I have been living with both genital herpes and genital warts for many years. My husband passed away 6 years ago, and I only learned afterwards about shedding and that a person can have no symptoms and pass the virus on. I was originally told I could only pass the virus on when I had an active outbreak, and have never understood how someone can have herpes and not experience symptoms.

First of all, it’s important to separate genital herpes from genital warts. Both are caused by viruses. However, the viruses are different, and they cause different kinds of symptoms.

Genital herpes is caused by two related but different herpes viruses: Herpes simplex virus type 1 (HSV-1) and Herpes simplex virus type 2 (HSV-2). Infections with HSV-1 are very common (about 75% of adults, depending on age and where you live) and usually cause an infection with few symptoms: most people never know they have it. HSV-1 infections can be passed during sex from one person to another, but it can also be passed by other types of contact as well. If people do have symptoms of HSV-1 infection, it is often with recurrent sores around their lips and mouth, commonly known as “cold sores” or “fever blisters.”

HSV-1 often causes genital herpes outbreaks. When it does, it is often only once. Then, the person never has another outbreak even though they still have the herpes infection. Their sex partners don’t get this infection because HSV-1 infections are already so common. This may explain your story because we’ve only known how to do specific tests for HSV-1 and HSV-2 for the past few years.

HSV-2 is different. HSV-2 infections are less common than HSV-1. However, about 25% – 30% of adults in the United States have an HSV-2 infection. HSV-2 infections are what people are usually thinking about when they talk about genital herpes. It is usually passed between people by sexual contact. However, most people with HSV-2 don’t know they have it either. Some people, however, get genital herpes outbreaks, often several times each year.

Genital warts are usually caused by human papilloma viruses (HPV). There are more than 100 types of these viruses, but only two of these types cause most cases of genital warts. Other HPV types cause several different types of genital and head/neck cancer. Although we are still learning more about HPV infections, most people with genital warts get over them without any complications. It’s important to know, however, that a vaccine is now recommended for almost all young women between ages 9 and 26 years that will prevent HPV infections by the two types that cause most genital warts, as well as the two types that cause most cancers.

–J. Dennis Fortenberry, MD, MS
Indiana University School of Medicine