The first outbreak and typical symptoms of the Herpes Simplex Virus.

During the first episode or “primary” outbreak

The first outbreak:

The first episode is the most severe as most people have not been exposed to the virus before and antibodies will not have been produced to trigger the immune response.

  • Symptoms usually develop within 2 to 20 days after first exposure to the virus
  • Could continue for up to 2 weeks
  • May be so mild that it goes unnoticed
  • Sometimes causes visible sores
  • Can last between 10 – 21 days

The symptoms may take longer to appear or be less severe in some people, especially in those with partial immunity to the virus from having facial herpes, e.g. cold sores.
When the herpes virus gets into skin cells it reproduces itself and starts to multiply, making the skin red and sensitive. Blisters or bumps may appear on the genital area, the blisters first opening, then healing with the regeneration of new skin tissue. 8 stages of a typical Herpes outbreak.

The infected area:

  • is usually painful to touch
  • may itch, burn or tingle during the outbreak
  • can appear red, raw or inflamed

Other symptoms include:

  • Swollen lymph glands
  • Painful inflamed blisters develop around infected area
  • Headache
  • Muscle ache
  • Fever
  • Vaginal or penis discharge
  • Infection of the urethra causing a burning sensation during urination
  • A burning sensation in the genitals
  • Lower back pain
  • Small red bumps may appear in the genital area following earlier symptoms, later developing into painful blisters, which crust over, form a scab, and heal.

No Symptoms

Up to 60% of people who have genital HSV show no signs of the disease and are unaware that they are infected, but are capable of transmitting the virus to others (asymptomatic viral shedding).

Recurrences (when symptoms return)

Subsequent recurrences of the virus may cause an outbreak of blisters.

Herpes Recurrences:

  • are usually shorter and less severe than the initial episode
  • may decrease in both severity and frequency over time
  • are usually preceded by warning symptoms (also known as prodromal symptoms)

After the lesions have healed, and the symptoms of recurrence have ended, pain and discomfort in the genital area is still sometimes felt (post-herpetic neuralgia).

Non-steroidal, anti-inflammatory drugs may be used to treat this condition. Some people find these drugs effective for the discomfort of the prodrome, and for the duration of the outbreak.

How common are recurrences?

  • 80% of persons having a first episode caused by HSV-2 will have at least one recurrence
  • 50% of persons with HSV-1 will experience a recurrence
  • The most common scenario is occasional recurrences (about 4 attacks per year)
  • Usually, the first year has the most viral activity

A recurrence takes place when the virus replicates in the nerve ganglia and particles of virus travel along the nerve to the site of primary infection in the skin or mucous membranes (inner, moist lining of the mouth, vagina etc).

There are very subtle forms of recurring herpes found on the penis, vulva, anus, thigh and buttocks or anywhere in or around the genital area that heal very quickly (within a matter of days).

Signs of Recurrent Outbreaks:

  • Breaks or irregularities in the skin, such as a cut, red bump or rash
  • Small sores or blisters that form a crust may occur anywhere in the region between the legs–thigh, buttocks, anus, or pubis
  • Healing occurs in half the time as the first outbreak

What brings on or “triggers” an outbreak?

Although it is not known exactly why the virus reactivates at various times, both physical and/or psychological factors can bring on an outbreak.

Physical Factors:

Physical factors differ from person to person, but may be caused from:

  • being run-down
  • suffering from other genital infections (affecting the local skin area)
  • menstruation
  • drinking a lot of alcohol
  • exposure of the area to strong sunlight
  • conditions that compromise a person’s immune system (where the body’s immune system is not functioning normally)
  • prolonged periods of stress
  • ultraviolet light
  • friction or damage to the skin, caused by, for example, sexual intercourse, may also lead to a recurrence
  • surgical trauma
  • anything that lowers your immune system or causes local injury can trigger recurrences.

Psychological Factors:

  • periods of prolonged stress can cause more frequent recurrences
  • it is also common to experience stress and anxiety as a result of having recurrences.

Prodromal Symptoms (warning signs)

A warning sign (prodrome) is experienced by many people in recurring outbreaks. Warning symptoms which indicate the virus is becoming active, and is on its way to the skin’s surface may include:

Warning signs that the herpes virus is active may include:

  • itching
  • tingling
  • numbness
  • burning
  • general fatigue
  • flu-like symptoms
  • fever
  • swelling of the lymph nodes in the area of outbreak
  • headache
  • painful urination
  • pain in the buttocks, back of legs, lower back

Cycle of a typical outbreak or recurrence

The symptoms of an active herpes outbreak or recurrence may occur in the following phases.

Symptomatic Course of the Disease:


Swelling, tenderness, and/or redness that may appear before the actual outbreak, and may include itching, and sensitivity. The inflammation may never progress to blisters.


One or several small fluid filled lesions, tiny red bumps, or rash may form and can resemble small fissures, especially near the anus.


When the skin breaks on the blisters, small, round, wet looking, ulcers leaking clear to milky colored fluid can be seen


The sores begin to dry, scab, and crust over beginning the healing process. The virus may possibly still be present until the ulcer has completely healed, and the scab falls off. NOTE: the sores do not always crust before healing.


New skin is formed and may look slightly red, or silver. Viral replication is complete, the virus has left the skin’s surface, and the skin is now safe to touch. Healing of the skin does not normally leave scarring. The virus then retreats into the nerves and lies dormant.

Routine Check-ups

A check up for herpes is important because:

  • lesions can be overlooked
  • lesions can be invisible to the human eye
  • there may never be any visible symptoms

If you have reason to believe that you may have been exposed to herpes, it is important to specifically request a test for herpes because it is not included in routine STD or health checks and must be specially requested.

Mistaken Symptoms

Herpes outbreaks can be mistaken for:

  • insect bites
  • jock itch
  • abrasions
  • razor burn
  • yeast infections
  • hemorrhoids
  • ingrown hair follicles

There are many conditions that are confused with herpes. Should any of the above symptoms occur, consult your doctor or other healthcare provider immediately. Genital herpes should always be diagnosed and treated professionally.