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Genital herpes is one of the most common sexually transmitted diseases in the US. Herpes zoster or shingles is caused by the varicella zoster virus.
This Herpes guide is intended to inform you about your disease, including how it is treated, ways to manage the symptoms to help you get through an outbreak, and things you can do to reduce the risk of spread to others.
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:: What are genital and oral herpes (cold sores)?
Genital herpes is a viral infection caused by the herpes simplex virus type 1 (HSV-1) or the herpes simplex virus type 2 (HSV-2). Herpes labialis (cold sore) is a viral infection mainly caused by the herpes simplex virus type 1 (HSV-1).
Despite the fact that HSV-1 causes the majority of oral herpes cases (cold sores) and HSV-2 causes the majority of genital herpes cases, both of these viruses can cause either oral or genital herpes.
Genital herpes is usually transmitted sexually. The virus cannot be spread through the air. It requires direct contact in a warm and moist environment for transmission. HSV-2 causes the majority, about 70%, of genital herpes cases. HSV-1 causes about 30% of genital herpes cases and is usually caused by unprotected oral sex. A cold sore on your partner's mouth can transmit the herpes virus to you as genital herpes. Using a barrier protection during oral sex can prevent this from occurring.
Many herpes simplex virus type-1 (HSV-1) infections occur during childhood when an infant or child is kissed by a relative or friend who has active HSV-1 oral herpes (cold sores).
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:: How common is genital herpes?
Genital herpes is one of the most common sexually transmitted diseases (STD) in the US:
- About 50 million Americans have genital herpes.
- According to the American Social Health Association (ASHA), 1 out of every 5
adults has genital herpes.
- The rate of infection is about 1 million Americans every year.
- About 50 to 80% of adults in the US are infected with HSV type 1 (oral herpes or
cold sores).
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:: Who is most at risk for genital herpes infection?
Anyone who has had or is having sexual contact is at risk of contracting genital herpes. Since the transmission of male to female is more likely than female to male, genital herpes is more common in women (about 1 out of 4) than in men (about 1 out of 5).
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:: How is herpes diagnosed?
Patients with painful, clustered blisters or sores, on top of red, swollen skin who know that they have been exposed to the herpes simplex virus are diagnosed with genital herpes on symptoms alone.
One way to know whether an irritation or wound you’ve developed on your skin is a symptom of genital herpes or not, is that the irritation or wound may return repeatedly in the same location even after you thought it was healed.
However, genital herpes may be difficult to identify in someone who does not have these signs. Your symptoms may be very mild or absent or you may not be experiencing an outbreak at the time of your visit. In that case there are two tests that can be used, a viral culture and/or blood test:
Viral culture test: a swab is rubbed on your sore to collect cells, which are tested for the presence of the herpes virus. If the virus is found (positive), then you have genital herpes but if it is not found (negative) you still may have genital herpes since the virus only sheds (appears on the skin) for a short period of time, blood tests are needed to confirm the presence or absence of the virus.
Blood tests: blood must be drawn and tested by a laboratory or your doctor. There are several tests that can be used to determine if you are infected with the virus by measuring your body's immune response against the virus. If you suspect you have been exposed to genital herpes but have no symptoms ask your doctor about a blood test.
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:: Can I have genital herpes and not know it?
Yes. Although symptoms can be visible and obvious, symptoms are more commonly very mild or absent and often go unrecognized. As many as 80% of people with genital herpes do not know they are infected.
* Note: Genital herpes symptoms can be mistaken for a simple irritation of the skin, razor burn, jock itch, allergic reaction, yeast infection, urinary tract infections, abrasions, ingrown hairs, hemorrhoids, or insect bites. Genital herpes differs from these conditions because it may return repeatedly in the same location even after you thought it was healed.
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:: What happens when I get infected with genital herpes?
When the virus infects you, you may experience a first outbreak that is either so mild it is barely noticeable, or it can cause an outbreak of painful sores on you skin.
The virus reproduces in your skin. Some of the virus may shed, which can infect other people, and some of the virus enters nerve cells, where it remains dormant.
