{"id":3559,"date":"2021-08-20T08:00:00","date_gmt":"2021-08-20T01:00:00","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=3559"},"modified":"2026-08-30T06:33:20","modified_gmt":"2026-08-29T23:33:20","slug":"herpes-%e1%80%9c%e1%80%ad%e1%80%84%e1%80%ba%e1%80%a1%e1%80%84%e1%80%ba%e1%80%b9%e1%80%82%e1%80%ab%e1%80%97%e1%80%ad%e1%80%af%e1%80%84%e1%80%ba%e1%80%b8%e1%80%9b%e1%80%95%e1%80%ba%e1%80%85%e1%80%ba","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/my\/2021\/08\/20\/herpes-genitalia-viral-infection\/","title":{"rendered":"Genital Herpes (HSV): Why It Recurs, and How to Control It"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-full is-style-rounded\"><img data-recalc-dims=\"1\" fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"800\" data-attachment-id=\"7037\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/new-photo-2024\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" data-orig-size=\"800,800\" data-comments-opened=\"1\" data-image-title=\"Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Dr. Soarawee Weerasopone \u2014 Board-Certified Urologist in Bangkok, Thailand&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/12\/New-Photo-2024.png?fit=800%2C800&amp;ssl=1\" 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4.022-2.484 4.022-3.722 0-2.016-1.284-3.722-4.097-3.722h-2.222z\"\/>\n    <\/svg>\n  <\/a>\n  \n  <a href=\"https:\/\/scholar.google.com\/citations?user=lTgsRMUAAAAJ&#038;hl=en\" \n     target=\"_blank\" \n     rel=\"noopener\"\n     title=\"Google Scholar\"\n     aria-label=\"View Google Scholar Profile\"\n     style=\"text-decoration: none; color: #4285F4; transition: transform 0.2s; display: inline-block;\"\n     onmouseover=\"this.style.transform='scale(1.15)'\"\n     onmouseout=\"this.style.transform='scale(1)'\">\n    <svg width=\"28\" height=\"28\" viewBox=\"0 0 24 24\" fill=\"currentColor\">\n      <path d=\"M5.242 13.769L0.5 9.5 12 1l11.5 8.5-4.742 4.269C17.548 11.249 14.978 9.5 12 9.5c-2.977 0-5.548 1.748-6.758 4.269zM12 10a7 7 0 1 0 0 14 7 7 0 0 0 0-14z\"\/>\n    <\/svg>\n  <\/a>\n  \n<\/div>\n\n\n\n<p class=\"has-drop-cap wp-block-paragraph\">Genital herpes is one of the conditions I see most often in the clinic. Because the painful genital ulcer is such a characteristic sign, the diagnosis is usually not difficult. What patients actually want answered is different: where did it come from, why has it happened to me, can it be cured, and how do I stop it coming back? This article takes those questions in turn.<\/p>\n\n\n<script type=\"application\/ld+json\">\r\n{\r\n  \"@context\": \"https:\/\/schema.org\",\r\n  \"@type\": \"FAQPage\",\r\n  \"mainEntity\": [\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What causes genital herpes?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Genital herpes is caused by Herpes Simplex Virus (HSV). There are two strains: HSV-1, which commonly causes oral ulcers but can also cause genital herpes, and HSV-2, which is the primary cause of genital herpes and lives in the genital area.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"How is genital herpes transmitted?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Genital herpes is transmitted through direct contact with the secretions or visible lesions of an infected person. After initial exposure, painful genital ulcers or vesicular clusters appear at the contact site, typically resolving within about 14 days.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"Can genital herpes be cured?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"No. Genital herpes cannot be cured. After the initial infection, the virus hides in the nervous system in a dormant state. The only thing that keeps it inactive is the patient's immune system. When immunity is lowered, the virus reactivates and symptoms return. This cycle can repeat throughout life.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What triggers genital herpes recurrence?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Herpes recurrences are triggered by conditions that lower the immune system, including any medical illness, excessive work leading to insufficient sleep, and mental or physical stress. Maintaining a healthy immune system is the best way to reduce recurrences.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"How is genital herpes diagnosed?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Genital herpes can be diagnosed clinically when symptoms are obvious or there is a well-recognized history of infection. Other methods include a Tzanck smear using a direct swab from the vesicular lesions, or an HSV PCR blood test for cases where direct swabbing is not possible.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"What medications are used to treat genital herpes?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"Antiviral medications are used to shorten the duration of symptoms and reduce transmission. Approved options include Acyclovir (the standard formula with low side effects), Valacyclovir (with better intestinal absorption), Penciclovir (topical therapy for oral HSV), and Ganciclovir (which also works against Cytomegalovirus). Without treatment, genital herpes typically resolves on its own within about 19 days.