What will I feel?
Here you will find a summary of the symptoms of genital herpes in men and women. Symptoms are disease-related subjective changes appearing in your organism that are noticeable by you (it is what you feel). Unlike symptoms, signs are objective changes that are noticeable not only by you but also by others (e.g doctor). In a classic disease process symptoms might appear a bit earlier than sign and is considered the key component of early diagnosis and treatment.
The majority of herpes positive people -80%-have never had any kind of symptoms before diagnosis and might never have one for the rest of their life span.
Even though having signs of herpes is uncommon (20% of people gets it), we’ve summarized information about them so that people who get them will be able to recognize the infection and take early action.
You will find below the symptoms of herpes summarized in tables:
- Genital symptoms in symptomatic males and females
- Oral and rectal herpes symptoms
The tables are followed by FAQ about the symptoms of herpes answered by our expert STD doctor. If herpes symptoms are what you want to know about this chapter is for you
Genital herpes symptoms: symptomatic males and females
This table summarizes genital herpes symptoms (what person feels) in symptomatic males and females (remember, only 20% of people with herpes are symptomatic). We’ve divided the symptoms into groups:
- Common (most symptomatic people experience them)
- Uncommon (very few people experience them)
- Most reliable (the signs doctors rely on the most because they can be explained by the pathophysiology of the disease process.
*Please pay special attention to a high number of asymptomatic patients
Common
Symptoms | Unusual
Symptoms | Most Reliable
Symptoms | Incubation
Period | Chance of symptom- free cases |
|---|
Genital area symptoms Prior to blisters appearance patients may feel tingling, itching and/or burning around the effected skin area
Areas effected in male:
- Scrotum
- Penile shaft
- Penile head
- Foreskin
Areas effected in female:
Systemic (general) symptoms - Headache
- Tiredness
- Lack of appetite
- Body aches
- Painful groin area
| - Aching legs and hips (shooting pain)
- Frequent need to urinate
| Genital area skin | 12-24 hours after initial exposure | 70-80% |
Herpes symptoms when it affects oral or anal areas
This table summarizes oral and rectal herpes symptoms (what person feels).Only 20% of people with herpes are symptomatic. We’ve divided the symptoms into groups:
- Common (most symptomatic people experience them)
- Uncommon (very few people experience them)
- Most reliable (the signs doctors rely on the most because they can be explained by the pathophysiology of the disease process
Common
Symptoms | Unusual
Symptoms | Most Reliable
Symptoms | Incubation Period | Chance of symptom- free cases |
|---|
Oral and anal skin area: Prior to blisters appearance patients may feel skin
Systemic symptoms - Headache
- Tiredness
- Lack of appetite
- Body aches
| Oral herpes:Rectal herpes:
- Leg aches
- Shooting leg pain
| Oral skin: | 12-24 hours after initial exposure | 70-80% |
Frequently Asked Questions
Here we summarize real patients’ questions, grouped by topic, and Dr. Fuzayloff’s answers to them. “Dr. F” (his patients’ name for him) has been an STD doctor for over two decades in Midtown Manhattan, NYC.
Herpes symptoms commonality 
Very uncommon. Around 80% of infected people do not have disease-related symptoms or the symptoms are rather mild to be noticed. Immune system of most people is strong enough to keep the virus suppressed, in the latent stage. It is important to remind that once herpes contracted it stays with the person for life. Occasionally immune system might go down and symptoms might show up.
The list of triggering factors that lead to the latter outcome includes but is not limited to:
- Stress
- Trauma
- Illness
- Menstruation
- Surgery
However, the chance of having herpes symptoms goes down over time. Herpes is the regressive condition- lesser chance of outbreak as the times goes on.
Herpes symptoms progression
Symptom progression
Most symptomatic people experience mild itch, tingling and burning of the local skin area shortly before skin eruptions (will talk about it in the sign portion). It usually 1-2-day lag between having symptoms and seeing signs
The symptom can be very subtle and very quick that most people do not notice the progression of symptoms.
Moreover, herpes symptoms and signs can appear at the same time.
Symptoms severity varies
Symptoms severity and progression may be different each time and depends on the competency of immune system at that particular moment. Immune system fluctuates depending on the stressors.
When symptoms do not progress into signs
Occasionally, symptoms do not progress into signs, when immune system acts fast suppressing the outbreak. It usually happens with subsequent herpes flare ups.
In those cases, the virus reaches the surface and skin become infectious but without skin sign appearance. Will talk about it in later chapters.
