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Health condition · Clinically reviewed

Genital herpes, antivirals, recurrences and everyday management.

Common, treatable and manageable. A stepped BASHH-based plan - swab, treat, and decide between episodic and suppressive antivirals.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BASHH, NICE and specialist GUM standards you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including NAAT testing, aciclovir dosing and suppressive therapy.

Key facts

Genital herpes at a glance.

The essentials, in plain English - what HSV is, how it behaves, and what the UK approach looks like.

  • What it is

    A common sexually transmitted infection caused by herpes simplex virus (HSV) - lifelong, with latent virus living in the dorsal root ganglia and reactivating episodically.

  • Types

    HSV-1 (traditionally orolabial, increasingly genital) and HSV-2 (traditionally genital). Both can affect the genital area.

  • How common

    Up to 25% of UK adults show HSV-2 seroprevalence, and HSV-1 genital infection is rising - most people never know they carry it.

  • Primary infection

    The first episode is usually the most severe - painful ulcers, dysuria, tender groin nodes and sometimes fever and malaise.

  • Recurrences

    Milder and shorter, often preceded by a tingling prodrome and settling within days.

  • Neonatal risk

    Rare but serious - highest risk when a mother acquires primary genital HSV in the third trimester. Specialist obstetric care is essential.

Why this guide matters

A specialist plan, not a Google spiral.

Genital herpes is common, manageable and rarely dangerous - but a proper diagnosis and plan make an enormous difference to how it feels day to day.

  • Test the ulcer, not a hunch

    A NAAT swab from an active lesion gives a definitive, type-specific diagnosis - the foundation of everything that follows.

  • Treat the first episode properly

    A five-day course of aciclovir or valaciclovir, started early, shortens symptoms and reduces complications.

  • Suppression changes the game

    For frequent, severe or troubling recurrences, daily antivirals reduce episodes, shedding and transmission - and give people their lives back.

How the diagnosis is made

From first symptoms to a confirmed plan.

The BASHH-recommended steps a UK GUM clinician will normally follow - so you know what to expect at every stage.

  1. 01

    Assessing

    Sexual and symptom history

    Onset, prodrome, sexual contacts, prior episodes and any systemic symptoms - to distinguish primary from recurrent disease.

  2. 02

    Assessing

    Genital examination

    Looking for the classic vesicles and painful ulcers, inguinal lymphadenopathy and any signs of retention or proctitis.

  3. 03

    Assessing

    Swab active lesions - NAAT PCR

    HSV PCR from an ulcer or vesicle base is the gold standard and gives a type-specific result (HSV-1 vs HSV-2).

  4. 04

    Confirming

    IgG type-specific serology

    Useful when lesions have healed or for partner testing - identifies past HSV-1 or HSV-2 infection.

  5. 05

    Confirming

    Full STI screen

    BASHH-recommended screen for HIV, syphilis, chlamydia, gonorrhoea and hepatitis - genital herpes travels with other infections.

  6. 06

    Planning

    Pregnancy testing

    Where relevant - a primary episode in pregnancy changes both treatment and delivery planning.

  7. 07

    Planning

    GUM referral

    Specialist genitourinary medicine review for confirmed diagnosis, partner notification and long-term management.

Typical timeline: from first symptoms to a confirmed diagnosis in a single GUM visit.

Symptoms

What genital herpes actually feels like.

A first episode is usually the loudest - painful ulcers, tender lymph nodes and dysuria. Recurrences are milder and often flagged by a prodrome you learn to recognise.

  • Painful genital ulcers

    Shallow, tender ulcers with a red base - the hallmark of primary infection and the reason many people first present.

  • Vesicles and clustered blisters

    Small fluid-filled blisters that burst quickly - most obvious in a primary episode.

  • Dysuria and urinary retention

    Passing urine over broken skin is intensely painful - severe cases can retain and need a catheter and specialist input.

  • Tender groin lymph nodes

    Bilateral inguinal lymphadenopathy is common in primary disease.

  • Prodromal tingling

    Burning, tingling or itching in the same area a day or two before a recurrence - the cue to start episodic treatment early.

  • Systemic symptoms

    Fever, headache, malaise and myalgia often accompany a primary episode.

  • Asymptomatic shedding

    Virus can be shed from the skin without any lesions - a key reason transmission happens between episodes.

  • Red flag - Elsberg syndrome

    Sacral radiculopathy with retention and perineal numbness in primary disease - needs urgent specialist care.

Treatment

How genital herpes is treated in the UK.

Antivirals for the acute episode, episodic or suppressive therapy for recurrences, and specialist pathways for pregnancy and immunocompromise - all per BASHH.

  • Aciclovir - primary episode

    Aciclovir 400 mg three times daily for five days is the BASHH first-line for primary genital herpes. Start early to shorten symptoms.

  • Valaciclovir - alternative

    Valaciclovir 500 mg twice daily for five days - a convenient prodrug of aciclovir with the same evidence base.

  • Famciclovir - alternative

    A further oral antiviral option where aciclovir or valaciclovir is not suitable.

  • Supportive care

    Analgesia, saline baths, topical lidocaine and petroleum jelly protect broken skin and make passing urine tolerable.

  • Episodic therapy - recurrences

    Short courses at the first prodrome - aciclovir 800 mg three times daily for two days, or 400 mg three times daily for three days.