\"\r\n      }\r\n    },\r\n    {\r\n      \"@type\": \"Question\",\r\n      \"name\": \"Is there a vaccine for genital herpes?\",\r\n      \"acceptedAnswer\": {\r\n        \"@type\": \"Answer\",\r\n        \"text\": \"No. There is currently no approved vaccine for genital herpes. The best prevention strategy is maintaining a healthy immune system and practicing safe sexual behaviors. Because genital herpes is associated with other STDs, a full STD screening is recommended.\"\r\n      }\r\n    }\r\n  ]\r\n}\r\n<\/script>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"745\" data-attachment-id=\"3568\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/2021\/08\/20\/herpes-genitalia-viral-infection\/skin-hsv\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Skin-HSV.jpg?fit=1200%2C1117&amp;ssl=1\" data-orig-size=\"1200,1117\" data-comments-opened=\"1\" data-image-meta=\"{&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Example of Herpes infection at buttock Ref: Campbell Walsh Wein Urology standard textbook.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Skin-HSV.jpg?fit=800%2C745&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Skin-HSV.jpg?resize=800%2C745&#038;ssl=1\" alt=\"Clustered herpes simplex vesicles on the skin of the buttock\" class=\"wp-image-3568\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Skin-HSV.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Skin-HSV.jpg?resize=300%2C279&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Skin-HSV.jpg?resize=1024%2C953&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Skin-HSV.jpg?resize=768%2C715&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Skin-HSV.jpg?resize=13%2C12&amp;ssl=1 13w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Herpes simplex infection affecting the skin of the buttock.<\/figcaption><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">The two strains of <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK554427\/\">herpes simplex virus<\/a><\/h4>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>HSV-1<\/strong> \u2014 usually lives around the mouth and causes oral ulcers, but can also cause genital herpes.<\/li>\n\n\n\n<li><strong>HSV-2<\/strong> \u2014 usually lives in the genital area, and is the main cause of genital herpes.<\/li>\n<\/ol>\n\n\n\n<h4 class=\"wp-block-heading\">How it behaves in the body<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">The virus is transmitted by direct skin-to-skin contact. After the first exposure, painful genital ulcers or clusters of vesicles appear. Symptoms of a first episode settle over a couple of weeks, but the virus does not leave \u2014 it withdraws into the nervous system and lies dormant there. When immunity dips \u2014 through illness, sleep deprivation or sustained stress \u2014 the virus reactivates and symptoms return, usually more briefly and more mildly than the first time. That cycle continues for life, which is why herpes is often described as a never-ending infection.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There is one fact about transmission that is more important than everything else on this page, and it is the one most often missed. <strong>The virus can be passed on when there are no sores and nothing to see or feel.<\/strong> This is called asymptomatic shedding, and it means a person can transmit herpes without knowing they have it and without having done anything careless. It is not a rare quirk: when sensitive testing is used, virus is detectable on the skin of the great majority of people carrying HSV-2, on roughly one day in five to one day in ten, and the large majority of infected people have never been diagnosed and have no idea. That combination is why most new infections come from someone with no symptoms at the time rather than from someone with a visible sore. If you take one thing from this article, take that one \u2014 it changes how you think about protecting a partner, and it changes how you think about where your own infection came from.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"472\" data-attachment-id=\"3569\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/2021\/08\/20\/herpes-genitalia-viral-infection\/blank-puzzles-and-wooden-cubes-with-the-text-std-lie-on-a-light-blue-background\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/STD.jpg?fit=1200%2C708&amp;ssl=1\" data-orig-size=\"1200,708\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;11&quot;,&quot;camera&quot;:&quot;Canon EOS 6D&quot;,&quot;caption&quot;:&quot;Blank puzzles and wooden cubes with the text STD lie on a light blue background.&quot;,&quot;created_timestamp&quot;:&quot;1618144441&quot;,&quot;focal_length&quot;:&quot;50&quot;,&quot;iso&quot;:&quot;160&quot;,&quot;shutter_speed&quot;:&quot;0.01&quot;,&quot;title&quot;:&quot;Blank puzzles and wooden cubes with the text STD lie on a light blue background.&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Directly contact with HSV patient&amp;#8217;s secretion is the main transmission route.