How Often Are Herpes Outbreaks

Why Does Genital Herpes Come Back

Herpes Simplex Virus Treatment / Alynn Alexander, MD

There are many different things that may trigger herpes recurrences. Sometimes, a person can learn to recognise why outbreaks appear but for other people there does not seem to be any particular reason for it.

Between recurrences the virus travels from the skin along the nerve to the nerve ganglion where it remains. Once you have been infected, the virus remains in the body, just as chickenpox and some other viruses do. Recurrent symptoms occur when the virus is reactivated or triggered. The symptoms normally appear in the same area as the first time. For some people they may move a short distance, e.g. from genitals to buttocks, but always within the same dermatome .

Some people feel aching, tingling, burning or sharp pains in the area affected preceding a recurrence. These are called prodromal symptoms or prodromes. They are a sign that the virus is trying to reactivate and there may be virus on the skin surface. Sometimes they last for a few days then disappear without any symptoms appearing on the skin.

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Herpes Myths To Stop Freaking Out About

A surprising number of people you know probably have herpes.

Shocked? You shouldnt be, since the virus is very common. According to the World Health Organization, 3.7 billion people under age 50 have herpes simplex virus type 1 thats 67 percent of the global population in that age bracket. Another 417 million people between ages 15 and 49 worldwide have herpes simplex virus type 2 .

Many people consider HSV-1 more benign, but it turns out theres not much difference between the two types of virus. While its true that HSV-2 is a sexually transmitted disease and can cause genital sores or blisters, type 1 can do the same thing.

One big misconception is that cold sores are caused by HSV-1 and genital herpes are always type 2, but thats not always the case, says Sarah Vensel, a physician assistant in San Francisco. Cold sores are so common theyve been normalized at this point. But genital herpes is sometimes the exact same virus just in a different location.

Not only is herpes incredibly common its also totally manageable. Allow us to set your mind at ease and debunk three widespread herpes myths:

Where Do Symptoms Appear

When a person has genital herpes, the virus lies dormant in the bundle of nerves at the base of the spine. When the virus reactivates , it travels nerve paths to the surface of the skin, sometimes causing an outbreak.

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.

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Symptoms Of Genital Herpes

Many people who have genital herpes may not be aware they have the infection, because they may not have any symptoms.

The first episode of herpes can cause considerable pain and distress. Symptoms of the first episode may include:

flu-like symptoms such as feeling unwell, headaches and pains in the back and legs, with or without enlarged glands in the groin
small blisters around the genitals these break open to form shallow, painful ulcers, which scab over and heal after one to two weeks
small cracks in the skin with or without an itch or tingling
redness or a distinct rash
some people also have considerable pain and swelling in the genital area, and hence may have additional pain and difficulty passing urine.

How Herpes Is Treated

There is no cure for herpes.

The health care provider may prescribe antiviral medicine to help speed up the healing process. It also shortens the time when the virus can spread from the herpes sores.
Pain may be treated with medicine such as Tylenol or Motrin or by applying an ice pack wrapped in a towel to the affected area.
If sores are in the mouth, avoid foods high in acid, like citrus fruits and juices.
The infected area should be kept clean and dry.
Wash hands often and avoid touching the sores to prevent spreading the virus.
It is important to stay healthy by getting enough rest, having proper nutrition and exercise and managing stress well.

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The Value Of A Diagnosis

If you develop any of the symptoms listed above, you should see a doctor for an evaluation. Your doctor may be able to diagnose herpes just by looking at your blisters or sores, and there are also lab tests to diagnose herpes.

Knowing you have genital herpes allows you to take steps to reduce outbreaks and to protect your sexual partner or partners.

According to the CDC, the outlook for an individual and the type of guidance that person needs depends on which virus is causing the genital herpes, HSV-1 or HSV-2. Recurrent outbreaks are much more frequent for genital herpes caused by HSV-2, as compared with cases caused by HSV-1.

The CDC recommends testing to find out which virus is involved.

The CDC also says that people with genital herpes should be tested for HIV infection. If you have herpes, its easier for you to develop an HIV infection because herpes sores give HIV an open path into your body.

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How Do You Get Herpes

There are two different herpes viruses: Herpes Simplex Virus type 1 and Herpes Simplex Virus type 2 .

While rare, a mother can pass genital herpes to the baby during vaginal childbirth.

Herpes is most easily transmitted when sores are open and wet, because fluid from herpes blisters easily spreads the virus. But herpes can also shed and be passed to others when there are no sores and the skin looks totally normal. Most people get herpes from someone who does not have any sores. When used consistently and correctly, condoms help protect against herpes and many other STDs.

