Initial and Recurrent Genital Herpes Outbreaks
Initial and Recurrent Genital Herpes Outbreaks
An outbreak of genital herpes may occur as an "initial" or first outbreak or it may be a recurrent
infection. Read on to learn more about each of these types of outbreaks, as well as what triggers an
Initial Genital Herpes Outbreak
An initial genital herpes infection occurs in people who have never been previously exposed to the
herpes simplex virus (HSV). Symptoms of an initial outbreak are usually the most severe because the body does not
have any type of immunity to the herpes virus. This is important because your body does not have the "resources" to
fight this first infection.
When your body is first exposed to the herpes virus, it responds by attacking
the virus with antibodies (a type of protein that is made by your body to fight a virus). Specific immune cells
and antibodies now present in your body learn how to target and keep the herpes virus in check. However, the
antibodies that attack the virus during specific outbreaks do not eliminate the virus overall, which is why once
genital herpes is contracted a person has it for life. Herpes outbreaks are usually milder after your body has
produced these antibodies, and after several years you may experience fewer outbreaks or no outbreaks at all.
After first becoming infected with the genital herpes virus most people develop
symptoms within 2 to 12 days, but it can take days, weeks, months, or even years for any symptoms to appear.
Remember, the amount of time it takes for symptoms to appear and the severity of these symptoms can vary greatly
from person to person. Because of this, it may be difficult to know when and from whom you may have contracted
genital herpes. Some people may have mild symptoms and not even realize they are having an outbreak of genital
herpes, while other people have severe outbreaks and others may have no symptoms at all.
You may experience any of the following symptoms during an initial
- You may feel sick like you have the flu, with fever, muscles aches, and
- Sores are more likely to develop during an initial infection, especially
in women. These sores can range in size, and may appear in several areas, including the genitals, mouth,
thighs, buttocks, and around the anus.
- The skin in the affected area may feel raw, painful, and
- There may also be a lot of swelling in affected areas. This is normal
because your body is attacking the virus.
- Lymph nodes (glands) may be swollen in the groin area, which means that
your immune system is fighting off the virus.
- In women, the cervix is infected in about 80% to 90% of initial
infections, and vaginal discharge may occur.
- It's possible to have GH without any symptoms
Without treatment, the first outbreak of genital herpes can last as long as 3
to 4 weeks, but in many cases, symptoms usually completely resolve within 2 to 12 days. If you are experiencing
symptoms that you suspect may be from a genital herpes outbreak you should see your doctor or go to a health
clinic while you are still experiencing the symptoms.
New diagnostic tests are now available that more accurately diagnose genital
Note: The effectiveness of FAMVIR has not been established for treating initial
episodes of genital herpes.
Recurrent (Repeated) Genital Herpes Outbreaks
Once you have had an initial outbreak of genital herpes, chances are you will probably have
additional symptoms or outbreaks from time to time. The frequency and severity of recurrent genital herpes
outbreaks can vary a lot. Some people may experience several outbreaks during a year, while others have only 1 or 2
outbreaks during their lifetime.
The number of outbreaks you experience can also change over time. Usually you
have more outbreaks during the first year you have genital herpes. The average number of outbreaks is 4 to 5 a
year. Many people notice that their outbreaks lessen in frequency and severity with time. The Centers for
Disease Control and Prevention (CDC) recommends suppressive genital herpes treatment for people with 6 or more
outbreaks per year. And statistics show that 7 out of 10 people have less than 6 outbreaks per year. If you're
one of these people, or if you don't want to take an antiviral medication every day, episodic treatment may be
right for you.
When you are not having symptoms, the herpes virus may be quietly sitting in
the nerves (ganglia) at the base of your spine and may be inactive. When the herpes virus becomes active, it
travels down nerve fibers to the skin in an area near the site of your first outbreak. Sores, bumps, or redness
may appear in this area. You may also experience burning, itching, and pain in or around the genital
There are effective oral prescription antiviral medicines available to reduce
the discomfort of your symptoms. Single-Day FAMVIR is one of them. In a clinical study of Single-Day FAMVIR,
patients started treatment within 6 hours of either symptom onset or lesion appearance and were able to stop or
shorten an outbreak with just a single day of treatment. Single-Day FAMVIR also relieved pain and burning within
24 hours in the majority of patients. The effectiveness of FAMVIR has not been established when treatment is
started more than 6 hours after the onset of symptoms or lesions.
Sometimes you can have outbreak without any symptoms; this is referred to as a
silent outbreak or asymptomatic viral shedding. During asymptomatic viral shedding you are contagious and can
spread the herpes virus, but not have any signs or symptoms.
The herpes virus can also be shed from sores that cannot be seen (e.g., on the
cervix in women), from the skin at or near the area of the first infection, and in fluids from the penis,
vagina, and mouth.
Because you don't always know when you may be shedding the virus, it is
important to always use a latex condom or latex barriers during sex. (Please see your doctor for alternative
barrier methods if you're allergic to latex.) Even when condoms are used they are not always effective. Avoid sexual contact with the
affected areas completely when you do have physical symptoms until the skin has healed.
What Triggers a Genital Herpes Outbreak?
There are some trigger factors that may cause the genital herpes virus to become active. If you have
experienced the symptoms of genital herpes some of these may sound familiar, and you probably have already noticed
the link between the trigger and the symptoms even if you didn't know that you were experiencing a herpes
Trigger factors vary from person to person and usually can't be avoided. Some
triggers are believed to be:
- Menstrual cycle
- Emotional stress
- Physical stress
- Sexual intercourse
- Another illness (especially with fever)
- Surgical trauma
- Steroidal medication (e.g., asthma medication)
- Poor diet
Managing the Stress in Your Life