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/STD.jpg?fit=800%2C472&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/STD.jpg?resize=800%2C472&#038;ssl=1\" alt=\"Illustration of sexually transmitted infection risk and direct contact transmission\" class=\"wp-image-3569\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/STD.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/STD.jpg?resize=300%2C177&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/STD.jpg?resize=1024%2C604&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/STD.jpg?resize=768%2C453&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/STD.jpg?resize=16%2C9&amp;ssl=1 16w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Direct skin-to-skin contact is the route of transmission \u2014 and it can happen when no sores are visible.<\/figcaption><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\">Where did I get it, and when?<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">This is the question that causes the most distress in my clinic, and it is often asked with a particular fear behind it \u2014 that a partner must have been unfaithful. So let me answer it as plainly as I can.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A first outbreak does not mean a recent infection.<\/strong> The virus can sit dormant for months or years before it produces symptoms for the first time, and because of asymptomatic shedding it can be passed on by someone who has never had a single sore in their life and has no idea they carry it. A new diagnosis is therefore not evidence of anything about your relationship, and I would ask you not to treat it as such before you have had that conversation properly. It is also worth saying that this infection is extremely common worldwide \u2014 far more common than the number of people who talk about it \u2014 and having it says nothing about your character or your judgement.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Timing can sometimes be narrowed down, but not always, and not from the outbreak alone. If it matters to you, say so at your appointment rather than working it out from the internet.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Diagnosis and treatment<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnosis can often be made clinically when the appearance is characteristic. Where confirmation is needed, the options are a Tzanck smear taken directly from a vesicle, or HSV PCR \u2014 the most accurate method, which also identifies whether the strain is HSV-1 or HSV-2.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Antiviral treatment with Acyclovir, Valacyclovir or Famciclovir shortens the duration of symptoms and the period during which the virus can be transmitted. Left untreated, an episode resolves on its own over a matter of weeks \u2014 so the purpose of treatment is not to cure the infection but to shorten and soften each episode, and to reduce the risk to a partner.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Starting early is what makes the difference.<\/strong> These medicines work by stopping the virus multiplying, so they help most when taken as soon as an episode begins \u2014 ideally at the first warning sensation of tingling, itching or burning, before the blisters appear, rather than several days in when the ulcers are already established. For anyone with recurrent outbreaks, it is worth asking your doctor for a supply to keep at home so you can start immediately rather than waiting for an appointment. That single arrangement changes the experience of this condition more than almost anything else.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Where outbreaks are frequent, <strong>suppressive therapy<\/strong> \u2014 a low dose taken every day rather than only during episodes \u2014 reduces both how often they occur and the chance of passing the virus to a partner. It is worth knowing the size of that second effect rather than assuming it: daily suppressive treatment <strong>roughly halves<\/strong> the risk of transmission to an uninfected partner. That is a real and worthwhile reduction, and it is also not zero \u2014 which is exactly why it is used alongside condoms and honest conversation rather than instead of them. If a couple is making decisions on this, the halving is the number to plan around. It is a reasonable thing to ask about if outbreaks are affecting your life or your relationship, and it does not have to be permanent.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"1171\" data-attachment-id=\"3567\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/2021\/08\/20\/herpes-genitalia-viral-infection\/penile-hsv\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Penile-HSV.jpg?fit=820%2C1200&amp;ssl=1\" data-orig-size=\"820,1200\" data-comments-opened=\"1\" data-image-meta=\"{&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Example of Herpes simplex infection at penile skin Ref: Campbell Walsh Wein Urology standard textbook.