When the virus leaves the nerve cells and returns to the surface of the skin, symptoms may reappear. The virus may stay dormant for days, weeks, months or even years before any symptoms appear. This makes it very difficult to know when and from whom the virus was contracted.
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:: What are the symptoms of genital herpes?
The symptoms of genital herpes may include:
- A rash, bumps, blisters, cuts, or sores in or around the genital area (vagina, vulva, anus, penis, or scrotum)
- Itching, burning, tingling, or swelling in or around the genital area
- Aches or pains in or around the genital area
- Discharge from the penis or vagina
- Burning and/or pain when urinating
- Flu-like symptoms (headache, fever, and swollen glands near the groin)
You may also experience some of these symptoms as warning signs before a genital herpes breakout occurs. Symptoms vary for each individual, and may vary from outbreak to outbreak.
Since genital herpes may occur without any symptoms, barrier protection (latex condoms) should be used before any sexual contact occurs for protection in between outbreaks.
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:: Where do the symptoms of genital herpes appear?
An outbreak of genital herpes can occur in any of the these areas: vagina, vulva, anus, buttocks, thigh, penis, scrotum or testicles.
* Note: Genital herpes symptoms can be mistaken for a simple irritation of the skin, razor burn, jock itch, allergic reaction, yeast infection, urinary tract infections, abrasions, ingrown hairs, hemorrhoids, or insect bites. Genital herpes differs from these conditions because it may return repeatedly in the same location even after you thought it was healed.
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:: How is genital herpes spread from one person to another?
The herpes simplex virus (HSV) is most often transmitted from one person to another through sexual contact. It can be spread between mouth and vagina or penis, finger and vagina or penis, penis and vagina or anus, or any other combination of these.
Skin-to-skin contact of the area surrounding the genital area can also spread the virus. Other methods of transmission such as touching a herpes sore then touching another person’s mouth, genitals or broken skin are possible, but are unusual.
Herpes virus can be spread in heterosexual and homosexual relationships (both men and women).
Herpes cannot spread through the air, from toilet seats or by trying on bathing suits.
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:: What is viral shedding?
Viral shedding is the stage at which the virus is present on the skin and can be transmitted to other people. This shedding may be accompanied by physical symptoms such as sores or by no symptoms at all.
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:: How do I prevent the spread of herpes?
To prevent the spread of herpes virus when you have a cold sore:
- Avoid oral sex.
- Avoid sharing cigarettes, lipstick or drinking from the same cup.
- Avoid kissing anyone including your children.
- Wash your hands thoroughly if you touch the affected area.
To prevent the spread of genital herpes:
- During an outbreak, avoid any sexual or skin-to-skin contact of the affected area and your partner.
- In between outbreaks, always use a latex condom or latex barrier to help prevent the virus from infecting your partner.
- Don’t share bath towels if you have active genital herpes symptoms. Wash towels, underwear and other clothing with regular detergent to kill the herpes virus.
- Avoid touching your herpes sores or any other physical signs of genital herpes.
- Wash your hands thoroughly if you touch the affected area.
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:: How is genital herpes treated and can it be cured?
Genital herpes is a lifelong disease. There is no cure for genital herpes, but over time, outbreaks occur less frequently and get milder for many people. After several years, your outbreaks may be rare or stop all together.
Antiviral medications are used either periodically (episodic treatment) to reduce symptoms and speed healing of genital herpes outbreaks, or continuously (suppressive treatment) to prevent or reduce the number of outbreaks.
There are currently three antiviral medications that are FDA-approved for the treatment of genital herpes.
Acyclovir  reduces the symptoms and duration of a genital herpes outbreak. When used daily it prevents or reduces the frequency and/or severity of recurrences.
Famvir reduces the symptoms and duration of a genital herpes outbreak, and many people may go almost a year with no outbreaks when it is used daily.
Valtrex reduces the symptoms and duration of a genital herpes outbreak. Many people may go a year with no outbreaks, when it is used daily. Valtrex, along with safer sex practices, is also the only herpes medication clinically proven to reduce the risk of spreading genital herpes to a partner.
