Genital herpes: symptoms, testing and what your result means

Genital herpes is a viral infection that stays mild for most people, and that many never notice at all. About 67 percent of everyone under 50 carries HSV-1, the virus that also causes cold sores. A test can give you clarity, but only if you pick the right test.

I notice that most questions we get at Discreet Test are not about the virus. They are about the test. Fair enough, because the wrong test answers a question you never asked.

This page puts the whole topic in order: what genital herpes is, which symptoms fit, how testing works, and what your result really means. Calmly, without judgement, and with honest limits on what a test can do.

What exactly is genital herpes?

Genital herpes is an infection of the skin and mucous membranes around the genitals or anus, caused by the herpes simplex virus. There are two types: HSV-1 and HSV-2. After a first infection the virus withdraws into a nerve root, where it stays for life. Sometimes it becomes active again.

The old idea was simple: type 1 belongs on the lip, type 2 on the genitals. That split no longer holds. In 2012 an estimated 3.7 billion people under 50 carried HSV-1 worldwide, and around 140 million of them carried it genitally (Looker et al., 2015).

That difference between the two types decides how you read a result. We work it out separately in cold sore or genital herpes.

Which symptoms fit genital herpes?

The classic picture is small blisters that burst and leave painful sores, often with a burning feeling when you urinate. A first outbreak sometimes adds flu-like symptoms and swollen lymph nodes in the groin. Many people, though, never get symptoms they recognise as herpes.

That last point is not a footnote. In a study of more than 3,400 young women, 74 percent of first HSV-1 infections and 63 percent of first HSV-2 infections happened without recognised symptoms (Bernstein et al., 2013).

In other words: having no symptoms tells you little.

Seeing a bump or blister right now and unsure what it is? Our page on bumps or blisters on your genitals helps you narrow the options. For the wider picture, read STI symptoms in men and women.

How is genital herpes tested?

There are two routes. If you have a blister or sore right now, a PCR test on a swab from that spot is the reference test. If you have no visible symptoms, only a blood test measuring antibodies remains: HSV-1 IgG and HSV-2 IgG. Those two tests answer different questions.

PCR on an active lesion detects clearly more than the older culture, which is why it is the test of choice when something is visible (LeGoff et al., 2014). A blood test says nothing about that. It only tells you whether you ever made antibodies.

This table is the thing I wish I had been handed when I first started reading about herpes.

The full explanation per test is in herpes test: blood test, PCR and what your result really says.

What does a positive HSV result mean?

A positive HSV-1 or HSV-2 IgG means your body once made antibodies against that type. It says nothing about where the virus sits, when you caught it, whether you can pass it on, or whether you will ever get symptoms. It is a yes to a very narrow question.

Picture two people who both get a positive HSV-1 IgG back, where the first had a cold sore 15 years ago and the second has a genital infection. Same result, two completely different situations. The lab cannot tell them apart.

That is why I find a lone positive IgG without symptoms harder than a negative one. It hands you a label without context. What you do with it belongs in a conversation with your GP, not in a search engine.

Why does the GGD not test for herpes as standard?

Because an antibody test in people without symptoms yields little and can cause a lot of worry. RIVM and Dutch STI practice therefore aim the standard STI check at chlamydia, gonorrhoea, HIV and syphilis. Herpes is not part of that panel. That is a deliberate choice, not an oversight.

The international picture is the same: broad screening for HSV antibodies in people without symptoms is not recommended (LeGoff et al., 2014). Thuisarts.nl explains that symptom-led approach in plain language.

We would rather say this out loud than hide it. At Discreet Test, HSV-1 and HSV-2 are not part of the standard STI packages either. You can add them on if you have a concrete reason, for instance because a partner has herpes. That is something different from screening blindly.

How contagious is herpes without blisters?

Even without visible blisters the virus can be present on the skin and mucous membranes now and then. This is called asymptomatic shedding. It happens in bursts rather than continuously, and it explains how people pass herpes on without anyone seeing anything.

How often has been measured carefully. In people with HSV-2 and symptoms the virus was found on 20.1 percent of days, and in people with HSV-2 but no symptoms still on 10.2 percent of days (Tronstein et al., 2011).

That number frightens people, and I understand why. Yet it mostly says something sober: herpes usually spreads through invisibility, not carelessness. Blame is not a useful concept here. We work this out in how you get herpes.

What can you do about an outbreak?

No medicine removes the virus from your body. There are antivirals that can make an outbreak shorter and milder, and that with daily use can lower both the number of outbreaks and the chance of passing it to a partner. Your GP decides whether that fits you.

The size of that effect has been measured. 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). A clear reduction, not a guarantee.

What the medicines do and do not do is covered in genital herpes treatment.

When is the best moment to test?

If you have symptoms now, act quickly: a PCR swab works best while the blister is fresh. If you want to know whether you caught something after a risk moment, your body needs time to build antibodies. Testing too early gives you a false sense of relief.

The incubation period and the antibody window are two different things, and that is exactly where people go wrong. We explain both in herpes incubation period. For other STIs, how long after sex you can test helps.

Unsure whether your first outbreak fits herpes? Our explanation of the first outbreak of genital herpes describes the course step by step.

What does herpes mean for your partner and your relationship?

For most couples herpes is a practical topic, not a breaking point. The conversation covers three things: knowing who carries what, knowing when the risk runs higher, and agreeing on rules that work for both of you. Condoms lower the risk, but they do not cover all skin.

What strikes me in the questions we get: people fear the conversation more than the virus. That is understandable and usually misplaced. A partner who hears that you got yourself checked mostly hears that you take them seriously.

Thinking about testing together before you stop using condoms? That is a good moment, and we describe it in testing together in a new relationship. Already had a positive result? Then notifying your partner after a positive STI test helps.

What if you are pregnant or want to be?

Herpes during pregnancy calls for guidance, not panic. The risk to the baby is small, but it is highest when someone catches the virus for the first time shortly before delivery. That makes this a topic for your midwife or gynaecologist, and not for a self-test.

If you have had herpes for a long time and become pregnant, the situation is usually calmer, because your antibodies pass to the baby as well. If you get symptoms for the first time in the third trimester, always report that to your midwife. She knows which steps fit.

Want a broader look at STIs and pregnancy first? Then STI testing during pregnancy is a good starting point.

What is a sensible next step?

If you have a blister or sore right now, go to your GP or a Centre for Sexual Health and ask for a PCR swab. That is the test that answers your question. Ordering a blood test while you have an active lesion is the wrong way round.

No symptoms, but a concrete reason, such as a partner with herpes? Then you can specifically test HSV-1 IgG and HSV-2 IgG with us and add them to your own test. Our doctor reviews the result and you can view it anonymously, as we explain in the anonymous STI test.

Looking for the overview of all STI tests first? Then start at which STI test you need and when. If you would rather start from home, an STI test at home explains how that route works.

And if you still have doubts after reading this: that is not a failure. Herpes is one of the few STIs that even doctors discuss with care. A short conversation with your GP often saves you more than another hour of searching online.

Sources

1. Looker KJ, Magaret AS, May MT, et al. Global and regional estimates of prevalent and incident herpes simplex virus type 1 infections in 2012. PLoS One. 2015;10(10):e0140765. PMID 26510007.
2. 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.
3. LeGoff J, Pere H, Belec L. Diagnosis of genital herpes simplex virus infection in the clinical laboratory. Virol J. 2014;11:83. PMID 24885431.
4. 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.
5. 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.
6. RIVM. STI guidelines and sexual health surveillance. Available via rivm.nl.
7. 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.