Last Updated on June 4, 2020 by Valinda Riggins Nwadike, MD, MPH
HSV affects everyone a little differently. Some people are bothered by frequent cold sores and/or genital herpes outbreaks, and others are not.
How much of a physical impact the virus has on someone’s body is primarily the result of four factors:
- how well a person’s immune system is able to combat the infection,
- how long the person has had the infection,
- whether or not the virus is established in its site of preference,
- and viral type.
Your Immune System
The immune system’s ability to respond to and suppress HSV triggers is a key factor in whether or not someone will experience frequent outbreaks.
For example, infants and people with compromised immune systems (those with cancer, HIV/AIDS, severe burns, or who are taking immunosuppressant medications) tend to experience severe recurrent outbreaks, because their immune system is weaker or weakened.
The healthier your immune system, the less likely you are to suffer from severe or numerous symptoms.
How Long You’ve Been Infected
In time, the severity, the duration, and the number of outbreaks a person with HSV experiences tends to decrease. That is true for both HSV1 and HSV2.
A larger number of people with oral HSV1 contracted the virus when they were children, so by the time those people reach adulthood, very few are bothered by their oral outbreaks enough to seek help or consider their symptoms a medical issue. That is because, over time, their immune systems formed antibodies to fight the virus, and they no longer have either severe and/or frequent outbreaks.
In contrast, the majority of Americans who are infected with genital HSV2 acquired the infection as teenagers or adults, so their bodies haven’t yet developed a significant level of antibodies necessary to combat the virus, and thus, they still experience severe and/or recurrent outbreaks. However, as with oral HSV1, the number of outbreaks one experiences with HSV2 usually reduces the longer they’re infected.
Type of Herpes and Where It’s Located
Both HSV1 and HSV2 can infect a person orally and/or genitally, however, both infections will cause milder symptoms when they are outside of their preferred location. HSV1 prefers to infect above the waist, and HSV2 prefers to infect below the waist.
Experts estimate that around 30% of genital herpes infections are caused by HSV1, but only 2-5% of those infections cause recurring genital outbreaks. Therefore, most people infected with HSV1 genitally have very few, if any, genital herpes outbreaks. To further emphasize the difference in recurrence between a genital HSV2 infection and a genital HSV1 infection, one study showed that genital HSV2 causes physical symptoms 10 times more often than genital HSV1.
Average Outbreak Rate
- During the first year of infection, those with recurring outbreaks of HSV1 orally or HSV2 genitally experience an average of 4 to 6 episodes.
- For those with genital HSV1, on average, studies have shown about one outbreak per year.
- When an oral HSV2 infection occurs, recurrent outbreaks are uncommon. In one study, oral HSV2 recurred an average of 0.01 times a year in newly infected people.
A possible fourth factor affecting recurrence rate is viral type. According to another study, genital HSV2 infections were the most frequently recurring herpes infections, followed by oral HSV1, genital HSV1, and last of all, oral HSV2.
Break it down for me, Jenelle.
Utterly confused? Here’s the deal:
- If you have an oral HSV2 infection, you probably won’t 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 don’t.
- The longer you have an HSV infection, the fewer outbreaks you’re 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.
Lastly, and this is very important, whether or not you experience physical symptoms/outbreaks, you are still able to transmit the infection to others (and there’s no guarantee the person who contracts the infection will experience the same amount of symptoms).
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Did this post help clarify your herpes questions? Have you always wondered how many outbreaks you should expect as well? Share your thoughts in the comments section below!