What To Do During a Genital Herpes Outbreak

Genital herpes is a lifelong condition. Once you’ve contracted it, the virus stays in your nerve cells forever — even if you never have symptoms.

And while that might sound overwhelming, there’s good news, too. For starters, genital herpes is usually dormant, or inactive, so try not to panic or assume that you’ll have to swear off sexual activity forever. With the right education and guidance from your healthcare provider, genital herpes is a manageable condition.

Infectious disease expert Oluwatosin Goje, MD, explains what you can do to cope with your genital herpes outbreaks and address symptoms when they do appear.

What happens during a genital herpes outbreak?

Genital herpes is a sexually transmitted infection (STI) that causes sores on your genitals and/or anus. And although you might not hear a lot of people talking about it, it’s fairly common: The U.S. Centers for Disease Control (CDC) estimates that about 12% of 15- to 49-year-olds in the U.S. have it.

There are two kinds of herpes simplex infections: HSV-2 is usually genital, while HSV-1 is the cause of cold sores on the mouth — but it can also cause genital herpes after oral and digital sexual activity.

Once you contract genital herpes, you have it forever, but that doesn’t mean it’s always active. When it is active, you’re having what’s known as an outbreak, when the virus is triggered and you start to show symptoms. The primary symptom is sores on your genitals, anus and surrounding region.

“Not everyone who has a diagnosis of herpes has outbreaks or flares,” Dr. Goje notes. “For those who do, the first year after diagnosis is the most difficult period, then, most people have fewer outbreaks as the year progresses.”

Look for signs that an outbreak is coming

Sometimes, you can tell that an outbreak is on its way. In the days or hours before sores appear, you may start to feel like you’re coming down with the flu, with symptoms like headache, fever, fatigue and swollen lymph nodes. Other symptoms include:

• Pain in your genitals.
• Tingling or shooting pain in your legs, hips or butt.
• Trouble urinating.

These early warning signs that an outbreak is coming are part of what’s called the prodromal stage. About 50% of people with genital herpes experience it.

“If you feel tingling, itching or burning before an outbreak, you should start taking medications at that time,” Dr. Goje advises.

How to manage a genital herpes outbreak

Once an outbreak has made its presence known, there are steps you can take to try to minimize it and ease your symptoms until it passes.

• Apply an ice pack to your genitals. Be sure to protect your skin by wrapping the ice pack in a washcloth.
• Take a bath. “Warm baths or sitz baths cleanse the area and keep it clean, which allows for rapid healing,” Dr. Goje explains.
• Keep your genitals dry. Too much moisture can irritate an outbreak. When you’re not in the bath or shower, keep your genitals dry by wearing cotton underwear and avoiding tight-fitting clothes.
• Adapt as needed. “Some people may need to urinate in a bowl of water or in a tub to prevent the burning from urination,” Dr. Goje says.
• Try OTC painkillers. You can take ibuprofen and use over-the-counter (OTC) lidocaine cream to reduce pain and discomfort.
• Take it easy. “If possible, rest, eat healthily and try to improve your immune system,” Dr. Goje advises.

Typically, the first herpes outbreak is the worst, in terms of severity and healing time. Future outbreaks are usually less severe and heal faster.

What to know about sex and genital herpes

Take a deep breath: Having genital herpes doesn’t mean that sex is off-limits. That said, genital herpes can be transmitted to other people — even when you’re not experiencing visible symptoms — so the combination of condoms and medication is critical.

“You can have a normal sex life by always using condoms with partners and using continuous antiviral suppression therapy,” Dr. Goje reassures.

But genital herpes is most contagious during outbreaks, so if you’re in the midst of one, it’s vital that you put sex (and related activities) on hold until you heal.

Can genital herpes outbreaks be prevented?

There’s no vaccine or cure for genital herpes, and Dr. Goje reiterates that not everyone who has genital herpes experiences outbreaks or flare-ups. But if you’re prone to them, she says there are some preventive measures you can take.

Ask about medication

Your healthcare provider may be able to prescribe you a medication that can keep outbreaks at bay.

“Systemic antiviral medication can help control the signs and symptoms of genital herpes,” Dr. Goje says. Ask your provider about daily oral medication options that may be right for you.

Identify (and avoid) your triggers

It can also be helpful to figure out your specific triggers, or what causes your outbreaks. For some people, it’s stress or fatigue. For others, it’s sun exposure.

“Keep a diary and document your activities before the outbreak,” Dr. Goje suggests. This may help you figure out what tends to cause your symptoms.

But there are times when you can’t control your triggers — like when the virus is activated by an infection, an illness, a weakened immune system or even menstrual periods.

“Sometimes, people cannot avoid outbreaks when they are sick or immunocompromised or taking medications that decrease their immunity,” Dr. Goje explains. “In these cases, focus on reducing your symptoms and minimizing the impact of the outbreak.”

You may be feeling all kinds of emotions as you deal with an outbreak. But through it all, try to remember: Although genital herpes is a lifelong condition, your outbreak will subside. Talk to your healthcare provider about how to best manage your genital herpes so that you can prevent future outbreaks.