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Why Does Outbreak Frequency Vary

Its unclear exactly what triggers a herpes outbreak, although certain factors make them more likely. People without chronic physical and mental health conditions who exercise, practice good nutrition, and get adequate sleep are likely to have fewer herpes outbreaks. Women also usually have more frequent herpes outbreaks than men. Its thought the hormone fluctuations experienced during periods, pregnancy, and menopause may trigger herpes outbreaks.

Antiviral medications, like valacyclovir, can also help reduce the frequency of herpes outbreaks. People on these medications have up to 70-80% fewer outbreaks than they would without the medication. Their outbreaks also tend to be shorter than people who dont take these meds. If youve been previously diagnosed with herpes, Nurx can prescribe oral or genital herpes treatment online and deliver the medication to your door with free shipping. To request herpes treatment from Nurx, get started here.

Nurx offers prescription cold sore and genital herpes treatment for as little as $0 with insurance or $15 per month without insurance.

What Happens If I Dont Receive Treatment

An All Natural OTC Topical Product for Genital Herpes Outbreak Symptoms

Genital herpes can cause painful genital sores and can be severe in people with suppressed immune systems.

If you touch your sores or fluids from the sores, you may transfer herpes to another body part like your eyes. Do not touch the sores or fluids to avoid spreading herpes to another part of your body. If you do touch the sores or fluids, quickly wash your hands thoroughly to help avoid spreading the infection.

If you are pregnant, there can be problems for you and your unborn fetus, or newborn baby. See Im pregnant. How could genital herpes affect my baby? for information about this.

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What Happens At A Sexual Health Clinic

The doctor or nurse at the sexual health clinic will:

ask about your symptoms and your sexual partners
use a small cotton bud to take some fluid from 1 of your blisters or sores for testing

The test cannot:

be done if you do not have visible blisters or sores
tell you how long you have had herpes or who you got it from

Symptoms might not appear for weeks or even years after you’re infected with the herpes virus.

How Does Genital Herpes Affect Pregnancy

Herpes simplex virus doesnt affect fertility or your ability to conceive. Pregnant women diagnosed with HSV-2 should start a daily antiviral at 36 weeks of pregnancy as prescribed, to prevent outbreaks during delivery. If you have an active infection at the time of childbirth, you can pass the herpes virus to your baby. Neonatal herpes puts a baby at risk for blindness, brain damage, skin infections and death. Your healthcare provider will perform a cesarean section to lower this risk.

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How Is Genital Herpes Diagnosed

HSV nucleic acid amplification tests are the most sensitive and highly specific tests available for diagnosing herpes. However, in some settings viral culture is the only test available. The sensitivity of viral culture can be low, especially among people who have recurrent or healing lesions. Because viral shedding is intermittent, it is possible for someone to have a genital herpes infection even though it was not detected by NAAT or culture. 11

Type-specific virologic tests can be used for diagnosing genital herpes when a person has recurrent symptoms or lesion without a confirmatory NAAT, culture result, or has a partner with genital herpes. Both virologic tests and type-specific serologic tests should be available in clinical settings serving patients with, or at risk for, sexually transmitted infections. 11

Given performance limitations with commercially available type-specific serologic tests , a confirmatory test with a second method should be performed before test interpretation. If confirmatory tests are unavailable, patients should be counseled about the limitations of available testing before serologic testing. Healthcare providers should also be aware that false-positive results occur. In instances of suspected recent acquisition, serologic testing within 12 weeks after acquisition may be associated with false negative test results. 11

Providers are strongly encouraged to look at CDCs STI Treatment Guidelines for further diagnostic considerations.

What Does Genital Herpes Look Like

While some people with genital herpes will never have any symptoms, other people can develop symptoms within a few weeks of being infected.

Often, before the lesions appear, patients describe a prodrome, characterized by a tingling or burning sensation in the area where the lesions will develop that can be noticed during urination, along with itching or discomfort in the genital area.

You can also have the following symptoms:

Blisters on the mouth or lips
Fever, headache or pain in the joints
Trouble urinating

The symptoms of genital herpes often go away and come back as recurring outbreaks. For most people, the first outbreak is the worst, and can last from two to three weeks. Future flare-ups are often less severe and do not last as long. Still, some people shed the virus regularly. The following triggers can make outbreaks more likely to occur:

Viral or bacterial infections
Menstrual periods

Recurrent genital herpes is most common in the first year after the initial infection and decreases as time goes on.

In many cases, anti-herpes medicine can help patients. When a person experiences a prodrome and suspects a recurrence is going to happen, they begin taking anti-herpes medications that lessen symptoms and shorten the time of the outbreak.