Treatment with any of these oral antiviral medications can be either episodic or suppressive:
Episodic treatment means you receive medication at the first sign of a genital herpes outbreak treating each outbreak when it occurs to relieve the symptoms of pain, burning, and itching and speed up the healing of sores. You take antiviral medication as soon as you feel an outbreak is coming on for 3 to 5 days depending on which medication you use, then stop treatment until the next outbreak. This method may be preferred if you have outbreaks infrequently or if they are mild when they occur. Episodic treatment does not reduce the number of outbreaks.
Suppressive treatment means you receive medication continuously to help suppress outbreaks of genital herpes before they occur. You take antiviral medication every day. This method may be preferred if you have frequent outbreaks, outbreaks are more severe with painful symptoms, outbreaks and anticipation of outbreaks are very stressful, or you simply want to minimize the number of outbreaks. Many people on suppressive therapy may go almost a year without experiencing an outbreak.
(Suppressive therapy with Valtrex has also been shown to lower the risk of spreading the virus to you partner.)
See our Acyclovir FAQ , Valtrex FAQ , and Famvir FAQ to learn more.
See also What is the difference between Acyclovir, Valtrex, and Famvir?
If you would like to buy any of these medications see our comparison pages for Acyclovir prices , Valtrex prices ,
and Famvir prices , where you can select your preferred online US pharmacy with the lowest prices, no prior prescription required.
If this is your first time ordering your prescription medications online, see our beginner’s guide , where the process of obtaining a prescription online and ordering your medication is explained.
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:: What is the difference between Acyclovir, Valtrex, and Famvir?
Each medication has been studied and FDA-approved for use as follows: (differences in bold)
Acyclovir use is approved for the:
- Treatment of initial episodes and the management of recurrent episodes of
genital herpes.
- Suppression of recurrent genital herpes.
- Treatment of herpes zoster (shingles).
- Treatment of chicken pox.
Valtrex use is approved for the:
- Treatment of initial episodes and the management of recurrent episodes of
genital herpes.
- Suppression of recurrent genital herpes.
- Treatment of herpes zoster (shingles).
- Treatment of cold sores (herpes labialis).
* Valtrex is also the only herpes medication studied and proven to reduce the risk of spreading genital herpes to a partner when used with safer sex practices.
Famvir use is approved for the:
- Treatment of recurrent genital herpes.
- Suppression of recurrent genital herpes.
- Treatment of recurrent herpes simplex virus infections (genital herpes and
cold sores) in HIV-infected patients.
- Treatment of herpes zoster (shingles).
Acyclovir is available in generic form. Valtrex (valacyclovir) is converted into acyclovir in your body but is better absorbed by the body and can be taken less often than acyclovir. Famvir (famciclovir) is similar to acyclovir and is also better absorbed and can be taken less often than acyclovir.
Clinical studies have not found any major difference in effectiveness of these three drugs and there are no studies directly comparing the efficacy of Valtrex and Famvir. The main difference between them is in how often the drug must be taken, and cost.
Generic acyclovir may offer some cost-saving, but Valrex and Famvir are better absorbed and are generally thought to be more effective. Valtrex and Famvir cost approximately the same per tablet but since Valtrex is taken once daily and Famvir is taken twice daily, suppressive therapy with Valtrex is more cost effective.
Below is a comparison of the dosing schedules for each drug:
Intermittent (episodic) therapy of genital herpes
Acyclovir 200mg tablet 5 times per day for 5 days
Famvir 125mg tablet 2 times per day for 5 days
Valtrex 500mg tablet 2 times per day for 3 days
Suppressive therapy of genital herpes
Acyclovir 400mg tablet twice daily, or 200mg tablet 3 to 5 times daily
Famvir 250mg tablet twice daily
Valtrex 500mg tablet once daily
Valrex has to be taken the least often, then Famvir, then Acyclovir.
See our Acyclovir FAQ , Valtrex FAQ , and Famvir FAQ to learn more.
If you would like to buy any of these medications see our comparison pages for Acyclovir prices , Valtrex prices ,
and Famvir prices , where you can select your preferred online US pharmacy with the lowest prices, no prior prescription required.
