Herpes Symptoms in Women and Men

What herpes symptoms look like

A first outbreak of genital herpes, when there is one, usually starts two to twelve days after exposure with tingling, itching or burning, followed by a cluster of small blisters that break into shallow, painful sores on the vulva, vagina, cervix, penis, scrotum, buttocks, thighs, anus or mouth. A first outbreak can also bring fever, body aches, swollen glands in the groin and pain when urinating, and takes two to four weeks to heal. Later outbreaks are usually shorter and milder, often with a warning tingle a day or two before, and become less frequent over time.

Many first outbreaks are mild – a single small sore, a crack in the skin, an irritated patch that is put down to razor burn or a yeast infection – and many people never notice one at all.

Why most people have no symptoms

The CDC estimates that about one in eight Americans aged 14 to 49 has HSV-2 and roughly half have HSV-1, and that most people with genital herpes have never been diagnosed, because the infection is usually mild or silent. The virus can be passed on when no sore is present. A test is the only way to know. Symptoms do not shorten the time an infection takes to show up on a test, and having none does not mean you are clear.

What else causes the same symptoms

Ingrown hairs, folliculitis, razor burn, friction, yeast infections, contact reactions to soaps or condoms, and other infections such as syphilis all get mistaken for herpes – and herpes gets mistaken for all of them. Looking cannot settle it. If you have a sore right now, the most accurate answer is a swab of the sore by a clinician; if it has healed, the blood test is the only option.

When to see a clinician rather than wait for a test

A blister or sore should be examined and swabbed while it is present – that is more accurate than the blood test and can be treated on the spot. Severe pain, difficulty urinating, a severe headache with a stiff neck, or eye pain and redness during an outbreak need prompt medical care. If you are pregnant and have herpes, or your partner does, tell your prenatal provider: it is managed routinely with medication late in pregnancy and, if a sore is present at delivery, a caesarean, and most babies of mothers with known herpes are born unaffected. A first infection late in pregnancy is the situation with the highest risk to the baby, which is why the provider needs to know.

How herpes is tested, and what the test cannot tell you

Our test is a type-specific IgG blood test that looks for the antibodies your body makes against HSV-1 and HSV-2 and reports each separately. It is a quick blood draw, and you do not need to have a sore to take it. Its limits are important: antibodies take weeks to months to appear after exposure, so a negative taken too soon is not final; a positive HSV-1 result cannot tell you whether the infection is oral (cold sores, which half of adults have) or genital; and a low positive HSV-2 result can be a false positive and should be confirmed with a second test before it is taken as final. The CDC does not recommend routine herpes blood testing for people with no symptoms and no known exposure, for exactly these reasons – and it does not recommend IgM tests at all. The timing is on our When to Get Tested page, or call (866) 872-1888. More about the test is on our herpes testing page.

After a positive result

Herpes is managed rather than cured, and for most people it becomes a small part of life. A member of our care team calls you, explains the result – which type, and what that means – and arranges a consultation with a physician who can prescribe antiviral medication: taken at the start of an outbreak to shorten it, or every day to keep outbreaks rare and reduce the chance of passing the virus to a partner. Condoms and daily medication together lower transmission considerably. Partners should know so they can decide about testing. Roughly one in six adults has genital herpes and lives, dates, marries and has children normally.