&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Penile-HSV.jpg?fit=700%2C1024&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Penile-HSV.jpg?resize=800%2C1171&#038;ssl=1\" alt=\"Herpes simplex lesions on the penile skin\" class=\"wp-image-3567\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Penile-HSV.jpg?w=820&amp;ssl=1 820w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Penile-HSV.jpg?resize=205%2C300&amp;ssl=1 205w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Penile-HSV.jpg?resize=700%2C1024&amp;ssl=1 700w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Penile-HSV.jpg?resize=768%2C1124&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2021\/08\/Penile-HSV.jpg?resize=8%2C12&amp;ssl=1 8w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Herpes simplex infection affecting the penile skin.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">There is currently no approved vaccine against HSV. Because genital herpes is associated with other sexually transmitted infections, a comprehensive STI screen is worth doing at the same time rather than testing for herpes alone.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Two situations that need mentioning to a doctor specifically<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Pregnancy.<\/strong> If you or your partner is pregnant, or planning to be, genital herpes must be raised with the obstetric team rather than managed quietly. The concern is not the mother but the baby: herpes passed to a newborn around the time of delivery is a serious infection. It is uncommon, and it is largely preventable when the team knows in advance \u2014 they can plan antiviral treatment late in pregnancy and make an informed decision about delivery. A first episode occurring during pregnancy matters more than a long-standing infection, so the history is worth giving in full. Nobody can plan around something they have not been told.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>HIV testing.<\/strong> Genital ulcers of any cause break the skin barrier, and having them raises the risk of acquiring HIV if exposed. This is a practical reason to include HIV in the screen rather than a judgement about anybody. HIV testing is not done in the urology clinic here \u2014 at Bangkok Hospital Headquarters it is handled by the Infectious Diseases department, and I refer patients there. Testing and treatment for other sexually transmitted infections, and HPV vaccination, are available with me.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">And one thing that genuinely does need urgent care rather than an appointment: <strong>if a severe first episode makes it impossible to pass urine, go to an emergency department the same day \u2014 in Thailand you can call 1669.<\/strong> A severe outbreak can cause enough pain and local nerve irritation to stop the bladder emptying, and that needs treating rather than enduring. Severe headache with neck stiffness and light sensitivity during an outbreak also needs same-day assessment.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Q1: Is herpes genitalia curable?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">No. Herpes genitalia caused by Herpes Simplex Virus (HSV) is not curable. Once infected, the virus permanently resides in the nervous system in a dormant (hibernating) state. However, it is very manageable. Antiviral medications such as Acyclovir and Valacyclovir effectively reduce the severity and duration of outbreaks, speed up healing, and reduce the risk of transmitting the virus to partners.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q2: How is herpes genitalia transmitted?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Herpes genitalia is transmitted primarily through direct skin-to-skin contact with an infected person&#8217;s secretions or active lesions during sexual activity. HSV-2, which mainly causes genital herpes, is spread through genital contact. HSV-1, which typically causes oral herpes, can also cause genital herpes through oral-genital contact. Importantly, transmission can occur even when an infected person has no visible sores, a phenomenon known as asymptomatic viral shedding.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q3: Does a first outbreak mean I was infected recently, or that my partner was unfaithful?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">No, and this is worth understanding before difficult conversations happen. The virus can lie dormant for months or years before producing symptoms for the first time, so a first outbreak does not date the infection. Because the virus can also be passed on when there are no sores at all, it can be transmitted by someone who has never had symptoms and does not know they carry it. A new diagnosis is therefore not evidence of infidelity. Genital herpes is also far more common than the number of people who discuss it, and having it reflects nothing about a person&#8217;s character or judgement. If the timing genuinely matters to you, raise it at your appointment rather than trying to work it out alone.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q4: Why does herpes genitalia keep coming back?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">After the initial infection, the HSV virus hides in the nervous system in a dormant state, kept inactive by the immune system. When the immune system is weakened due to illness, excessive stress, sleep deprivation, or other medical conditions, the virus reactivates and travels back to the genital skin, causing a new outbreak. Recurrent episodes are usually shorter and milder than the first. This reactivation cycle can repeat throughout a person&#8217;s lifetime, which is why herpes is described as a never-ending viral infection.