Think you can tell that a rash or sore is a genital herpes infection just by looking at it? If you said “no,” you’re right. You can’t. And neither can your healthcare provider.
Herpes Signs and Symptoms
While some people realize that they have genital herpes, many do not. It is estimated that one in eight 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.
Because signs can vary a great deal, we recommend that an individual see a healthcare provider to be tested if they have a lesion of any kind. This can be swabbed for testing.
A person may show symptoms within days after contracting genital herpes, or it may take weeks, months, or even years. Some people may have a severe outbreak within days after contracting the virus while others may have a first outbreak so mild that they do not notice it. Because of these possibilities, it can be difficult for people to know when and from whom they may have contracted the virus.
The First Episode
If you were diagnosed with genital herpes in the last few days, you may be experiencing a number of uncomfortable or painful symptoms. Or, perhaps the symptoms are rather mild, barely noticeable, and resemble an insect bite or a rash. First episodes usually occur within the first two weeks after the virus is transmitted.
The “classic” symptoms that most people associate with genital herpes are sores, vesicles, or ulcers – all of which can also be called “lesions.” (The scientific literature on herpes uses the term “lesion” to describe any break or irregularity in the skin.) These classic lesions of genital herpes often resemble small pimples or blisters that eventually crust over and finally scab like a small cut. These lesions may take anywhere from two to four weeks to heal fully.
During this time, some people will experience a second crop of lesions, and some will experience flu-like symptoms, including fever and swollen glands, particularly in the lymph nodes near the groin. Headache and painful urination also sometimes accompany full-blown symptoms of first episodes.
Again, while first episodes can amount to a major bout with illness, the signs of herpes come in a wide variety – and in some people an initial infection produces mild symptoms or even symptoms that are ignored.
For many people, herpes lesions can so mild that they may be mistaken for:
- insect bites
- yeast infection
- “jock itch”
. . .and other conditions. In other words, the signs go unrecognized as being caused by genital herpes. Signs and symptoms can be found on the penis and vulva, near the anus, on the thigh, on the buttocks, and virtually anywhere in the genital area.
Treatment with antiviral drugs is standard during first episodes and can speed healing significantly. If you haven’t already, you may want to discuss treatment with your healthcare provider at this time.
Recurrent Genital Herpes
If you have recently made it through a first episode that consisted of full-blown symptoms, you know something about signs and symptoms already. The good news is that the first episode is almost always the worst that HSV throws your way. Signs and symptoms of recurrent episodes (when they occur) tend to be milder and heal much more quickly, typically within two to twelve days.
If the first episode produced fairly mild symptoms, then later recurrences usually won’t be more severe. But, as noted earlier, when genital herpes recurs after a first episode, it doesn’t always cause recognizable signs and symptoms.
Some people have recurrent outbreaks with the so-called “classic” blister-like herpes lesions that crust over, or with painful sores. In recurrent herpes, however, this process usually takes about half the time it does in first episodes. In addition, many people have very subtle forms of recurrent herpes that heal up in a matter of days. And lastly, herpes is capable of reactivating without producing any visible lesions This is called asymptomatic reactivation.
Much of the broad description of herpes “lesions” included above applies to recurrent herpes as well. Lesions may take the form of something resembling:
- a red spot
- a pimple
- an ingrown hair
- razor burn
- insect bite
There’s quite a variety. And while genital herpes certainly can and does cause these signs of infection literally on the genitals (the penis or the vulva) it also can produce signs of infection nearby. Herpes sores on or between the buttocks are common (and sometimes slow to heal), as are lesions on the thigh. Herpes can bring about what feels like a tiny fissure around the anus, something easily confused with hemorrhoids. So remember: recurring signs and symptoms in the genital or anal area could be herpes lesions.
But what if you don’t see any lesions nor have other symptoms? In some studies, people with herpes were completely unaware of lesions about one-third of the time that the virus was found to be active in the genital area. While recognizing lesions and other symptoms is important, this cannot always tell you when the virus is active.
Recognizing the Signs: The Prodrome
Early in the phase of reactivation (also called an outbreak), many people experience an itching, tingling, or painful feeling in the area where their recurrent lesions will develop. This sort of warning symptom—called a “prodrome”—often comes a day or two before lesions appear. To be on the safe side, it’s best to assume virus is active (and, therefore, can be spread through direct skin-to-skin contact) during these times.
Where do symptoms appear?
When a person has genital herpes, the virus lies dormant (sleeps) in the bundle of nerves at the base of the spine. When the virus reactivates (wakes up), it travels nerve paths to the surface of the skin, sometimes causing an outbreak.
The nerves in the genitals, upper thighs and buttocks are connected, so a person can experience outbreaks in any of these areas. Such areas include the vagina or vulva, penis, scrotum or testicles, buttocks or anus, or thighs.
Genital herpes, regardless of whether it is HSV-1 or HSV-2, does not cause symptoms on the mouth or face. For more on oral-facial herpes, see the oral herpes page.
How often do outbreaks occur?
The number of outbreaks someone has varies from person to person. The average number of outbreaks for a person with genital HSV-2 is four to five per year. The average for genital HSV-1 is less than one outbreak per year.
Usually, there are more outbreaks during the first year, and many people find that outbreaks become less severe and less frequent with time.
Herpes “triggers” (determining exactly what leads to an outbreak) are highly individual, but with time, many people learn to recognize, and sometimes avoid, factors that seem to reactivate HSV in their own bodies. Illness, poor diet, emotional or physical stress, friction in the genital area, prolonged exposure to ultraviolet light (commonly for oral herpes, such as a beach trip or skiing weekend), surgical trauma, and steroidal medication (such as asthma treatment) may trigger a herpes outbreak.
The frequency of outbreaks can often be managed through effective stress management, and getting adequate rest, nutrition, and exercise. For people with frequent outbreaks, suppressive (daily) therapy with any one of the antiviral treatments can reduce outbreaks by as much as 80%.
Herpes may raise strong emotional issues, especially in the first few weeks or months after a diagnosis. Some people initially feel embarrassment, shame, anger, or depression. The good news is that these emotions tend to fade away over time. Some studies have shown that even six months can make a difference in adjusting to herpes.
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