While some people realize that they have genital herpes, many do not. It is estimated that one in five persons in the United States has genital herpes; however, as many as 90 percent are unaware that they have the virus. This is because many people have very mild symptoms that go unrecognized or are mistaken for another condition or no symptoms at all.
Pain, itching and the appearance of sores called lesions are common symptoms of genital herpes. Lesions may appear inside or outside the vagina, and on or around the penis. In both women and men, these sores may appear in and around the anus.6 Lesions typically appear from two days to two weeks after you first get infected with the virus, and will take seven to 14 days or more to heal.7
Particularly when someone is on suppressive antiviral medication and practicing safer sex, risk of transmission can be greatly reduced. Cullins suggests female condoms (condoms that go inside the vagina and cover most of the vulva, though it's important to note that not all people with vaginas are female) to provide the most protection against transmission, though condoms that go over the penis will protect what they cover.
A doctor will base a presumptive diagnosis on information provided by the patient and on the physical examination. The characteristic appearance of the herpes sores leaves little doubt about the diagnosis, so the typical appearance of the sores is key to the diagnosis. This appearance helps distinguish oral herpes from oral thrush, shingles, gonorrhea, and syphilis. In addition, chapped or sunburned lips can resemble oral herpes, but the tissue stain (Tzanck smear, see below) shows no virus-induced cell changes. Further testing is usually not necessary but is sometimes done.