Genital Herpes Symptoms & Stages

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Genital herpes flare-ups may present varying symptoms, and occur in stages. Let’s examine how to identify a possible outbreak while taking a look at the signs of each stage.

Otherwise known as the herpes simplex virus, herpes is classified into two distinct types: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).
  • HSV-1 is primarily transmitted via oral-to-oral contact, and typically results in the appearance of cold sores. It is important to note that herpes simplex virus 1 can also cause genital herpes. According to information published by The World Health Organization (WHO), an estimated 3.7 billion people under the age of 50 have HSV-1 infection globally.
  • HSV-2 is a sexually transmitted infection that results in genital herpes. WHO indicates that an estimated 491 million people between the ages of 15-19 are infected with HSV-2 globally.

Both strains of infection last the lifespan of the recipient, although – in some cases – no sign or symptoms of herpes appear. Since most infections are asymptomatic, self-identifying herpes can be difficult. 


What are the early stages of genital herpes?

The early onset of genital herpes can present in a number of different ways. Generally speaking, the first symptom that you are likely to notice is inflammation of the skin around your genitals, resulting in a burning or itching sensation. 

Symptoms typically surface within 1-2 weeks of infection. This stage is identified as the prodrome or beginning stage. The appearance of inflammation indicates the virus has progressed to the surface of the skin. 

Symptoms during the early stages can include:

  • Burning or itching around the genitals
  • Pain when urinating
  • A bumpy raised area
  • Sores or blisters
  • Fever and/or flu symptoms
  • Body ache

For women, the first signs of genital herpes usually present inside the labia, are associated with painful urination and unusual vaginal discharge. Inflammation of the cervix can also be a sign of infection. 

For men, the outbreak of genital herpes in the urethra results in the same symptoms, a burning feeling when urinating. 

The incubation period is the time from exposure, to when symptoms will first appear. Whilst the average time is 1-2 weeks, this can vary; with some people not displaying symptoms for months, or even years after becoming infected. Although rare, some people may never experience symptoms at all.


What are the stages of genital herpes?

There are four distinct phases of a herpes outbreak. Below is an explanation of a genital herpes timeline, and what an infected individual can expect as the outbreak progresses throughout the body.


1.  Prodrome stage

This is the first stage of a genital herpes outbreak, when the first signs start to appear. This is when the virus travels to the surface of the skin, causing symptoms such as itchiness, tingling and burning around the affected area.

The prodrome stage causes symptoms which lets your body know that you are about to experience an outbreak. Flu-like symptoms such as headache, fever, swollen glands and body ache are common.

The prodrome stage can last for a few hours, to 2 days. It usually stops once blisters develop. Although sores do not develop during the prodrome phase, you are still contagious.


2.  The blister stage

The blisters stage is marked by the appearance of blisters and ulcers. The formation of these small red bumps is followed by a filling with clear to whitish fluid. These blisters are extremely sensitive and at times painful, and the skin surrounding the bumps often appears irritated. 

Similar to the appearance of a razor burn, rash, or pimples, herpes at the sores stage can be difficult to accurately identify, although the cluster formation can provide enough differentiation to aid in diagnosing. 

Although the fever associated with the prodrome stage could persist in this phase of infection, it is typically only noted during an initial herpes breakout. For women, blisters inside the vagina can take up to three weeks to heal.


3.  The ulcer stage

The ulcer stage of herpes progression occurs when the blisters begin to burst and drain. These open sores are identified as ulcers and develop in the location where the blister was. Sores usually last for around 1-3 weeks, depending on the severity of the outbreak. This is usually described as the most painful stage of genital herpes.  

Over time, the ulcers will form a yellowish fluid which then hardens to form a scab over the sore. 

Crusting or scabs will develop over the area as it dries out. Wet areas, such as the inside of the genitals take longer to heal due to the inability for the area to dry.