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q5: When should I start antiviral treatment for an outbreak?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">As early as possible. Antivirals work by preventing the virus from multiplying, so they help most when started at the very first warning sensation \u2014 the tingling, itching or burning that many people learn to recognise before any blister appears \u2014 rather than several days later when ulcers have formed. If you have recurrent outbreaks, ask your doctor about keeping a supply at home so you can begin immediately instead of waiting for an appointment. For frequent recurrences, daily suppressive therapy is an alternative that reduces both outbreak frequency and transmission risk to a partner.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q6: How is herpes genitalia diagnosed?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Herpes genitalia can be diagnosed clinically when the characteristic painful genital ulcers or vesicular clusters are visible and the patient has a known history. Laboratory confirmation options include a Tzanck smear (direct swab from the lesion) or HSV PCR when direct swabbing is possible. HSV PCR is the most accurate diagnostic method and can also identify whether the strain is HSV-1 or HSV-2.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q7: I have herpes and I am pregnant, or planning to be. What should I do?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Tell your obstetric team, and tell them early. The concern is not the mother&#8217;s health but the risk of passing the infection to the baby around the time of delivery, which is a serious infection in a newborn. It is uncommon and largely preventable when the team knows in advance, because they can plan antiviral treatment in late pregnancy and make an informed decision about how you deliver. A first episode occurring during pregnancy carries more weight than a long-standing infection, so give the full history rather than a summary. This applies equally if your partner has genital herpes and you do not.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q8: Should I be tested for HIV as well?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">It is worth including. Genital ulcers of any cause break the skin barrier and raise the risk of acquiring HIV if exposed, so testing is a practical precaution rather than a judgement. HIV testing is not performed in the urology clinic \u2014 at Bangkok Hospital Headquarters it is handled by the Infectious Diseases department, and patients are referred there. Testing and treatment for other sexually transmitted infections, and HPV vaccination, are available in the urology clinic.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q9: What symptoms during an outbreak need urgent care?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Being unable to pass urine is the main one. A severe first episode can cause enough pain and local nerve irritation to stop the bladder emptying, and that needs same-day treatment rather than endurance \u2014 go to an emergency department, or call 1669 in Thailand. A severe headache with neck stiffness and sensitivity to light during an outbreak also needs same-day assessment. Otherwise, an outbreak that is unusually severe, not settling, or occurring alongside a condition that weakens the immune system should be reviewed promptly rather than managed at home.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q10: How can I prevent herpes genitalia outbreaks?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Maintaining a healthy immune system is the most important factor in preventing recurrent outbreaks. This includes adequate sleep, stress management, regular exercise, and a healthy diet. For patients with frequent recurrences, suppressive antiviral therapy (daily low-dose Acyclovir or Valacyclovir) significantly reduces outbreak frequency and roughly halves the risk of transmission to an uninfected partner. Halving is a worthwhile reduction but it is not elimination, so suppressive therapy is used alongside condoms rather than instead of them. Consistent condom use also reduces, though does not eliminate, transmission risk, because the virus can be shed from skin that a condom does not cover.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Q11: Can I discuss this by video consultation?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes, and many patients prefer to for this particular condition. Bangkok Hospital Headquarters offers a Telemedicine service, arranged in advance by email to the Urology department at bhquro@bdms.co.th. It suits reviewing a known diagnosis, discussing suppressive therapy, and talking through what to tell a partner. A first episode is better seen in person, because confirming the diagnosis and swabbing a lesion cannot be done remotely, and because other causes of genital ulcers need to be excluded. Samitivej Sriracha is in-person only, booked through the Urology department line 088-022-1445.