Genital Herpes

The most accurate diagnosis is PCR testing of a swab from an active lesion — highly sensitive and specific. Blood tests (type-specific IgG antibodies) detect prior HSV-2 or HSV-1 infection but cannot determine the site of infection or when it was acquired. Clinical diagnosis based on appearance alone is unreliable — lab confirmation is important.

Yes — asymptomatic viral shedding occurs on approximately 10–20% of days without any symptoms or visible lesions. This is the primary mode of transmission. Disclosure to partners, daily suppressive antiviral therapy (which reduces shedding by ~50%), and consistent condom use together reduce — but don't eliminate — transmission risk.

The primary (first) outbreak is typically the most severe — often with painful ulcers, flu-like symptoms, and prolonged healing over 2–4 weeks. Recurrences are usually shorter, milder, and may be preceded by prodromal tingling or itching. Frequency of recurrences decreases over time for most people.

Neonatal herpes is a serious concern — transmission during delivery when active lesions are present carries significant risk. Suppressive antiviral therapy starting at 36 weeks significantly reduces outbreak risk at delivery. Cesarean section is recommended when active genital lesions or prodromal symptoms are present at the time of labor.

Valacyclovir and acyclovir are very well tolerated — headache and nausea are the most common effects at standard doses. Famciclovir has a similar profile. Long-term suppressive therapy is considered very safe based on extensive use data. Adequate hydration reduces the very small risk of kidney effects at high doses.