4.  The healing stage

The healing stage can take a long time to reach. In the event of an individual’s first outbreak, anywhere from 2-4 weeks is a common duration before healing starts. Typically, subsequent flare-ups result in quicker healing times. During this final stage, white/yellow crusts and scabs form over the ulcer, indicating the healing process has begun. Irritation or itchiness of the skin surrounding the sores is still often associated with the healing stage, and any picking of the scab could result in scarring. After the scab has naturally fallen off, the surrounding area might remain pink or slightly irritated for some time.


Where does herpes appear?

Hepres symptoms in men can present in different areas to women. Knowing what to look for – and where – can help a potentially infected individual recognize the need to seek treatment. Here’s where to look for signs of an oncoming flare-up.

Herpes in Men

  • The mouth and lips are areas that present symptoms in the event of HSV-1 infection, resulting in cold sores or blisters. In the case of oral herpes, the sores look similar to pimples or small bumps, and are typically red, white or yellow in colour. Men may experience swollen lymph nodes during the onset of an infection.
  • Genital sores are the primary indicators of an HSV-2 outbreak. Small, pimple-like bumps appearing on the penis may develop into larger sores once they begin filling with a yellowish substance. Swollen lymph nodes in the area surrounding the groin are common.
  • The scrotum and rectum may develop sores or blisters, particularly on the skin surrounding the anus.
  • The fingers can also be affected by a herpes outbreak – this is called herpetic whitlow, and is commonly associated with children who suck their thumbs. Herpes sores around the fingernail are often preceded by pain or tingling in the affected area. Multiple sores in this area often take on a honeycomb-like appearance.
  • Infection of the eye, also known as herpes keratitis, may affect one or both eyes and causes pain or sensitivity, often resulting in orbital discharge. 


Herpes in Women

  • In addition to the mouth and lips that are affected by HSV-1 infection, women have multiple areas surrounding the genitals that are commonly affected by the outbreak of HSV-2. Pain while urinating – or a tingling sensation – is one of the common symptoms that can often be mistaken for another issue, such as a urinary tract infection (UTI).
  • The vulva, or external sex organ of the female body may develop sores or blisters. Multiple anatomical locations of the vagina could present symptoms of an infection.
  • The vaginal opening is a particularly sensitive area, and discomfort or irritation in this area is often an early indication of a possible genital herpes outbreak.
  • An outbreak within the cervix may not be visually identifiable, but similar to the vaginal opening, this area will be very sensitive if a flare-up results in sores or blisters. Similar to the mouth, the healing stage can take longer to progress in areas of the vagina. Inflammation of the cervix is a commonly associated symptom of HSV-2 outbreak. 
  • The upper thighs and groin are home to breakouts that can be falsely identified as razor burn or heat irritation but should be observed in the event of a possible flare-up.
  • In addition to the buttocks and anus, the perineum, or delicate skin between the vagina and rectum, is commonly irritated during infection and could present honeycomb-like clusters of tiny sores or blisters.
  • Similar to men, areas such as the fingertips and eyes are also areas that could flare-up as the result of a herpes outbreak.


Can you get herpes on the bum?

Anal herpes is possible for both men and women. Most cases of herpes around the anus are spread through anal intercourse with an infected person, although it is possible to transmit this STD through oral-anal sex from a partner infected with HSV-1. It is also possible for HSV-2 to spread and become anal herpes in the case of open sores or wounds around the anus.


Can genital herpes only cause one sore?

A single herpes bump looks like a pimple, or irritation on the surface of the skin. Although herpes is commonly identified by a honeycomb, or cluster pattern of red and raised bumps, a single bump is possible, especially early on in the blister stage of a flare-up, or in mild cases. If a single sore is accompanied by other symptoms, it may be a good idea to carry out a herpes test.


What about other sores that look like herpes but aren’t?

  • Folliculitis, a condition commonly known as an infected ingrown hair is often mistaken for herpes spots. Bacteria – frequently Staphylococcus Aureus – enters the hair follicle through a small pimple that has developed around it. Areas surrounding both the mouth and genitals may be irritated or affected by ingrown hairs as a result of shaving or grooming.
  • The outbreak of acne pimples can also be incorrectly associated with a herpes flare-up, as both can occur around the genitals, buttocks, or mouth of an individual.
  • For women, yeast infections, particularly when they affect the outer labia, are also commonly mistaken for genital herpes.
  • Bacterial vaginosis (BV) is basically an imbalance of the normal bacteria universe in the vagina. As outlined by the Centers for Disease Control and Prevention (CDC), while BV is not considered a sexually transmitted infection (STI), it can increase a woman’s risk of contracting one.


