- Herpes simplex virus can cause symptoms on the mouth (oral herpes) or genitals (genital herpes).
- About 50 to 80 percent of American adults have oral herpes, which is commonly called cold sores or fever blisters.
- About one in five adults in the United States has genital herpes. However, most people don’t know they are infected because their symptoms are too mild to notice or mistaken for another condition.
- Herpes is most easily spread from genital-to-genital or oral-to-genital contact during an active outbreak or during prodrome -- the few days just before an outbreak.
- Oral and genital herpes can be uncomfortable, but they are generally not dangerous infections in healthy adults.
- Herpes does not affect the immune system. It is rare for adults to have any health problems from genital herpes.
- However, having genital herpes makes it easier to acquire and/or transmit HIV, a virus that can cause AIDS.
- There are several days throughout the year when herpes can be spread even when no symptoms are present (called asymptomatic reactivation or asymptomatic shedding).
- The surest way to prevent the spread of genital herpes is to avoid sexual contact during an active outbreak and to use condoms for sexual contact between outbreaks. Suppressive (daily) antiviral therapy with valacyclovir has also been proven to reduce the risk of transmission to a partner.
- Most couples decide together how to reduce the risk.
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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. 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 a culture test or for other sensitive tests.
When do signs & symptoms appear?
• A person may show symptoms within days after contracting genital herpes, or it may take weeks, months, or years.
• Some people may have a severe outbreak within days after contracting the virus.
• Some people 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.
What are the signs or symptoms of herpes?
Signs and symptoms of genital herpes can vary greatly from person to person. They can be mild for one individual and severe for another.
Symptoms of genital herpes: 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. When a person is infected for the first time with either HSV type, the immune response is not well developed, and the virus is able to multiply more rapidly and in more places than it can later. Signs and symptoms during a first episode, therefore, can be quite pronounced. On the other hand, many people have a first episode that is so mild they don't even notice it; rather it is a later episode, or “reactivation,” that is first noticed by them many months or years later.
• 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
• abrasions
• yeast infection
• “jock itch”
• and other conditions.
In other words, the signs go unrecognized as being caused by genital herpes. Also, signs and symptoms can be found:
• on the penis and vulva
• near the anus
• on the thigh
• on the buttocks
• 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 health care provider at this time.
Symptoms of 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 subsequent recurrences will not usually increase in severity. 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 (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
• hemorrhoids
• insect bite
There's quite a variety, in short. 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 well be HSV 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.
Prodrome
Early in the phase of reactivation (recurrence, 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 precedes lesions by a day or two. 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; therefore, a person can experience outbreaks in any of these areas. Such areas include:
• vagina or vulva
• penis, scrotum, or testicles
• buttocks or anus
• thighs
(Genital herpes, regardless of whether it is HSV-1 or HSV-2, does not cause symptoms on the mouth or face.)
How often do outbreaks occur?
The amount 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 tend to lessen in severity and frequency 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%.
EARN ABOUT HERPES > Treatment
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