What Are the Long-Term Effects of Genital Herpes?

After the initial infection, HSV remains in the body and can become inactive in nerve cells. It can reactivate later and cause another outbreak.^[5]

Genital HSV-2 generally causes more frequent recurrences than genital HSV-1. Outbreak patterns vary from person to person, but recurrent HSV-2 outbreaks often become less frequent over time.^[1]

Possible Outbreak Triggers

• Emotional stress
• Illness or fever
• Menstrual period
• Surgery or injury
• Sun exposure (more often associated with oral herpes)^[5]

Daily suppressive therapy may be worth discussing with a clinician if outbreaks are frequent, painful, or affecting your quality of life, or if reducing the chance of transmission is a priority. For people with recurrent genital HSV-2, daily antiviral medication can reduce outbreak frequency and may lower the risk of passing HSV-2 to a partner, though it does not eliminate that risk.^[1]

One of the most significant — and least talked about — long-term effects of genital herpes isn't physical at all. It can be the psychological burden that follows a diagnosis.^[6]

A 2023 study published in The Lancet Regional Health – Americas used quality-adjusted life years (QALYs) to model the full health burden of genital herpes in the US. The model found that post-diagnosis psychosocial distress and recurrent outbreaks were key contributors to the estimated health burden.^[7]

Some people with genital herpes may experience^[6]:

• Anxiety and fear about future outbreaks
• Low mood or depression after diagnosis
• Concerns about disclosure to current or future sexual partners
• Feelings of shame, stigma, or reduced self-worth
• Fear of rejection in romantic relationships
• Reduced sexual confidence and intimacy

These emotional effects are real and valid, and support is available. Counseling, peer support groups, and working with a provider you trust can help. For many people, the distress may ease over time as they learn to manage the infection and navigate conversations with partners.^[6]

Based on 2020 estimates, the WHO reports that 520 million people ages 15 to 49 worldwide have HSV-2, the main cause of genital herpes.^[5] You are far from alone.

This is one of the most clinically significant long-term concerns associated with HSV-2. According to the WHO, HSV-2 infection increases the risk of acquiring HIV by approximately three times.^[5]

Why? There are two main mechanisms:

• Physical changes in genital tissue: Herpes sores and HSV-2-related inflammation can disrupt the genital or anal skin, which may make it easier for HIV to enter the body.^[5]
• Immune changes in genital tissue: HSV-2 is associated with an increased presence of immune cells that HIV can infect, which may make it easier for HIV to establish infection.^[8]

Importantly, this elevated risk is not limited to times when sores are visible. HSV-2 can cause changes in genital immune cells even without recognized symptoms.^[8]

For people with genital herpes who are HIV-negative, consistent condom use, and PrEP (pre-exposure prophylaxis for HIV) are strategies worth discussing with a healthcare provider.^[2,5]

If you have genital herpes and become pregnant — or become pregnant while herpes-positive — it's essential to tell your provider. There are specific risks and precautions to be aware of.

Risks During Pregnancy

• Some research suggests genital herpes infection may increase the risk of miscarriage or preterm birth.^[4]
• Neonatal herpes — transmission to the baby during delivery — is the most serious concern.

Neonatal Herpes

Neonatal herpes can occur when an infant is exposed to HSV, most often during delivery.^[4] It's rare — the World Health Organization estimates about 10 cases per 100,000 births globally — but it can be serious, leading to neurological damage or death if not treated promptly.^[5]

The highest risk is when someone acquires a new genital herpes infection near the time of delivery, before their body has had time to develop protective antibodies.^[1] People who had genital herpes before pregnancy have a lower (but not zero) risk of transmission.^[1]

How to Reduce the Risk

• Tell your OB or midwife about your herpes status — even if you haven't had an outbreak in years
• Your provider may recommend antiviral medication starting at36 weeks of pregnancy to reduce outbreak risk at delivery^[1]
• If you have active sores or warning symptoms when labor begins, a cesarean section may be recommended to reduce the baby's exposure to HSV^[1]

Neurological complications from genital herpes are uncommon — but they're worth knowing about, especially if you notice unusual symptoms during or after an outbreak.^[1]

Aseptic Meningitis

In some cases, HSV-2 can cause aseptic meningitis — inflammation of the membranes surrounding the brain and spinal cord. This can happen during a first outbreak or a recurrence, and is a rare complication of HSV-2 genital herpes.^[1] Symptoms include:

• Severe headache
• Stiff neck
• Sensitivity to light
• Fever
• Nausea^[1]