What is known today:
- Symptoms usually more severe with first outbreak
- Each subsequent outbreak gives milder symptoms
- Symptoms usually progress into signs (skin redness/blister/sore) within 1-2 days
I am 25 y.o male and have symptoms of genital skin burning/itching for a month. It (symptoms) is unchanged and constant. Skin is normal. Is it herpes causing my symptoms?
Based on the information we have it is very unlikely. Herpes symptoms usually followed by herpes signs in 1-2 days. The herpes outbreak usually goes through stages: symptoms, followed by signs appearance, followed by gradual resolution of the symptoms and signs. It is very unusual to be symptomatic for a month without having visible signs.
Most reliable symptoms for herpes diagnosis and why?
The most reliable herpes symptoms are the symptoms that doctor trust the most when establishing the diagnosis. Those are the symptoms that best explains the disease pathophysiology process, how the disease should evolve over time.
In case of the herpes, the most reliable symptoms are the tingling, burning, and pain of the affected area (genitals, mouth, face, and anus). It is caused by virus affecting the nerve fibers of the area after entering the body through damaged skin or mucosa.
Other herpes symptoms such as tiredness, flu like symptoms are general and may be noticed with conditions other than herpes too.
Herpes outbreak and systemic symptoms
In about 24% of cases, herpes flare up accompanied by systemic symptoms. Systemic symptoms are the ones that affect the whole organism such as:
- Fatigue
- Lack of appetite
- Body aches
- Fever
- Chills
- Other flu-like symptoms.
People start having systemic symptoms with herpes flare up as early as 12 hours after initial exposure.
It is more common to have systemic symptoms with first outbreak.
Herpes symptoms and herpes diagnosis prediction.
One of the most frequent question people ask is: “How reliable herpes symptoms are in establishing the herpes diagnosis?”.
It is not very reliable. The diagnosis cannot be established based on symptoms alone. It is one of many things that is considered by a doctor in terms direction of early testing and treatment.
Since most herpes symptoms are very general and vague it can be a sign of other medical conditions or even anxiety.
Time from herpes exposure to having symptoms.
About 70-80% of infected individuals are symptom-free. Among symptomatic patients, the symptoms may appear as early as 12-24 hours after exposure. However, the majority of people develop symptoms 2-10 days after being infected.
I have resolution of herpes symptoms. What does it mean?
Once you have herpes it will stay with you for the rest of your life and you can pass the infection to other people with and without symptoms.
Herpes virus does not get cleared by your immune system as many other viruses. It stays suppressed (latent form) in the local nerve ganglia and can resurface from time to time depending on the immune system at that moment.
So, if you believe you have had herpes symptoms and they got better, you can get a blood test for the HSV antibodies 3 months after the initial outbreak to get diagnosed officially.
I am 27 y.o female and have been experiencing tingly felling around the vagina opening for 6 months.
Everything started after I was notified by my ex that he is positive for the herpes. My herpes tests (multiple) never came back positive. Seen by multiple doctors (from neurologist to urologist), a lot of medical studies were done (MRIs of brain and lumbar spine, nerve conduction, CT scans, etc) with normal results. They(doctors) all assumed it must be psychological. How can it be explained?
Sometimes the “symptoms” are just the result of your stress. Psychological cause for any disease can be established only after excluding other stuff. It cannot be considered as a first thing “off the bed”
Why people develop psychological symptoms?
In case of herpes, this feeling usually appears after a risky (for that person) sexual intercourse (new partner, unprotected sexual act, and etc.).
It makes person uncomfortable and person starts reading about all possibilities that can happen and start questioning if they have those symptoms.
How doctors come to that (psychological reason) conclusion.
1. Current symptoms should be carefully evaluated.
2. Symptom and signs timing are important. Disease history can give a right context
3. Is it following the normal disease process? In this case, herpes process.
4. Can other conditions give the same or similar symptoms? Rule them out with special testing and specialist evaluation.
5. Psychological cause is assumed at this point
Chance of herpes transmission at the time of the symptoms
Genital herpes is very contagious. The chance of herpes transmission from an infected person may reach:
- 20.1 % for symptomatic patients (it is the highest when a person has visible signs such as blisters filled with fluid).
- 10.2% with no symptoms
Note: Taking antiviral medications reduces the chance of herpes contraction by up to 50%.
Herpes person most infectious with:
- First systemic prodrome signs (fatigue, fever, chills)
- Local symptoms of tingling, burning, itch
- Herpes signs of blister/sore
- And even after the resolution of the signs, when crust fells off
How soon after contracting a disease am I contagious?
If you just contracted the herpes you will start passing the infection right after the incubation period ends (2-12 days after the initial exposure). Again, you will be passing the infection with and without the symptoms.
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