Genital Herpes Symptoms and Diagnosis

Genital herpes symptoms can range from painful sores and difficulty urinating to no symptoms at all.

The most common symptom is the appearance of blisters that break and turn into painful, itchy sores. Such sores may arise where you can see them in these areas:

• Inner thighs and buttocks
• External areas of the female genitals
• Penis and scrotum
• Anus

Herpes sores can also erupt inside your body, where you cannot see them. Women can have sores in the vagina and on the cervix. Both sexes can have sores in the rectum, the part of the large intestine closest to the anus.

You may notice herpes sores going through predictable stages:

• Small red bumps or tiny white blisters may crop up first, within a few days or a few weeks of the first infection, or in a later outbreak.
• Ulcers may form when blisters rupture and ooze or bleed.
• Scabs form when the ulcers crust over and start to heal.

Everyone experiences genital herpes somewhat differently. Besides sores, symptoms of genital herpes can include these kinds of uncomfortable or painful sensations:

• Burning when you urinate, or if any of your urine touches sores.
• Having trouble urinating because sores and swelling are blocking the urethra, the tube through which urine passes. This problem can become extreme.
• Pain, itching, or tenderness in your genitals.

Genital herpes can be caused by either herpes simplex type 1 (HSV-1) or herpes simplex type 2 (HSV-2). If your case of genital herpes is caused by HSV-2, you may have flu-like symptoms, including chills and fever. You may also develop swollen glands in your throat or pelvis, and feel achy and tired.

Lots of people who have been infected with either HSV-1 or HSV-2 don't know it because they have never noticed any signs or symptoms.

People often mistake a herpes outbreak for another problem. You may think you have the flu, another STD, or that you have pimples or ingrown hairs, when in fact you have genital herpes symptoms.

Primary Herpes Outbreak

If you do develop symptoms, your first outbreak will most likely start 2 to 20 days after you get infected. In some people, though, a first outbreak occurs years after that first infection. Generally, first outbreaks last two to four weeks. Then the sores and symptoms fade away, but the virus remains in your body in a dormant or quiet state much of the time. That lingering virus can cause later outbreaks, but usually the first is the worst.

During a primary outbreak of genital herpes, you may experience symptoms that mimic the flu, such as:

• Fever
• Achy muscles
• Headaches
• Swollen lymph nodes in the groin
• Malaise, a general feeling of distress

Later Outbreaks

Repeat outbreaks are especially common in the first year of a herpes infection. If you have a repeat outbreak, it may begin with some low-level warning symptoms during a period called a prodrome. A few hours or a few days before a repeat outbreak, you may feel itchy, tingly, or burning sensations in your genitals. These sensations generally arise where the infection first entered your body. Your legs, buttocks, and lower back may hurt.

“Most people do have a prodrome with a recurrent outbreak, with tingling and burning in their skin. Then they usually break out in sores in the same place over and over when they actually become symptomatic,” says I. Cori Baill, MD, an obstetrician-gynecologist and an associate professor at the University of Central Florida College of Medicine in Orlando.

For most people, recurrences are somewhat less painful and shorter than the initial outbreak. The frequency of any later outbreaks, or recurrences, varies from person to person. Outbreaks may not occur at all or they may arise several times a year, or less often. Sores that occur in recurrences usually heal faster than the sores associated with a first episode of illness.

In many cases, outbreaks become more widely spaced as years pass.

If you develop any of the symptoms listed above, you should see a doctor for an evaluation. Your doctor may be able to diagnose herpes just by looking at your blisters or sores, and there are also lab tests to diagnose herpes.

Knowing you have genital herpes allows you to take steps to reduce outbreaks and to protect your sexual partner or partners.

According to the Centers for Disease Control and Prevention (CDC), the outlook for an individual and the type of guidance that person needs depend on which virus is causing the genital herpes, HSV-1 or HSV-2. Recurrent outbreaks are much more frequent for genital herpes caused by HSV-2, as compared with cases caused by HSV-1.

The CDC recommends testing to find out which virus is involved.

The CDC also says that people with genital herpes should be tested for HIV infection. If you have herpes, it’s easier for you to develop an HIV infection because herpes sores give HIV an open path into your body.

During active outbreaks, your viral load is heavier, and at those times you are most likely to infect a sexual partner, says Dr. Baill. “Without an outbreak, the viral load is usually insufficient to infect a normal, healthy partner.”

Remember, some people with HSV infections never have signs or symptoms of genital herpes at all. Although you are most contagious during outbreaks when sores are visible, you can also be contagious at times when you are free of any visible sores.

Herpes sores will arise in the spot where the infection entered your body. You can spread the herpes infection widely by touching your own sores and then touching other spots on your body, including your eyes. You can give yourself genital herpes if you touch your own cold sore and then touch your genitals or anus.

The infection can spread easily this way, says Baill. Good personal hygiene can prevent that kind of accidental viral transfer, though.

“People touch their mouths all day long. They wipe their hands around their faces,” says Baill. She tells her patients to wash their hands both before they go to the bathroom and after. This way, virus from a sore on their face is less likely to infect their genitals or anus.

If your herpes symptoms are bothersome or you’re worried about giving someone else the virus, see your doctor or another healthcare provider.

Antiviral medications can help make genital herpes sores go away faster, reduce the number of outbreaks, and lower the risk of transmission.

Consistent use of condoms and dental dams during sex also lowers — but doesn’t eliminate — the risk of transmitting the virus.

If you don’t have a primary care doctor or gynecologist, you can find expert advice at a Planned Parenthood clinic or a community health center.