I. Intro

Key Points
About 11.9% of people between the ages of 14 to 49 have HSV-2 in the United States.Prevalence increased with age and is about 7.7% more common among females than males.
People with genital herpes are three times more likely to get HIV.Latex condoms provide some protection, but the virus may also be present in other areas of the body that aren’t protected by a condom.

There are two types of HSV. Genital herpes is usually caused by vaginal or anal sex with a person who is infected with herpes simplex virus type 2 (HSV-2). In less common cases, herpes simplex virus type 1 (HSV-1) — which typically causes oral herpes — can be transmitted to the genital area through oral sex.

About 11.9% of people between the ages of 14 to 49 had HSV-2 in the United States in 2015-2016, according to the Centers for Disease Control and Prevention (CDC). Prevalence increased with age and was about 7.7% more common among females than males. The CDC estimates that there are about 776,000 new cases of genital herpes infections each year in the United States.

Genital herpes is common around the globe. About 417 million people between the ages of 15 to 49, or 11%, have HSV-2, according to the World Health Organization. Infection is highest in Africa at about 32%, followed by 14% in North and South America.

General Information
Infectious OrganismHerpes simplex virus type 2
Other Commonly Used NamesGenital herpes
Testing Collection MethodSwabs, blood
TransmissionVaginal or anal sex
PreventionAbstinence, although the risk of transmission can be reduced with latex condoms, mutual monogamy, and antiviral medication

II. Overview of Genital Herpes Testing

The purpose of herpes testing is to screen for a herpes simplex virus infection. Testing for HSV-1 or HSV-2 is recommended if:

  • You have blisters, sores or ulcers in the genital area that may be from the herpes virus
  • You have or had a sexual partner with a genital herpes infection
  • You’re pregnant, and either you or your partner have experienced sores or ulcers in the genital area
  • You’ve had multiple sexual partners and wish to have a full screening for STDs

The CDC doesn’t recommend routine herpes testing of healthy adults or adolescents who are not experiencing herpes symptoms.

If you have blisters or sores in the genital area, a doctor may be able to diagnose the virus based on a physical examination of the sores along with a patient history to determine if you may have been exposed to the virus.

Your doctor may also request testing for confirmation of whether your symptoms are from an HSV-1 or HSV-2 infection. Possible tests include swabs for a viral culture or DNA test or a blood test.

III. How a Genital Herpes Infection Works

Genital herpes is transmitted mainly through vaginal or anal sex with an infected person. It’s spread through contact with body fluid, skin, or sores. Herpes simplex virus is most contagious when symptoms are present but can be transmitted even if there are no lesions present.

Although rare, genital herpes can be passed on to an infant during birth if the mother has genital herpes. This occurs in 10 out of 100,000 births, according to the World Health Organization. The chances of neonatal herpes is higher if the mother was infected late in pregnancy. Neonatal herpes is extremely dangerous and requires immediate medical attention.

According to the World Health Organization, HSV-2 is very common among HIV-infected persons, with a prevalence of about 60% to 90%. People with genital herpes are three times more likely to get HIV. This is because HIV can enter the body through sores caused by genital herpes. The presence of CD4 cells in the genital area, which are cells targeted by HIV, also increases with HSV-2 infection.

Abstinence is the only way to prevent the spread of HSV. Latex condoms provide some protection, but the virus may also be present in other areas of the body that aren’t protected by a condom.

IV. Stages of Genital Herpes

Primary Infection

During the initial infection, you may experience sores or blisters in the genital area, buttocks, and hips, which can be accompanied by headache, fever, swollen glands, and painful urination. The blisters swell and break, eventually crusting over and healing. Take care not to touch the sores or fluids as you may transmit the virus to another part of your body.

Some people have asymptomatic HSV-2 infections, which means they do not experience symptoms.

Latent or Dormant Stage

After the initial outbreak, HSV-2 retreats to the body’s sensory neurons, where the virus becomes dormant and hides from the body’s immune system. Research has found that this survival strategy ensures the virus becomes active again in the future and continues spreading.

Asymptomatic Reactivation or Shedding

From time to time, the virus reactivates and becomes contagious. During this stage, those who are infected shed the virus and can transmit it to others through sexual contact. There’s no way to predict when the virus becomes active again.

According to the CDC, those with HSV-2 genital infections that don’t experience symptoms shed the virus 10.2% of days, compared to 20.1% of days for those who experience symptoms. Shedding occurs more frequently with HSV-2 than HSV-1.

Recurring Outbreaks

It’s common to experience recurrences of genital herpes ulcers in the same area that they first appeared. While it’s impossible to know when outbreaks will occur, they can be triggered by stress, fatigue, or hormones. Flare-ups tend to decrease in severity and frequency over time.

V. Symptoms of Genital Herpes

Symptoms generally appear within 14 days of infection but may also surface weeks or years later, so you might not know when you acquired the infection. Symptoms vary in severity, but they generally include:

  • Blisters or ulcers on the penis, vulva, anus, buttocks, or thighs
  • Flu-like symptoms such as fever, aches, and swollen lymph nodes
  • Tingling or pain in the hips, legs, and buttocks prior to the appearance of ulcers

The sores may be uncomfortable or extremely painful and take about 14 to 28 days to heal. Some symptoms are mild and may be mistaken for an insect bite, rash, or yeast infection.