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you are experiencing symptoms of herpes genitalia or recurring genital ulcers, Dr. Soarawee Weerasopone offers confidential sexual health consultations at Bangkok Hospital Headquarters. <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Book a Consultation<\/a>. Appointments at Samitivej Sriracha Hospital can be arranged by calling the Urology department on <a href=\"tel:0880221445\">088-022-1445<\/a>. Questions about the cost of consultation, testing or treatment should go to the hospital directly \u2014 for Bangkok Hospital, by email to <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Reference<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Herpes Simplex Virus. StatPearls, National Center for Biotechnology Information. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK554427\/\" target=\"_blank\" rel=\"noreferrer noopener\">NCBI Bookshelf NBK554427<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Not every genital ulcer is herpes, and a first episode should be assessed rather than self-diagnosed. No medical advice, diagnosis or prescription is provided through personal messaging channels or social media. Always consult a qualified healthcare professional before starting any medical treatment. In an emergency, attend the nearest emergency department \u2014 in Thailand the emergency number is 1669.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/08\/20\/herpes-genitalia-viral-infection\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2021\/08\/20\/herpes-genitalia-viral-infection\/\",\n      \"name\": \"Genital Herpes (HSV): Why It Recurs, and How to Control It\",\n      \"description\": \"How herpes simplex virus is transmitted, including transmission with no visible sores; why a first outbreak does not date the infection; why it lies dormant and reactivates; how it is diagnosed; why starting antivirals at the first warning sensation matters; how much suppressive therapy reduces transmission; and what to do about pregnancy, HIV testing and urinary retention.\",\n      \"inLanguage\": \"en\",\n      \"datePublished\": \"2021-08-20\",\n      \"dateModified\": \"2026-08-30\",\n      \"lastReviewed\": \"2026-08-30\",\n      \"specialty\": \"https:\/\/schema.org\/Urologic\",\n      \"medicalAudience\": { \"@type\": \"MedicalAudience\", \"audienceType\": \"Patient\" },\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#website\" },\n      \"author\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"reviewedBy\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"publisher\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"disambiguatingDescription\": \"HIV testing and pre- or post-exposure prophylaxis are not provided in this urology clinic; at Bangkok Hospital Headquarters HIV is managed by the Infectious Diseases department and patients are referred there. Testing and treatment for other sexually transmitted infections, and HPV vaccination, are provided.\",\n      \"about\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/08\/20\/herpes-genitalia-viral-infection\/#genital-herpes\" }\n    },\n    {\n      \"@type\": \"MedicalCondition\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/08\/20\/herpes-genitalia-viral-infection\/#genital-herpes\",\n      \"name\": \"Genital herpes\",\n      \"alternateName\": \"Herpes simplex virus infection\",\n      \"description\": \"Infection with herpes simplex virus, usually HSV-2 in the genital area but also HSV-1 through oral-genital contact. After the first episode the virus withdraws into the nervous system and lies dormant, reactivating when immunity dips; recurrent episodes are typically shorter and milder than the first. It is not curable but is very manageable. A first outbreak does not date the infection, because the virus may lie dormant for months or years before producing symptoms, and because it can be transmitted by a person who has never had symptoms; a new diagnosis is therefore not evidence of recent acquisition or of infidelity.\",\n      \"signOrSymptom\": [\n        {\"@type\": \"MedicalSignOrSymptom\", \"name\": \"Painful genital ulcers\"},\n        {\"@type\": \"MedicalSignOrSymptom\", \"name\": \"Clusters of vesicles on genital or surrounding skin\"},\n        {\"@type\": \"MedicalSignOrSymptom\", \"name\": \"Prodromal tingling, itching or burning before lesions appear, which is the point at which antiviral therapy is most effective\"}\n      ],\n      \"transmissionMethod\": \"Direct skin-to-skin contact during sexual activity. Transmission occurs both from active lesions and, importantly, in the absence of any visible sores through asymptomatic viral shedding. Shedding is detectable by sensitive testing in the great majority of people carrying HSV-2 and occurs on a substantial minority of days, and most people carrying the virus have never been diagnosed, so most new infections are acquired from a partner who has no symptoms at the time rather than from a visible sore. Condoms reduce but do not eliminate risk, because shedding can occur from skin the condom does not cover.