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Break It Down For Me Jenelle

Utterly confused? Heres the deal:

If you have an oral HSV2 infection, you probably wont ever experience an outbreak or visual symptoms.
If you have a genital HSV1 infection, you might experience one outbreak per year.
If you have a genital HSV2 or an oral HSV1 infection, the number of outbreaks you experience and their severity will largely depend upon how healthy you keep your immune system. Some folks experience fairly severe and somewhat frequent outbreaks, and others dont.
The longer you have an HSV infection, the fewer outbreaks youre likely to have.

Remember: there are exceptions to every rule. One of those exceptions? If you have a compromised immune system, you are likely to experience more outbreaks than the average person in any of the categories previously mentioned.

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Is Herpes Simplex Related To Herpes Zoster

Herpes simplex and the varicella-zoster virus are related, but they arent the same. VZV causes chickenpox and shingles.

Like HSV-1 and HSV-2, shingles can cause a painful, blistering rash. The shingles rash usually shows up on the back, side, abdomen , neck and face. It is often only on half of your body, following the pattern of your nerves. See your healthcare provider if you have a new rash and suspect you may have shingles.

A note from Cleveland Clinic

Herpes simplex is a virus. Once you have herpes, its a lifelong condition. A herpes infection can lead to outbreaks , but youll also have times when you have no symptoms. The main sign of herpes is sores that appear on the infected skin. Some people choose not to treat herpes, especially if symptoms are mild. Others take antiviral medications to reduce the severity and frequency of outbreaks.

Last reviewed by a Cleveland Clinic medical professional on 05/17/2022.

References

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Onset Of First Outbreak

The first outbreak of oral herpes usually develops within about one to three weeks after infection. This initial outbreak may last for up to three weeks.

With genital herpes, the first outbreak usually occurs within about two to 20 days. Similar to oral herpes, the initial outbreak may last as long as three weeks.

If You Have Genital Herpes Already Can It Be Spread To Other Parts Of The Body Such As The Arms Or Legs

Could a Fever be a Sign of Genital Herpes?

No. Genital herpes cannot be transmitted to another part of your body such as your arm, leg or hand after the first infection occurs. If you have genital HSV II, you will not get HSV II at another site in your body. The immune system produces antibodies that protect other parts of your body from infection. However, there are cases where a person has multiple site infections from the same virus. This is usually acquired at the time of the first infection. For example, if someone has never had herpes but then has oral and genital sex with an infected partner, they can acquire the infection at both sites.

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Herpes Might Not Have Any Symptoms

You or your partner may not have any herpes symptoms that you can see or feel, or the signs of herpes may be so mild you dont even notice them. Sometimes people confuse herpes symptoms with other things, like pimples, ingrown hairs, and the flu.

Herpes symptoms come and go, but that doesnt mean the infection goes away or that you cant spread it to other people. Once you have herpes, it stays in your body for life.

Will I Have A Re

It is true that most people with herpes have a recurrence but there are many people who dont. If the symptoms do return, for most people they tend to be less and less severe as time goes on and as your immune system builds up antibodies. Herpes outbreaks are different for everyone. Even though it is the same virus, it could cause a particular symptoms in one person and yet cause completely different symptoms in their partner . The typical frequency of a herpes outbreak is four times a year or once every three months. If a person has been infected with the herpes virus it does not necessarily mean that they will ever experience an outbreak or a re-ocurrence.

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What Are Herpes Recurrences And How Likely Are They

Recurrences are repeat symptoms which appear at or close to the place where the infection was first noticed. These are often fairly minor and may be no more than a small spot that heals in a few days. They may be accompanied by sensations itches or nerve twinges. They are unlikely to be as severe as first symptoms and may be almost unnoticed.

Can Genital Herpes Be Treated

Your physician can prescribe different medications to help reduce your symptoms and speed up the healing of an outbreak. These medicines work best when you start them soon after an outbreak occurs.

To reduce pain during an outbreak:

Sit in warm water in a portable bath or bathtub for about 20 minutes. Avoid bubble baths.
Keep your genital area clean and dry, and avoid tight clothes.
Take over-the-counter medications, such as acetaminophen or ibuprofen. Avoid aspirin.

Let your physician know if you are worried about your genital herpes. He or she can recommend a support group to help you cope with the virus.

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Can Herpes Be Transmitted During Its Incubation Period

The chances are low that a person can transmit HSV to someone else within the first few days following their initial contact with the virus. But because of HSV dormancy, among other reasons, not many people can pinpoint the moment they contracted the virus.

Transmission is common from contact with a partner who might not know they have HSV and isnt showing symptoms of infection.