HSV-2 meningitis can be self-limited, but it still needs prompt medical evaluation. Treatment may include IV acyclovir followed by oral antiviral medication.^[1]

Mollaret's Meningitis

A small subset of people who develop HSV-2-related aseptic meningitis may experience recurrent episodes — a rare pattern called Mollaret's meningitis. HSV-2 is a common cause, but treatment and prevention of recurrence should be individualized with a specialist.^[1]

Encephalitis

Herpes encephalitis — inflammation of the brain tissue itself — is very rare. It is more commonly associated with HSV-1 than HSV-2. If you experience confusion, personality changes, seizures, or difficulty speaking, seek emergency care immediately.^[9]

Rarely, a first episode of genital herpes can affect nerves in the lower spine and cause urinary retention, meaning difficulty urinating or being unable to empty the bladder fully. This complication needs prompt medical assessment and often improves with treatment.^[10]

If you are unable to urinate, seek urgent medical care. If you are having significant pain or difficulty urinating during an outbreak, contact a healthcare provider promptly. A short-term catheter may be needed to relieve urinary retention.^[10]

Complication	What It Is	When to Seek Care
Herpetic whitlow	HSV infection of a finger, often near the fingernail, after direct contact with infectious fluid	If you develop painful blisters, swelling, or tenderness on a finger[11]
Herpes keratitis	HSV infection of the cornea. It is more often linked to HSV-1 than genital HSV-2.	Same day for eye pain, redness, light sensitivity, blurred vision, or watery discharge[12]
Severe disseminated HSV infection	A rare, severe HSV infection that can affect internal organs, such as the liver or lungs	More likely in people with weakened immune systems and can also occur during pregnancy; requires emergency care[1]

To help prevent spreading the virus to other parts of your body: don't touch sores with bare hands, and if you do, wash your hands thoroughly before touching your face, eyes, or any other area.^[12]

The good news is that the most common long-term effects of genital herpes — recurrent outbreaks and their physical and emotional toll — are manageable. Here's what works:

Antiviral Medications

• Episodic therapy — taken at the first sign of an outbreak to shorten its duration and severity^[1]
• Suppressive therapy — daily antiviral medication to reduce outbreak frequency and asymptomatic shedding. For people with recurrent genital HSV-2, it can also lower the risk of passing HSV-2 to a partner^[1]

Suppressive therapy may be especially helpful for people with frequent outbreaks, people with partners who do not have HSV-2, and anyone whose outbreaks significantly affect their quality of life.^[1]

Reducing Transmission Risk

• Use condoms consistently — they reduce (but don't eliminate) transmission risk
• Avoid sexual activity during active outbreaks and prodromal symptoms (tingling, itching before sores appear)^[1]
• Discuss daily suppressive therapy with a healthcare provider if reducing HSV-2 transmission is a priority^[1]
• Talk openly with partners — let current partners and future partners know before initiating sexual activity^[1]

Supporting Your Mental Health

• Talk to a therapist or counselor, especially in the months after diagnosis
• Seek out peer support — online and in-person communities exist for people with herpes
• Work with a healthcare provider who approaches herpes matter-of-factly — it's one of the most common infections in the world^[5]

Contact a provider if you experience:

• A first outbreak, even if symptoms seem mild^[1]
• Recurrences that are frequent, painful, or affecting your quality of life — a provider can help determine whether suppressive therapy is appropriate^[1]
• Difficulty urinating during an outbreak^[10]
• Severe headache, stiff neck, or sensitivity to light — seek urgent medical care^[1]
• Eye pain, redness, sensitivity to light, or changes in vision — seek same-day eye care^[12]
• Any new or unusual symptoms you can't explain
• You're pregnant or trying to conceive
• You have HIV or another condition that suppresses your immune system^[1]

Know Your Sexual Health Status With Everlywell

HSV-2 increases the risk of acquiring HIV if exposed. Talk with a healthcare provider about which STI tests are right for you, even if you do not have symptoms.^[5]

Everlywell's at-home STD test screens for five common STIs — chlamydia, gonorrhea, trichomoniasis, hepatitis C, and syphilis — with private at-home collection, lab-certified results, and secure online delivery. No clinic visit required.

If you're already managing herpes and need antiviral treatment or a prescription refill, Everlywell's online STI treatment consultations connect you with a licensed provider in 2 hours or less — who can evaluate your symptoms and send a prescription directly to your pharmacy if appropriate.

Managing herpes well starts with having the right support. Everlywell is here to help make that easier.