If this is your first time ordering your prescription medications online, see our beginner’s guide , where the process of obtaining a prescription online and ordering your medication is explained.
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:: How often do outbreaks of genital herpes occur?
The number of outbreaks someone has varies from person to person, but the average number of outbreaks per year is four to five. Usually the first outbreak is the most severe outbreak a person will have and there are often more outbreaks during the first year.
Many people find that outbreaks occur less frequently and get milder over time. After several years your outbreaks may be rare or stop all together.
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:: What triggers an outbreak of genital herpes?
It is believed that some factors may trigger the genital herpes virus to become active leading to an outbreak. Trigger factors vary from person to person. Trigger factors usually can't be avoided, but try to recognize what your triggers might be and limit or avoid them if you can.
Some triggers might be physical injury, emotional stress, physical stress, menstrual cycle, lack of sleep, prolonged sun exposure, flu or cold (especially with fever), surgical trauma, sexual intercourse, some medications (steroids), and nutritionally poor diet.
Effective stress management and getting adequate rest, nutrition and exercise can help reduce the frequency of outbreaks.
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:: What should I do to help me get through an outbreak of genital
herpes?
In addition to taking your prescription oral antiviral medication, some of the following may help speed up healing and help you feel more comfortable during an outbreak.
1. Keep the affected area clean and dry. Use a blow dryer set on low or cool to dry the genital area after showering or bathing.
2. Try to avoid touching or scratching the affected areas during an outbreak.
3. Wash your hands after contact with the affected areas.
4. Do not break open the blisters.
5. Avoid excessive heat or sunlight as these might trigger an outbreak.
6. Avoid wearing tight or restrictive clothing. Wear cotton underwear as it absorbs moisture and allows for ventilation.
7. Do not use sprays, feminine deodorants or douches on the affected areas.
8. Do not use petroleum jelly, rubbing alcohol, ether, antibiotic cream, cortisone cream or natural remedies on the affected areas, as they can sting and will not help heal the sores.
9. Place cool or lukewarm cloths on the affected areas during the outbreak to help to soothe itching and burning.
10. Take a warm bath to help to soothe itching and burning. This may or may not be helpful for you as some people find that getting the sores wet is unpleasant.
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:: Can I have children if I have genital herpes and will I pass it on to
them?
Yes, you can have children, and having genital herpes does not necessarily mean you will pass it on to you child.
If you have genital herpes before becoming pregnant there is very low risk of passing it to you child. According to the American Medical Association, only about 1 in 3,000 babies (0.033%) get genital herpes from their mothers.
If you are not experiencing an outbreak during delivery there is usually no virus in the birth canal to infect the baby. If you are having an outbreak during delivery, your doctor can perform a cesarean section to reduce contact between the infection and the baby.
If your partner has genital herpes or cold sores and you are pregnant and don't have genital herpes, it is important to avoid getting infected during pregnancy.
You should avoid any skin-to-skin contact when herpes symptoms are present. See How do I prevent the spread of herpes? . It is especially important to not have any sexual contact during the last trimester, because women who get their first herpes infection during their third trimester of pregnancy have a higher risk of passing the virus to the baby.
Talk to your doctor if you or your partner have genital herpes and you are pregnant or planning to become pregnant. The safe and effective use of oral antiviral mediations during pregnancy has not been established, talk to your doctor about treatment options.
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:: What precautions should I take if I have a newborn?
It is important to prevent the spread of the herpes virus to a newborn. An infant’s immune system takes time to develop, and serious widespread infection can occur especially if they are exposed to the virus before they are 6 months old.
The American Academy of Pediatrics recommends the following guidelines:
- Parents with active herpes symptoms should wash their hands before and after
caring for their infants.
- Parents who have cold sores should wear a disposable surgical mask during
handling of their newborn infant until the herpes lesions have crusted and dried.
- Parents should not kiss or nuzzle infants until the herpes lesions have cleared.
- Active herpes lesions on other sites of the body should be covered while handling
a baby.
- Talk to your doctor if you plan on breastfeeding.
