Herpes Symptoms – STI Symptoms & Signs

Last Updated on July 29, 2021 by Nancy Carteron, MD, FACR

STI Symptoms – Herpes (HSV1 & HSV2)

Many people with herpes will not have any visible signs or symptoms at all, or not be aware of them.

It is estimated that 80% of people in the United States has some form of herpes and 1 in 5 people has genital herpes; however, as many as 90% are unaware that they have the virus.

Some people will get symptoms within 2–5 days of coming into contact with the virus. In other people, the virus may be in the body for several weeks, months or possibly years before any signs or symptoms appear.

Some people remain asymptomatic for life (even though they are still capable of shedding the virus and transmitting it to others).

Therefore, when you get symptoms, it doesn’t necessarily mean you’ve only just come into contact with the virus. Because of those possibilities, it can be difficult for people to know when and from whom they contracted herpes.

The first time that herpes symptoms appear is called “first episode” or “initial outbreak.” Initial herpes symptoms are usually more noticeable/more severe than later outbreaks.

Initial herpes sores usually heal in about 2 to 4 weeks. But the virus stays in the body. It can flare up and cause sores again. Symptoms from flare-ups usually heal in 10 to 14 days.

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For many people, herpes lesions can be so mild they may be mistaken for:

• Insect bites
• Abrasions
• Yeast infections
• “Jock itch”
• A pimple
• An ingrown hair
• Razor burn
• Hemorrhoids

If you do get signs or symptoms, they usually follow a pattern. You may have some or all of the following:

• Aches and pains in the lower back, buttocks, thighs, knees, down the legs or in the groin
• Blisters, sores, or ulcers – most often on the mouth, lips and gums, thighs, buttocks, or genitals
• Chills
• Decreased appetite
• Enlarged lymph nodes in the neck or groin
• Feeling generally unwell with flu-like symptoms
• Fever
• Fever blisters
• Headache
• Pain in the infected area
• Pain when urinating caused by the urine flowing over sores
• Red blisters that break open and leak
• Several smaller blisters that grow together into a large blister
• Small blisters filled with clear yellowish fluid
• Stinging, tingling or itching
• Swollen, tender glands in the pelvic area, throat, and under the arms
• Tiredness

Recurrent Outbreaks

When a person has herpes, the virus lays dormant (sleeps) in a bundle of nerves in the spine. When the virus reactivates (wakes up), it travels nerve paths to the surface of the skin, sometimes causing an outbreak.

Herpes is capable of reactivating without producing any visible lesions (asymptomatic reactivation), but when signs and symptoms of recurrent outbreaks do occur, they are usually milder than with the first outbreak and clear up more quickly.

Some people have recurrent outbreaks with the so-called “classic” blister-like herpes lesions that crust over with painful sores.

There is often an early warning tingling sensation and they may get a flu-like illness before an outbreak. This sort of warning symptom – called a “prodrome” – often comes a day or two before lesions appear.

To be on the safe side, it’s best to assume the virus is active (and, therefore, can be spread through direct skin-to-skin contact) during these times.

The recurrent blisters and sores are usually fewer, smaller, and less painful and heal more quickly. This process usually takes about half the time it does than in first episodes. In addition, many people have very subtle forms of recurrent herpes that heal in a matter of days.

Recurrent outbreaks normally appear in the same part of the body as in previous outbreaks, but in some people they may appear nearby.

Oral Herpes

When a person has oral herpes, “cold sores” or “fever blisters” can show up on the lips, around the mouth, on the gums, or in the throat. Some people get mouth ulcers when they first come into contact with the HSV virus.

Others have no symptoms.

Symptoms may be mild or severe.

Severe symptoms may last up to 3 weeks and all symptoms may return in weeks, months, or years.

Prodrome/warning symptoms include:

• Itching of the lips or skin around mouth
• Burning near the lips or mouth area
• Tingling near the lips or mouth area
• Sore throat
• Fever
• Swollen glands
• Painful swallowing

Genital Herpes

Most people with genital herpes have no symptoms, have very mild symptoms that go unnoticed, or have symptoms but do not recognize them as a sign of infection.

The classic genital herpes symptoms is a cluster of blistery sores — usually on the vagina, vulva, cervix, penis, buttocks, thighs, or anus.

Symptoms may last a couple weeks, go away, and they may return in weeks, months, or years.

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