VI. Genital Herpes Testing

Several tests can confirm whether you have a herpes simplex virus infection. If you have genital ulcers, a DNA test or viral culture can test a sample of cells with a swab. If you don’t have symptoms, a blood test can look for HSV antibodies.

DNA Test (Nucleic Acid Amplification Test)

Also known as a polymerase chain reaction, this test looks for the genetic material of the herpes simplex virus in a sample collected from a blister. The analysis is ideally performed within 48 hours of the sores first appearing.

The test typically involves collecting skin, fluid, or cells from a blister or an ulcer.

  • A health care provider inserts a collection swab into the blister.
  • The swab is firmly rotated to collect a specimen.
  • The specimen is put into a vial and transported to a laboratory for testing.

No preparation is required.

Herpes Viral Culture

A viral culture involves collecting a specimen from a genital ulcer to check for the presence of HSV. The specimen is added to cells to see if the cells become infected by the herpes simplex virus. If they do, then HSV is present. False-negative results are possible if the specimen is collected when the sores have started to heal as there’s less of the virus to test.

To collect a sample of skin, fluid, or cells from a blister or an ulcer:

  • A health care provider inserts a collection swab into the blister.
  • The swab is firmly rotated to collect a specimen.
  • The specimen is put into a vial and transported to a laboratory for testing.

No preparation is required.

HSV Antibodies Blood Test

A blood test is useful when symptoms aren’t present. It checks for the blood protein that bodies produce to fight pathogens such as viruses or bacteria. If the test detects the presence of HSV antibodies, your body has produced them in response to an infection.

False negatives are possible if the test is taken before antibodies have had time to develop in the body. It may take up to 16 weeks for antibodies to be detectable.

An antibody test is performed on a blood sample, usually drawn from the arm.

  • An area of the arm, such as inside the elbow, is cleaned and disinfected.
  • An elastic is tied around the upper arm to make the vein swell so it’s easier to draw a sample of blood.
  • A small needle is inserted into the site to draw a sample of blood into a small tube.
  • The needle is removed, and pressure applied to the puncture site.
  • The blood sample is sent for testing.

No preparation is needed.

VII. Treatment of Genital Herpes

Genital herpes is a lifelong infection, but it can be managed with medication.

Several antiviral drugs are commonly prescribed to treat genital herpes, including Acyclovir, Valacyclovir, and Famciclovir. These can help to prevent or shorten outbreaks and reduce the likelihood, but not eliminate, transmission of the virus. Your physician can advise whether these drugs are the right ones for you.

Antiviral medication can be taken during the first outbreak of genital herpes or recurrences. Your physician may recommend episodic therapy, where you take medication only when a flare-up occurs. Suppressive therapy is recommended for those who experience frequent recurrences and involves taking medication daily to help prevent outbreaks.

Those with suppressed immune systems are at risk of complications if genital herpes is left untreated. This includes transmission of the virus to other areas of the body such as the eyes, fingers, throat, lungs, and brain.

VIII. Frequently Asked Questions

What’s important to know about genital herpes?

Genital herpes can be transmitted even if you aren’t exhibiting symptoms. It’s a lifelong infection that can be managed with medication. Most healthy adults have little risk of a serious outcome.

How can I order a herpes test?

Ask your physician or health clinic for a herpes test, or visit a Planned Parenthood center.

There are also websites that sell home test kits for genital herpes. The kits are usually delivered to your home in a plain, unbranded envelope for privacy purposes.

How is a genital herpes home test kit used?

A herpes home test kit contains the supplies you need to perform a swab for herpes simplex virus, including the collection swab and specimen holder. Most kits also include detailed instructions and a return envelope for returning the sample to the lab. Once the laboratory receives your specimen and performs the test, results are usually retrieved online by an order number.

Blood tests can also be ordered online. You can print the order at home and take it to a partner laboratory to have your blood sample drawn and tested.

What does a positive result for herpes simplex virus mean?

A positive test result means that your HSV viral culture, DNA test, or antibodies blood test has detected a herpes simplex virus infection. Consult your doctor for treatment options.

What does a negative result for herpes simplex virus mean?

A negative test result means it’s unlikely you have an HSV infection, but false negatives can occur.

A swab test is most accurate when samples are collected within 48 hours of the ulcers appearing because more of the virus is present. Samples collected as the sore heals may result in a false negative.

A blood test for HSV antibodies can result in a false negative if your body hasn’t yet produced antibodies when the test is taken. It can take up to 16 weeks for antibodies to be detectable.

How long does it take to get results from a genital herpes test?

While times vary depending on the laboratory, these are the typical test times for herpes simplex virus:

DNA test: 1 to 3 days

Viral culture: 2 to 14 days

Antibodies blood test: 2 days, although a rapid test may provide results in 2 hours.

IX. Additional Resources

Click on these websites for more information on genital herpes, including testing procedures and treatment options.

X. Sources