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:: What is herpes zoster (shingles)?
Shingles, or herpes zoster, is an infection caused by the varicella zoster virus. This is the same virus that causes chicken pox.
Shingles and chicken pox primarily differ in that shingles blisters usually erupt in a band along one side of the body while chicken pox blisters erupt all over the body.
Once you get chicken pox, the varicella zoster virus stays in your body for life.
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:: What causes shingles?
You cannot get shingles if you have not had chicken pox.
After chicken pox blisters heal the varicella zoster virus that caused them travels down nerve fibers and lays dormant in certain nerve cells. It may remain there dormant for many years or even decades.
Sometimes the virus gets reactivated. It then travels back to the surface of your skin where it causes an outbreak.
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:: How common is shingles?
- Twenty percent of the population will get shingles in their lifetime.
- About one million Americans get shingles each year.
- About 2.5 per 1000 cases are among people aged of 20 to 50.
- About 5 per 1000 cases are among people aged 50 to 60.
- About 10 per 1000 cases are among people aged 70 to 80.
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:: How is shingles diagnosed?
It is difficult to diagnose shingles before a rash appears. Initial symptoms such as itching, numbness, tingling, or pain on one side of the body or face can be mistaken for kidney stones, gallstones, appendicitis, or even a heart attack depending on where the affected nerve is located on the body.
Once the shingles rash appears, it is easier to recognize because it is usually in the pattern of a band on one side of the body. In some cases your doctor may take a swab of the blisters to send to a laboratory to test for the presence of the varicella zoster (shingles) virus.
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:: Is shingles contagious?
You cannot get shingles from someone who has it. However, you can get chicken pox from someone who has shingles because the same virus that causes shingles, varicella zoster virus, causes chicken pox.
If you have never had chicken pox, and you have not received a chicken pox (varicella zoster) vaccination, you can develop chicken pox (not shingles) if you come in contact with a person who has shingles.
The virus can only be transmitted if there is skin-to-skin contact of an open blister. If you have shingles try to avoid touching the affected areas and wash your hands thoroughly if you must touch the affected areas. Don’t let anyone else, especially someone who has not had chicken pox or varicella zoster vaccination, come in contact with your rash.
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:: Who is at risk for shingles infection?
Anyone who has had chicken pox has the varicella virus in their body and is at risk of developing shingles. More than 90% of Americans over age 15 have had chicken pox.
Shingles is most common in people over age 50 and in those who have a weak immune system due to factors such as HIV infection, cancer or some cancer treatments or certain medications taken after an organ transplant.
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:: Can I get shingles more than once?
Yes. Although most people who get shingles develop immunity to the varicella zoster virus and don’t get it again, about 4% of people will have another outbreak in the future.
When shingles does recur, it is often in people with weak immune system due to factors such as HIV infection, cancer or some cancer treatments or certain medications taken after an organ transplant.
A second outbreak may be many years after the first outbreak and the rash is usually in a different location from the first outbreak.
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:: What are the symptoms of shingles?
Shingles occurs in two stages, the prodromal stage and the eruptive stage.
The initial stage occurs about 2 to 5 days before the rash appears and is called the prodromal stage. Symptoms may include fever, headache, nausea, chills, and numbness, itching, tingling, burning, or shooting pain on one side of the body or face. These symptoms may be very mild and can be mistaken for other illnesses.
The prodromal stage is followed by the eruptive stage which begins with redness and swelling of the skin followed by bumps that form into clear fluid filled blisters. The blisters can be on your chest, back, abdomen, buttocks, arm, leg or face, and they usually appear in a patch or band on one side of your body only. New blisters will continue to appear for up to 5 days. The blisters can be mildly irritating, itchy, or intensely painful. The blisters become filled with pus and then form a scab within 14 days. The blisters won’t leave scars, but your skin may be lighter where they were. Shingles can make you feel very uncomfortable while you have it, but it usually is not dangerous to healthy people.
The rash, blisters, and pain caused by shingles will usually go away in about 3 to 5 weeks, even without treatment. After the blisters are gone, some people may develop postherpetic neuralgia (PHN) an extremely painful condition that may last for months or years.
