Herpes Symptoms

Genital herpes infections can be classified as being in one of the following three categories: primary, initial (or non-primary), or recurrent.

PRIMARY outbreak is defined as one that occurs in a person who has no prior antibody to herpes simplex virus. This means that they have never had either HSV 1 or HSV 2. Symptoms in these people are sometimes more severe. However, perhaps half of the people experiencing a true primary outbreak may have symptoms that they do not recognize as troublesome or have no symptoms. Lets talk about people who do have symptoms with their primary outbreak. They may have whole body involvement things like headache, aching joints, tiredness, fever, pain in the legs, and flu- =like symptoms. The lymph nodes in the groin are often enlarged and tender and may feel like large peas. When lymph nodes en-large, it should be seen as a good thing in this situation. It means that the immune system is mounting an aggressive response. Lesions or sores may appear in other areas of the body, most often the throat or mouth (if they have both given oral sex to and had inter-course with the person who infected them). Genital symptoms may include several sores covering a wide area both vertically and horizontally (often on both sides of the genitals), painful urination, itching, and a discharge from the penis or vagina. The sores begin as blisters, then break open and form ulcers in the skin (women often do not notice a blister stage). Crusts or scabs then form and eventually fall off. Lesions on the inner labia do not form crusts, but instead, new skin replaces the sores. Women will usually have lesions on the cervix as well, and men may have them inside the penis, hence the discharge described above, which occurs due to infected cells being sloughed off from those areas. About 20% of women with primary herpes infections also get a yeast infection in the vagina, making the itching and discharge more bothersome.

Frequently, a new crop of sores will appear 5-7 days after the first batch is seen. The typical primary outbreak lasts from 2-4 weeks in those people who recognize symptoms.

NON-PRIMARY(or initial) infections occur when a person has been infected with the herpes simplex virus before, almost always HSV 1. In this case, the person has antibodies which keep the infection at this new location under better control. However, the anti-bodies do not keep someone from getting the infection at a new site on the body. So a person could have a history of cold sores caused by HSV1 (or have been infected without knowing or remembering), and still get genital herpes caused by HSV 2. The symptoms for non-primary infections are less severe than the primary infection and most often go unnoticed. The sores will cover a smaller area, not be as uncomfortable, and may be on one side of the genitals only. The whole-body symptoms described above are less likely to occur. The time to recovery is generally shorter. It is important to note here that most people falling into this category have outbreaks that are minor enough to go unnoticed. In fact, it is now felt that as much as 80-90% of first time genital outbreaks are not recognized. RECURRENT infections occur in people who have had a previous HSV infection at or near the same site on the body. For people with genital herpes, that includes having outbreaks anywhere in the "boxer shorts" area. The same group of nerves supplies the genitals, thighs, lower abdomen, rectum and buttocks. A person need not have had sexual contact in any part of that area to have outbreaks there. For example, one need not have had anal sex to have an outbreak around the rectum. Sometime outbreaks occur in just the same place every time they appear, but this is not always the case. During recurrent outbreaks, most people do not experience the whole-body symptoms like headache, fever, etc. The sores cover a still smaller area, are most often on one side of the genitals only, and many people do not experience pain with their outbreaks.

The average recurrence lasts about 2-10 days, with outbreaks in women tending to last a bit longer than those in men due to the moist, warm character of the female genitals. Fifteen to 30 percent of women have virus present on the cervix during recurrences.

Bear in mind that these are averages, and outbreaks can vary a great deal, even in the same person. A person could have genital herpes for 30 years and not know it! When they finally do have an outbreak that they recognize, it can cause unnecessary havoc in relationship when issues of fidelity arise.

A WORD ABOUT ORAL HERPES Because oral herpes can result in a sexually transmitted infection, it is appropriate that it be discussed briefly in this book. However, it should be noted that the vast majority of oral lesions (cold sores and fever blisters) are not sexually transmitted. Oral herpes is usually acquired between the ages of 0-10, and is frequently the result of an adult with a cold sore kissing a child. Many acquisitions are totally without symptoms.

Adults who get an oral first infection can have symptoms that are both dramatic and painful. Blisters can develop around the mouth, in the mouth, and on other places on the face. The lymph nodes in the neck and head may enlarge and become very tender. Like genital herpes, the infected person may feel like they have the flu. About 40% of people infected with HSV 1 have recurrences that occur on the border between the lip and the face (commonly known as cold sores or fever blisters). Canker sores, which occur inside the mouth, are not caused by herpes Sores on the inner lip could either be herpes or canker sores. When a cold sore is present, one should not be the giver of oral sex to someone else. Like genital herpes, there is a risk of giving off (or shedding) the oral herpes virus without symptoms present. This is felt to occur on about 18% of the days sampled, when the test used to look is PCR.

About a third of first time genital outbreaks are now caused by HSV 1. At the first outbreak, there is no difference between how type I and type 2 behave. However, if a person has been infected with type I genitally, they are far less likely to have recurrences.

About 55% of people with type I infections have recurrences, usually about once every other year, as opposed to people who have type 2, who have almost a 100% recurrence rate. It is very important that when lab tests are done to confirm herpes, they are also typed (HSV 1 or 2) as you can see that the viruses behave quite differently in the genital area. It is also important to know the viral type because a person who has HSV 1 genitally can still acquire SV 2 genitally (the reverse almost never happens). In addition, HSV 1 genital infection can happen in a relationship where neither person has ever had another sexual partner if the couple participate in oral sex with each other.

About half the people with genital herpes experience something known as prodrome. Prodrome is a set of symptoms that occur before an actual outbreak is present. Itching, tingling, a crawling-under-the-skin feeling, pain down the back of the leg or in the buttocks, may all be signs of a recurrence on the way. Some people get the prodrome signs but no recurrence. Over time, a pattern may emerge that will help predict the onset of a herpes outbreak. The virus can certainly be transmitted during prodrome, so at that point, one should stop sexual contact with the infected area, be it mouth or genitals. Some people get prodrome symptoms without getting an outbreak. This is called an “ aborted ”

outbreak. It may be beneficial to keep a calendar of prodrome and outbreaks for a while to see how well one can predict a recurrence. Developing an awareness of prodromal symptoms is one way to try to reduce the chances of transmission to another person. Click here to see herpes pictures

Triggering mechanisms are those things that happen to people that seem to be associated with the onset of an outbreak. Menstruation, sunlight, pregnancy, birth control pills, diet, friction (which includes prolonged or vigorous intercourse or masturbation), stress, illness, and heat have all been identified by various persons as possible triggering mechanisms. Again, keeping a calendar of events as they are associated with outbreaks may help to identify one's own triggering mechanisms, if indeed there are any. It is worth noting that only one study has shown that stress has any relationship to recurrences. Several other studies have not confirmed this connection.

The average number of recurrences per year for people who have HSV 2 is four or five. This varies greatly from person to person, with some people having as many outbreaks as two per month to others having outbreaks once every five years. Men generally have one more outbreak per year than women. The first year of having herpes may not be a good measure of things to come; people may have more outbreaks in this first year than they do subsequently.

Giving off the virus without symptoms is also more common during that first year of having herpes.

Extracts from: "The updated Herpes Handbook" by Terri Warren, R.N., M.S., M.Ed.

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