\",\n      \"riskFactor\": [\n        {\"@type\": \"MedicalRiskFactor\", \"name\": \"Reduced immunity through illness, sleep deprivation or sustained stress, which triggers reactivation\"}\n      ],\n      \"possibleComplication\": [\n        {\"@type\": \"MedicalEntity\", \"name\": \"Urinary retention during a severe first episode, from pain and local sacral nerve involvement, requiring same-day emergency assessment\"},\n        {\"@type\": \"MedicalEntity\", \"name\": \"Aseptic meningitis: severe headache with neck stiffness and photophobia during an outbreak requires same-day assessment\"},\n        {\"@type\": \"MedicalEntity\", \"name\": \"Neonatal herpes acquired around delivery, which is serious but uncommon and largely preventable when the obstetric team is informed in advance; a first episode occurring during pregnancy carries greater risk than long-standing infection\"},\n        {\"@type\": \"MedicalEntity\", \"name\": \"Genital ulceration breaches the skin barrier and increases the risk of HIV acquisition on exposure, so HIV testing should form part of the screen\"}\n      ],\n      \"typicalTest\": [\n        {\"@type\": \"MedicalTest\", \"name\": \"Clinical diagnosis from the characteristic appearance\"},\n        {\"@type\": \"MedicalTest\", \"name\": \"Tzanck smear taken directly from a vesicle\"},\n        {\"@type\": \"MedicalTest\", \"name\": \"HSV PCR, the most accurate method, which also identifies HSV-1 versus HSV-2\"}\n      ],\n      \"possibleTreatment\": [\n        {\n          \"@type\": \"MedicalTherapy\",\n          \"name\": \"Episodic antiviral therapy\",\n          \"description\": \"Aciclovir, valaciclovir or famciclovir shorten the duration of symptoms and the period of transmissibility. Efficacy depends on early initiation: the greatest benefit comes from starting at the prodrome, before lesions appear, rather than once ulcers are established. Patients with recurrent outbreaks benefit from holding a supply at home so treatment can begin immediately.\"\n        },\n        {\n          \"@type\": \"MedicalTherapy\",\n          \"name\": \"Suppressive antiviral therapy\",\n          \"description\": \"Daily low-dose therapy for frequent recurrences. It reduces outbreak frequency and approximately halves the risk of transmission to an uninfected partner. That reduction is worthwhile but is not elimination, so it is used alongside condoms and disclosure rather than instead of them. It need not be permanent. Treatment does not eradicate the virus, and there is currently no approved HSV vaccine.\"\n        }\n      ]\n    },\n    {\n      \"@type\": \"FAQPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/08\/20\/herpes-genitalia-viral-infection\/#faq\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2021\/08\/20\/herpes-genitalia-viral-infection\/#webpage\" },\n      \"mainEntity\": [\n        {\"@type\": \"Question\", \"name\": \"Is herpes genitalia curable?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"No. Genital herpes caused by herpes simplex virus is not curable, because the virus resides permanently in the nervous system in a dormant state. It is, however, very manageable: antiviral medication such as Acyclovir or Valacyclovir reduces the severity and duration of outbreaks, speeds healing, and lowers the risk of transmission to partners.\"}},\n        {\"@type\": \"Question\", \"name\": \"How is herpes genitalia transmitted?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Transmission is by direct skin-to-skin contact during sexual activity. HSV-2 spreads through genital contact; HSV-1, which usually causes oral herpes, can cause genital herpes through oral-genital contact. Crucially, transmission can occur even with no visible sores, through asymptomatic viral shedding. Shedding is detectable in the great majority of people carrying HSV-2 and occurs on a substantial minority of days, and most people carrying the virus have never been diagnosed, which is why most new infections come from a partner with no symptoms at the time rather than from a visible sore.\"}},\n        {\"@type\": \"Question\", \"name\": \"Does a first outbreak mean I was infected recently, or that my partner was unfaithful?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"No. The virus can lie dormant for months or years before producing symptoms for the first time, so a first outbreak does not date the infection. Because it can also be passed on when there are no sores at all, it can be transmitted by someone who has never had symptoms and does not know they carry it. A new diagnosis is therefore not evidence of infidelity. Genital herpes is far more common than the number of people who discuss it, and having it reflects nothing about a person's character or judgement.\"}},\n        {\"@type\": \"Question\", \"name\": \"Why does herpes genitalia keep coming back?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"After the first infection the virus lies dormant in the nervous system, held inactive by the immune system. When immunity is weakened by illness, stress, sleep deprivation or other conditions, the virus reactivates and travels back to the genital skin, causing a new outbreak. Recurrent episodes are usually shorter and milder than the first, and the cycle can repeat throughout life.