Herpes Treatment Advice

Signs and symptoms of herpes

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 health care 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.

A person may show symptoms within days after contracting genital herpes, or it may take weeks, months, or years. For this reason, it can be difficult for people to know when and from whom they may have contracted the virus.

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.

But for many other 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. See our section on Treatment as well.]

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.

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.

Early in the phase of reactivation 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.

Herpes’ triggers (what leads to an outbreak/recurrence) 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.