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:: What is Postherpetic Neuralgia (PHN)?
Postherpetic neuralgia (PHN) is the most common complication of shingles. The varicella zoster virus damages nerve fibers resulting in severe pain from shingles that may last for months and sometimes years, after the shingles rash has healed.
The primary symptom of postherpetic neuralgia (PHN) is pain, which may be aching, stabbing, throbbing, sharp or piercing. The intensity of the pain can vary from mild to debilitating, but pain-free periods are rare.
Other symptoms of PHN include itching and burning, and very sensitive skin (especially to heat or water). The symptoms of PHN are usually limited to but may extend beyond the area of the skin where the shingles rash appeared.
The nerve damage caused by the varicella zoster virus (shingles) cannot be reversed, and treatment cannot improve nerve healing. The pain associated with PHN is treated with various over-the-counter, prescription medications and combinations of medications. Anti-viral medications such as Famvir have been specifically shown to reduce the duration of PHN if started within 72 hours of developing the original shingles outbreak.
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:: How is shingles treated?
The severity and duration of shingles can be significantly reduced for many people with the use of oral prescription antiviral medications. Antiviral therapy should be started within 72 hours after the rash appears.
There are currently three antiviral medications that are approved for the treatment of shingles.
Valtrex and Acyclovir reduce the duration of herpes zoster infection, leading to faster healing of lesions, shorter period of viral shedding, and reduced new lesion formation.
Famvir reduces the duration of herpes zoster infection as well. Famvir also significantly reduces the number of days of pain from postherpetic neuralgia (PHN).
In addition to these antiviral prescription medications, pain relievers and anti-inflammatory medications, prescription and/or over-the-counter, are used to decrease the pain caused by the infection.
See our Acyclovir FAQ , Valtrex FAQ , and Famvir FAQ to learn more.
See also What is the difference between Acyclovir, Valtrex, and Famvir?
If you would like to buy any of these medications see our comparison pages for Acyclovir prices , Valtrex prices ,
and Famvir prices , where you can select your preferred online US pharmacy with the lowest prices, no prior prescription required.
If this is your first time ordering your prescription medications online, see our beginner’s guide , where the process of obtaining a prescription online and ordering your medication is explained.
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:: What causes a shingles outbreak?
It is not known exactly what causes the varicella zoster virus to become active and cause a shingles outbreak.
An outbreak may be caused by a weakening of the immune system which can occur as we get older, or with an HIV infection, some cancer and transplant medications, or even with temporary weakening of the immune system from colds, the flu or a sunburn.
Severe stress and major depression have also been identified as possible triggers. There is not always an obvious trigger before an outbreak occurs.
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:: What should I do to help me get through a shingles outbreak?
In addition to treating shingles with antiviral medication, there are steps you can take to improve comfort, reduce pain and itching, and help the shingles rash to heal.
1. Do not scratch the rash as this may cause bacterial infection.
2. To temporarily relieve itching and pain use an anti-itch/analgesic lotion that contains pramoxine such as Caladryl Clear, Prax Lotion or generic pramoxine lotion. Apply it 3 to 4 times daily to the affected areas.
3. A damp compress of an astringent solution such as Domeboro can help dry out the lesions and provide an antibacterial effect. Use the compress for newly blistered areas for 15 to 20 minutes, twice a day. Make sure you keep it out of the eyes.
4. A compress of clean cool water can help relieve itching and soothe the rash.
5. Warm baking soda baths may help soothe the affected areas. Avoid hot water as it may lead to further itching.
6. Try to keep the rash uncovered or wear loose-fitting clothing.
7. Severe itching may be relieved with over-the-counter oral diphenhydramine (Benadryl).
8. Use aspirin, acetaminophen (Tylenol), or ibuprophen (Advil) as appropriate to relieve pain.
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* The information contained in RxPriceCheck.com is for educational purposes only and is not intended as medical advice. Consult your healthcare provider regarding your medical condition. All product names are trademarks or registered trademarks of their respective holders. View our terms of use .
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