Does herpes itch or burn?

Genital herpes often causes itching at the start of an outbreak. This can last until blisters start to appear. The itching is likely to return once the healing stage begins. A burning sensation is usually felt once the blisters have appeared. Burning is likely to get worse as the blisters burst open.


How long does a genital herpes outbreak last?

Herpes outbreaks usually last for about 1-2 weeks, although the first flare-up after infection may last between 2-4 weeks. In most cases, symptoms will go away on their own without treatment, however, the duration of the outbreak depends on how quickly the body can combat it and whether or not antiviral medications are taken to speed recovery.

As a general rule, the first outbreak tends to be the most severe and longest-lasting, with the second outbreak and subsequent outbreaks after that diminishing in severity and duration. In some cases, flare-ups may pass within a few days.

It is worth noting that infected individuals may be susceptible to multiple outbreaks in a row, with genital herpes infections that affect areas such as the labia, vagina and penis taking longer to heal.


How to treat symptoms

Genital herpes is diagnosed with a physical examination and laboratory tests. In most cases, a viral culture test, polymerase chain reaction (PCR) test and blood test are administered to help diagnose a herpes infection.

Medication is very effective in managing genital herpes, and typically individuals are able to continue leading a normal, healthy life while infected.

The two most common antiviral medicines used to heal herpes sores faster are aciclovir tablets (commonly sold under the brand name Zovirax) and valaciclovir tablets (also known as Valtrex.)

By using herpes treatment after the onset of a herpes flare-up, the severity and duration of genital herpes symptoms and sores are reduced, especially in instances of a recurrent outbreak.

Aciclovir and valaciclovir are also able to reduce the frequency of outbreaks and help to minimise the risks associated with transmission to others. In general, medication for genital herpes is well-tolerated and has few side effects. 


How to prevent herpes outbreaks

  • A healthy, robust immune system helps keep the virus at bay, so active living and maintaining a balanced diet may assist in preventing recurring outbreaks.
  • Avoiding excessive alcohol consumption is also thought to reduce the chance of a flare-up.
  • Stress is thought to be a trigger for herpes outbreaks, so ensuring quality sleep and other stress-reducing activities can aid in keeping herpes at bay.
  • Medication such as aciclovir and valaciclovir can be taken over a long period of time, to reduce the number of outbreaks. Typically, those that suffer from 6 or more outbreaks a year, are offered suppression therapy.


What about cream?

Herpes cream is only available to treat cold sores. Currently, there is no cream available to manage symptoms of genital herpes.

There is no cure for herpes, however, it can be managed using antiviral medication and barrier methods. Honest discussions between sexual partners can help avoid complications further into a relationship. If you feel as though you may be developing symptoms associated with herpes – such as sores or blisters – a herpes test kit can help to diagnose infections.

How long after a herpes outbreak is it still contagious?

You are most contagious right before, and during an outbreak, when the viral load is at its highest. It can take a few weeks for sores to completely heal, and for the virus to become dormant. When the virus lays dormant in your body, there is a much lower chance of passing herpes on to sexual partners. Because of the nature of the virus, it’s not possible to know whether you are contagious or not. Even after an outbreak has healed, there is no way to know if another one is on the way. If it is, you will be contagious. If your outbreaks follow a pattern of when they appear, you may have an indication as to whether or not an outbreak is likely. However, this is not accurate. Although you may not be displaying symptoms, you may be contagious. Over time, a person who has had herpes for a long time is less contagious than a person who has recently been infected. 

Whilst all of our content is written and reviewed by healthcare professionals, it is not intended to be substituted for or used as medical advice. If you have any questions or concerns about your health, please speak to your doctor.