You get herpes through skin-to-skin contact with a spot where the virus is present at that moment. That can happen during sex, but also through kissing or oral sex. Here is the sting: the virus is regularly present without anyone seeing a blister.
That is the sentence I would happily pin above every forum where people blame each other. Herpes does not spread through carelessness. It spreads through invisibility.
Below we walk through the routes, including the ones you do not need to worry about. For the complete picture, read our overview of genital herpes.
How is herpes transmitted?
Through direct contact between skin or mucous membrane and a spot where the virus is active. For genital herpes that usually means vaginal, anal or oral sex. The virus does not need a cut: contact with mucous membranes or thin skin is enough for it to cross.
The table below lists the routes, including the ones people wrongly fear.
| Route | Can herpes pass this way? |
|---|---|
| Vaginal or anal sex | Yes, also without visible blisters |
| Oral sex with a cold sore | Yes, HSV-1 can land genitally |
| Kissing | Yes, for HSV-1 around the mouth |
| Skin-to-skin contact without penetration | Yes, if the virus is on that spot |
| Toilet seat, towel or swimming pool | No, not in practice |
| Sharing a glass or cutlery | No |
Those last two rows save a lot of people a sleepless night. The virus survives poorly outside the body. More on that kind of misunderstanding is in can you get an STI from oral sex, a toilet seat or a towel.
Can you get herpes when nobody has blisters?
Yes, and that is the rule rather than the exception. The virus surfaces on the skin now and then without anything becoming visible. This is called asymptomatic shedding. Someone can pass the virus on during a day they feel completely healthy.
How often that happens has been measured precisely. In people with HSV-2 and no symptoms the virus was found on 10.2 percent of days, and in people with symptoms on 20.1 percent of days (Tronstein et al., 2011).
Work that through. Roughly 1 day in 10 for someone with no complaints at all.
Why do so many people not know they have it?
Because a first infection usually causes no recognisable symptoms. No blisters, no pain, nothing that would make you think of an STI. Without symptoms there is no reason to test, and without a test it stays unnoticed.
The figures are clear: 74 percent of first HSV-1 infections and 63 percent of first HSV-2 infections ran without recognised symptoms (Bernstein et al., 2013). RIVM and Dutch STI practice account for this by not screening for herpes routinely.
Which type you have matters here, and we explain that in cold sore or genital herpes.
How well does a condom protect against herpes?
A condom lowers the risk, but does not remove it. The virus can also sit on skin the condom does not cover, such as the groin, the pubic area or around the anus. That is why a condom works less absolutely for herpes than for chlamydia or gonorrhoea.
Picture two partners using condoms consistently for 6 months, and one of them still gets infected. That does not mean anyone cheated. It means the virus sat outside the covered zone.
What does help is a combination: condoms, no sex during an outbreak, and with a steady partner sometimes daily antiviral medication. In a study of couples, 1.9 percent of partners caught HSV-2 when the carrier took daily valacyclovir, against 3.6 percent on placebo (Corey et al., 2004). Your GP decides whether that fits you.
When is the risk of transmission highest?
During an outbreak, and in the days around it. The virus is most active and most detectable then. Many people feel it coming as tingling or burning at the familiar spot, before anything is visible. That is a good moment to postpone sex.
Outside that period a lower but real risk remains. It never reaches zero. Naming that honestly works better than pretending the virus stays neatly inside the blisters.
How quickly you notice anything after infection is in herpes incubation period.
What is your next step?
Have a blister or sore right now? Get a PCR swab at your GP or a Centre for Sexual Health. Thuisarts.nl explains what to expect at such an appointment.
Want to know without symptoms whether you carry HSV-1 or HSV-2, for instance because your partner has herpes? Then you can add HSV-1 IgG and HSV-2 IgG separately to your own test with us. Which test answers which question is in herpes test.
Sources
- Tronstein E, Johnston C, Huang ML, et al. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection. JAMA. 2011;305(14):1441-1449. PMID 21486977.
- Corey L, Wald A, Patel R, et al. Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med. 2004;350(1):11-20. PMID 14702423.
- Bernstein DI, Bellamy AR, Hook EW, et al. Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women. Clin Infect Dis. 2013;56(3):344-351. PMID 23087395.
- RIVM. STI guidelines and sexual health surveillance. Available via rivm.nl.
- Thuisarts.nl (NHG). I have genital herpes. Available via thuisarts.nl.
This information is general and does not replace personal medical advice. Every STI test result at Discreet Test is reviewed by a BIG-registered doctor. Always discuss symptoms or treatment decisions with your GP, the GGD or a Centre for Sexual Health.
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