Genital and anal herpes: symptoms, contagion and treatment

What is genital herpes?

Herpes is caused by herpes simplex viruses: HSV-1, which causes cold sores on the mouth, and HSV-2, mostly genital. According to WHO, in 2020 520 million people aged 15 to 49 had HSV-2 worldwide (13%), and about 376 million had genital herpes caused by HSV-1, often passed on through oral sex.

Once caught, the virus stays in the body for life, “asleep” in the nerves, and can wake up in outbreaks.

What are the symptoms?

Most infections go unnoticed or are very mild. When there are symptoms (WHO):

• tingling, burning or itching, then clusters of small blisters that turn into painful ulcers;
• on the penis, buttocks, around or inside the anus (painful bowel movements, discharge);
• during the first outbreak: fever, body aches, swollen glands.

Recurrences are usually shorter and milder. Tiredness, stress, sun and fever can trigger them.

How is it transmitted?

Through skin-to-skin and mucosal contact: penetration, oral sex, rimming, rubbing. A key point stressed by WHO: HSV-2 is transmitted even when the skin looks normal, and often without symptoms. The risk is highest during an outbreak, though.

Herpes and HIV

WHO states that HSV-2 infection roughly triples the risk of acquiring HIV: sores open a door for the virus. One more reason for PrEP or condoms if you have frequent outbreaks.

How is it treated?

Herpes can’t be cured, but Sexosafe and WHO point out that it can be controlled:

• antivirals (aciclovir, valaciclovir) shorten and soften outbreaks, especially if taken at the first tingle;
• with frequent outbreaks, daily suppressive treatment reduces recurrences and the risk of transmission.

A genital or anal sore should always be shown to a doctor: it may be herpes, but also a syphilis chancre or mpox, which are treated differently.

How to limit transmission?

1. No sex during an outbreak, from the first tingle until healed.
2. Condoms: they reduce the risk without removing it (lesions outside the covered area).
3. No oral sex if you have a cold sore on your lip.
4. Talk about it with a regular partner: many couples live very well with herpes.