Genital herpes diagnoses are on the rise in England, according to recent figures from the UK Health Security Agency, despite an overall decrease in newly diagnosed sexually transmitted infections.

In 2025, 28,779 people were diagnosed with a first episode of genital herpes, marking an increase of just over three percent compared to the previous year. However, health experts suggest the true number of infections is likely much higher, as many individuals do not exhibit symptoms and may be unaware they are carrying the virus.

Sarah Mulindwa, a senior sexual health nurse, explained that the asymptomatic nature of genital herpes contributes significantly to its spread. "Many people don't develop symptoms straight away following contact, and some may never develop noticeable symptoms at all," she stated. "Herpes can remain dormant in the body for months or even years before causing an outbreak, which means people often have no idea when or where they first acquired the virus."

This dormant period is followed by periods of "viral shedding," when the herpes virus is active on the skin and can be transmitted to others, even without visible sores. This phenomenon, known as asymptomatic shedding, is a primary reason for the virus's prevalence.

Transmission and Symptoms

Genital herpes can be transmitted through vaginal, anal, and oral sex. Transmission can occur even when the infected person has no visible sores. The virus responsible for cold sores, HSV-1, can also be transferred from the mouth to the genitals during oral sex.

For those who do develop symptoms, they typically appear between two and 12 days after exposure, with an average onset of four to six days. The first outbreak is often the most severe, potentially lasting two to four weeks and including painful blisters or ulcers around the genitals, anus, or mouth. Other symptoms can include tingling or itching before sores appear, pain during urination, swollen glands, and flu-like symptoms such as fever, headache, and muscle aches.

Future outbreaks are generally milder and shorter, especially with early antiviral treatment. However, the frequency and pattern of outbreaks vary significantly among individuals. Some may experience only one outbreak, while others may have several per year.

Common triggers for outbreaks include stress, illness, hormonal changes, and friction around the affected area. For women, hormonal fluctuations related to menstruation and menopause may also play a role, though research in this area is ongoing. The impact of herpes extends beyond physical symptoms, with many individuals experiencing anxiety and embarrassment due to the stigma surrounding the infection.

Diagnosis and Treatment

Diagnosis of herpes is typically confirmed through a swab test taken from open sores, which can identify whether the infection is caused by HSV-1 or HSV-2. While blood tests can detect antibodies to the virus, they are not routinely used in UK sexual health clinics as they cannot reliably indicate when or where the infection was acquired.

Antiviral medications such as aciclovir, valaciclovir, and famciclovir can help manage herpes by shortening outbreaks, reducing symptoms, and lowering the risk of transmission. For individuals experiencing frequent recurrences, daily antiviral medication can significantly decrease both outbreaks and viral shedding.

Debunking Myths

Several myths surrounding herpes contribute to its stigma. Contrary to popular belief, herpes is not rare and can affect individuals regardless of their number of sexual partners. It is one of the most common viral sexually transmitted infections. Furthermore, it is not always apparent when someone has herpes, as many people remain asymptomatic. Transmission is also possible without visible sores.

Regarding diet, there is limited strong evidence to suggest that specific foods directly trigger herpes outbreaks. While some individuals report personal triggers like alcohol, chocolate, or nuts, maintaining a healthy lifestyle, adequate sleep, and stress management are considered more important factors. The effectiveness of lysine supplements remains mixed according to scientific evidence.

Herpes does not prevent individuals from having healthy relationships or sexual lives. Most people diagnosed with herpes go on to lead normal lives, form relationships, and have families.

Herpes in Women and Pregnancy

Women are biologically more susceptible to acquiring genital herpes during vaginal sex due to the nature of the genital lining. Outbreaks in women can occur on the vulva, around the vagina, on the cervix, buttocks, or anus. In men, sores typically appear on the penis, scrotum, buttocks, or around the anus.

Most women with herpes experience healthy pregnancies and deliver healthy babies. The primary concern arises if a woman contracts herpes for the first time during the final months of pregnancy, as she may not have developed protective antibodies to pass on to the baby. In cases of active genital sores or early symptoms during labor, a Cesarean section may be recommended to minimize the risk of transmission. Neonatal herpes is rare but can be severe, underscoring the importance for pregnant individuals with a history of herpes to inform their healthcare providers early in their pregnancy.