\"}},\n        {\"@type\": \"Question\", \"name\": \"When should I start antiviral treatment for an outbreak?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"As early as possible. Antivirals prevent the virus multiplying, so they help most when started at the first warning sensation of tingling, itching or burning, before any blister appears, rather than days later when ulcers have formed. Patients with recurrent outbreaks should ask about keeping a supply at home so treatment can begin immediately. For frequent recurrences, daily suppressive therapy reduces both outbreak frequency and transmission risk.\"}},\n        {\"@type\": \"Question\", \"name\": \"How is herpes genitalia diagnosed?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"It can often be diagnosed clinically when the characteristic painful ulcers or vesicle clusters are visible. Laboratory confirmation is by Tzanck smear taken directly from a lesion, or HSV PCR, which is the most accurate method and also identifies whether the strain is HSV-1 or HSV-2.\"}},\n        {\"@type\": \"Question\", \"name\": \"I have herpes and I am pregnant, or planning to be. What should I do?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Tell the obstetric team, and tell them early. The concern is not the mother's health but the risk of passing the infection to the baby around delivery, which is serious in a newborn. It is uncommon and largely preventable when the team knows in advance, because antiviral treatment can be planned in late pregnancy and an informed decision made about the mode of delivery. A first episode during pregnancy carries more weight than long-standing infection, so the full history matters. This applies equally where the partner has genital herpes and the pregnant person does not.\"}},\n        {\"@type\": \"Question\", \"name\": \"Should I be tested for HIV as well?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"It is worth including. Genital ulcers of any cause break the skin barrier and raise the risk of acquiring HIV on exposure, so testing is a practical precaution rather than a judgement. HIV testing is not performed in this urology clinic; at Bangkok Hospital Headquarters it is handled by the Infectious Diseases department and patients are referred there. Testing and treatment for other sexually transmitted infections, and HPV vaccination, are available in the urology clinic.\"}},\n        {\"@type\": \"Question\", \"name\": \"What symptoms during an outbreak need urgent care?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Being unable to pass urine is the main one: a severe first episode can cause enough pain and local nerve irritation to stop the bladder emptying, and that needs same-day treatment at an emergency department. A severe headache with neck stiffness and light sensitivity during an outbreak also needs same-day assessment. An outbreak that is unusually severe, not settling, or occurring alongside a condition that weakens the immune system should be reviewed promptly rather than managed at home.\"}},\n        {\"@type\": \"Question\", \"name\": \"How can I prevent herpes genitalia outbreaks?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Keeping the immune system healthy matters most: adequate sleep, stress management, regular exercise and a good diet. For frequent recurrences, daily suppressive antiviral therapy significantly reduces outbreak frequency and roughly halves the risk of transmission to an uninfected partner. Halving is worthwhile but is not elimination, so suppressive therapy is used alongside condoms rather than instead of them. Consistent condom use reduces, though does not eliminate, the risk of transmission, because the virus can be shed from skin a condom does not cover.\"}},\n        {\"@type\": \"Question\", \"name\": \"Can I discuss this by video consultation?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Yes, and many patients prefer to for this condition. Bangkok Hospital Headquarters offers a Telemedicine service, arranged in advance by email to the Urology department at bhquro@bdms.co.th. It suits reviewing a known diagnosis, discussing suppressive therapy, and talking through what to tell a partner. A first episode is better seen in person, because confirming the diagnosis and swabbing a lesion cannot be done remotely and other causes of genital ulcers need to be excluded. Samitivej Sriracha is in-person only, booked through the Urology department line 088-022-1445.\"}}\n      ]\n    }\n  ]\n}\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>Genital herpes cannot be cured, but it can be controlled well \u2014 and that distinction matters more than most patients realise. Dr. Soarawee Weerasopone, urologist at Bangkok Hospital, explains how HSV behaves, why outbreaks return, and what actually reduces them.<\/p>","protected":false},"author":185281453,"featured_media":10048,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"Genital herpes (HSV): how it is transmitted, why outbreaks recur, how it is diagnosed, and how suppressive therapy reduces recurrence. 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