of Herpes Simplex Virus Among Symptomatic and Asymptomatic Persons with HSV-2 Infection. JAMA. 2011 Apr 13; 305(14): 1441–1449
Herpes can be transmitted through sexual intimacy, or through contact with someone who is actively shedding the herpes virus. Viral shedding is contagious. T he virus can be actively shedding itself at the site of infection without displaying any visible signs or symptoms. This is called “Asymptomatic Viral Shedding.”
 Elizabeth Tronstein, et. al. Genital Shedding of Herpes Simplex Virus Among Symptomatic and Asymptomatic Persons with HSV-2 Infection. JAMA. 2011 Apr 13; 305(14): 1441–1449.
Generally, the first outbreak is the worst. Over time, if you have recurrent outbreaks, you may find that the symptoms become more minor, or you may not even have symptoms. However, everyone reacts differently to the herpes virus. Some people may never have an outbreak, where others may frequent outbreaks.  
 Dinesh Jaishankar and Deepak Shukla Genital Herpes: Insights into Sexually Transmitted Infectious Disease. Microb Cell. 2016 Sep 5; 3(9): 438–450.
I recently became pregnant, and I feel like I am experiencing more frequent herpes outbreaks. Is this possible?
Yes, this is possible. During pregnancy your immune system is compromised, so that your body doesn’t fight the fetus as a foreign invader. When your immune system is weakened you are more likely to have herpes outbreaks. It is important to tell your doctor about your pregnancy. 
 Rajul Patel, et. al. 2017 European guidelines for the management of genital herpes. First Published August 24, 2017
 Christelle Bourgeois. et. al. Estradiol impairs the Th17 immune response against Candida albicans. Journal of leukocyte biology. September 2011
Yes, you can still get infected. Herpes sores can spread beyond the area covered by the condom, which means herpes can still be transmitted even when a condom is worn. 
Martin ET Krantz E, Gottlieb SL, Magaret AS, Langenberg A, Stanberry L, Kamb M, Wald A. A pooled analysis of the effect of condoms in preventing HSV-2 acquisition. Arch Intern Med. 2010 Jun 14;170(11):929.
Balanitis is a condition that causes the swelling of the foreskin, or head of the penis. Balanitis affects approximately 1 in 20 males, and usually occurs in uncircumcised men. Although it can be painful, it generally is not serious, and can usually be relieved with topical medication. Whereas herpes is caused by a viral infection, balanitis is often caused by an overgrowth of bacteria or yeast.