  • Suppressive therapy

    Daily aciclovir 400 mg twice daily (or valaciclovir 500 mg once daily) for frequent (six or more per year), severe or troubling recurrences - also reduces asymptomatic shedding and transmission.

  • Pregnancy management

    Specialist obstetric input - suppressive aciclovir from 36 weeks and Caesarean delivery for primary infection in the third trimester to protect the baby.

  • Partner notification and counselling

    A calm, structured conversation with GUM - condoms, disclosure and the reassurance that most partners tolerate the news better than people expect.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or GUM clinician knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • BASHH. UK national guideline for the management of anogenital herpes.

  • NICE CKS. Herpes simplex - genital.

  • RCOG / BASHH. Management of genital herpes in pregnancy.

  • MHRA / BNF. Aciclovir, valaciclovir and famciclovir prescribing information.

Red flags

When genital herpes needs urgent care.

Most episodes settle with a course of antivirals. These are the situations that need specialist input the same day.

  • Urinary retention

    Severe primary disease can cause acute urinary retention - needs urgent assessment, catheterisation and specialist input.

  • Elsberg syndrome

    Sacral radiculitis with perineal numbness and retention - a rare complication of primary HSV needing urgent neurology and GUM review.

  • Aseptic meningitis

    Headache, neck stiffness and photophobia in primary infection - assess urgently, as HSV can cause meningoencephalitis.

  • Primary infection in late pregnancy

    Highest risk of neonatal herpes - urgent specialist obstetric and GUM referral, and delivery planning by Caesarean.

  • Neonatal herpes

    Any newborn with vesicles, sepsis, seizures or unexplained deterioration needs immediate paediatric infectious-disease care.

  • Immunocompromised patients

    Disseminated or atypical disease - specialist input, higher-dose oral or intravenous aciclovir and close monitoring.

  • Eczema herpeticum

    Widespread HSV on eczematous skin - a dermatological emergency. See our guide on eczema and dermatitis for context.

  • Proctitis

    Severe rectal pain, discharge and tenesmus with HSV - specialist GUM and proctology assessment.

  • Psychosexual distress

    The diagnosis carries a real emotional weight - low mood, relationship strain or anxiety warrant a proper conversation and support.

Living with it

A common condition, with a manageable rhythm.

Four things that make the biggest difference - recognising the prodrome, choosing between episodic and suppressive therapy, sensible protection, and knowing where to turn for support.

A quiet reminder

The diagnosis is common. The distress often isn't.

Good counselling, honest conversations and the right antiviral plan take most of the weight out of an HSV diagnosis.

  1. 01 Recognise

    Learn your prodrome

    Most people can spot the tingling that precedes a recurrence - starting antivirals then shortens the episode dramatically.

  2. 02 Reduce

    Consider suppressive therapy

    If you get six or more episodes a year, or if recurrences are severe, daily antivirals genuinely change quality of life.

  3. 03 Protect

    Condoms and honesty

    Condoms reduce transmission but do not eliminate it. Disclosure to partners is difficult but almost always the right call.

  4. 04 Support

    You are not alone

    The Herpes Viruses Association and GUM counsellors help enormously - the diagnosis is common, treatable and manageable.

Frequently asked

Everything we get asked about genital herpes.

Quick answers on testing, antivirals, recurrences, pregnancy and telling a partner.

  • What is genital herpes?

    A sexually transmitted infection caused by herpes simplex virus - either HSV-1 or HSV-2. The virus lives latently in the dorsal root ganglia for life and reactivates from time to time to cause recurrent outbreaks. Most people carry it without ever knowing.

  • How is it diagnosed?

    The gold standard is a NAAT (PCR) swab taken directly from an ulcer or blister, which also tells you whether it is HSV-1 or HSV-2. Where lesions have healed, an IgG blood test can confirm past infection. Diagnosis is usually made in a specialist GUM clinic alongside a full STI screen.

  • How is a primary episode treated?

    A five-day course of an oral antiviral - typically aciclovir 400 mg three times daily, or valaciclovir 500 mg twice daily - shortens the episode and reduces its severity. Analgesia, saline baths and topical lidocaine make the first few days more bearable, and severe cases need specialist care for urinary retention.

  • What if I get frequent recurrences?

    If you have six or more episodes a year, or recurrences that are severe or disabling, suppressive therapy - daily aciclovir 400 mg twice daily or valaciclovir 500 mg once daily - reduces frequency, shortens episodes, cuts asymptomatic shedding and reduces the chance of passing the virus on. It is usually reviewed annually.

  • Can I still have children?

    Yes - the great majority of pregnancies in women with herpes are uneventful. The important scenarios are a primary infection late in pregnancy (which carries the highest neonatal risk and is usually managed with Caesarean delivery) and recurrent disease near term (managed with suppressive aciclovir from 36 weeks). Specialist obstetric and GUM input plans this carefully.

  • How do I tell a partner?

    Openly, factually and without dramatic apology - herpes is very common, manageable, and most partners handle the news far better than people fear. Condoms, avoiding sex during outbreaks and taking suppressive antivirals all reduce transmission. GUM counsellors and the Herpes Viruses Association are excellent for rehearsing the conversation.

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