What are the symptoms of genital herpes?
The first time you are infected with genital herpes simplex it is called the primary infection. This may, or may not, cause symptoms (described below). Following a primary infection, the virus is not cleared from the body but lies inactive (dormant) in a nearby nerve. In some people, the virus 'activates' from time to time and travels down the nerve to the nearby skin. This causes recurrent symptoms of genital herpes if the primary infection was in the genitals, or recurrent cold sores if the primary infection was around the mouth.
It is common not to develop any symptoms
Most people never develop any symptoms when they are infected with the virus. At least 8 in 10 people with genital herpes simplex virus do not know that they are infected. (Or, they only have a short bout of very mild symptoms which is not recognised as genital herpes. For example, just a slight area of itch or a small red area which soon goes.) In such people, the virus stays inactive in the root of a nerve that supplies the genitals, but never causes recurrent episodes of symptoms. However, even people who do not develop symptoms may, on occasions, have virus in their genital area and therefore be infectious to sexual partners. In fact, this is how many genital herpes simplex infections are passed on.
A first episode of symptoms
At first you may feel generally unwell with a mild fever and aches and pains. Groups of small, painful blisters then appear around your genitals and/or back passage (anus). They tend to erupt in crops over 1-2 weeks. The blisters soon burst and turn to shallow, sore ulcers.
Images above via Wikimedia Commons
The glands in your groin may swell and feel like lumps at the top of your legs. It is common to have pain when you pass urine, especially in women.
In women, a vaginal discharge may occur. Women may also have blisters and ulcers on the neck of the womb (cervix) at the top of the vagina. The inside of the back passage may also be affected. The ulcers and blisters can last up to 10-28 days and then gradually heal and go without scarring.
Sometimes less typical symptoms occur. For example, you may just have a small raw area, one or two small ulcers, or just an area of irritation with nothing to see. Sometimes symptoms last just a few days.
Note: sometimes a first episode of symptoms appears months or years after being first infected. This is why a first episode of symptoms can occur during a current faithful sexual relationship. You may have been infected months or years ago from a previous sexual partner who did not realise that they were infected.
It is not clear why some infected people develop symptoms, some don't and some have a first episode of symptoms months or years after first being infected. It may be something to do with the way the immune system reacts to the virus in different people.
Recurring episodes of symptoms
After the first episode, further episodes of symptoms occur in some people from time to time. This is called recurrent infection. It is not clear why the dormant virus erupts from time to time. Recurrences tend to be less severe and shorter than the first episode. It is more usual to have 7-10 days of symptoms with a recurrence, unlike the longer phase of symptoms that may occur during the first episode. Most people do not develop a fever and do not feel particularly unwell during a recurrence. A tingling or itch in your genital area for 12-24 hours may indicate a recurrence is starting. The time period between recurrences is variable.
Recurrences tend to become less frequent over time. In people who have recurrences, their frequency can vary greatly. Some people have six or more a year. For others it is less frequent than this. On average, people tend to have 1 to 4 recurrences per year during the first two years after the first episode. Some people do not have recurrences at all after a first episode of symptoms. Some people can identify some things that may trigger a recurrence. Such triggers include sunlight, physical illness, excess alcohol, or stress. If you can identify a trigger, it may be helpful to try to avoid this in the future, if possible.
Did you find this information useful?
- Herpes simplex - genital; NICE CKS, September 2012 (UK access only)
- 2014 UK National Guideline for the Management of Anogenital Herpes; British Association for Sexual Health and HIV (2014)
- Management of Genital Herpes in Pregnancy; British Association of Sexual Health and HIV and Royal College of Obstetricians and Gynaecologists (Oct 2014)
- 2017 European guidelines for the management of genital herpes; International Union against Sexually Transmitted Infections (IUSTI) (2017)
- 2015 Sexually Transmitted Diseases Treatment Guidelines - Genital Herpes; Centers for Disease Control and prevention CDC, (2015)
- Hollier LM, Wendel GD; Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection. Cochrane Database Syst Rev. 2008 Jan 23 (1):CD004946.
- Kang SH, Chua-Gocheco A, Bozzo P, et al; Safety of antiviral medication for the treatment of herpes during pregnancy. Can Fam Physician. 2011 Apr 57(4):427-8.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.