Genital Herpes
Genital herpes is a lifelong viral infection (HSV-1 or HSV-2) with intermittent outbreaks, managed per the CDC Sexually Transmitted Infections Treatment Guidelines, 2021.
Symptoms
The first episode can be the most severe: painful genital blisters or ulcers, sometimes with fever and swollen lymph nodes. Recurrent episodes are typically milder and shorter, and many people have minimal or unrecognized symptoms.
Causes and risk
Direct skin-to-skin contact during sex, including when the infected partner has no visible symptoms (asymptomatic shedding does occur).
How it is evaluated
NAAT (PCR) testing of a lesion is the preferred way to confirm active infection; type-specific blood serology can identify prior infection between outbreaks, though the FDA has flagged false-positive risk with some serology tests, so unexpected positive results should be confirmed.
Treatment
Antiviral therapy (acyclovir, valacyclovir, or famciclovir) treats the first episode and can be used episodically for recurrences, or daily as suppressive therapy to reduce outbreak frequency and transmission risk to a partner -- daily valacyclovir meaningfully lowers the chance of passing the infection on.
When to seek care
Severe pain preventing urination, symptoms in a pregnant partner near delivery, or signs of spreading infection beyond the genital area need prompt evaluation rather than routine antiviral treatment alone.