What to Expect From Your First Genital Herpes Outbreak

Your first episode is usually quite different than future ones

Man concerned about first herpes outbreak
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Genital herpes is a common sexually transmitted infection (STI) that affects more than 400 million people in the world.

You may be surprised to learn that many people who are infected with the herpes simplex virus do not have any symptoms.

But if you do develop symptoms, it's important to know that the first genital herpes outbreak is worse than future recurrences. In fact, not only do future genital herpes outbreaks tend to be milder, but they also occur less frequently with time.

Knowing what to expect during your first outbreak and how to prevent and treat future ones is key, not only for your lifelong health but that of your partners as well.

Causes and Timing

In the past, genital herpes was caused mainly by the herpes simplex virus type 2 (HSV-2). But now, new genital herpes infections can be caused by both the herpes simplex virus type 1 (HSV-1) and HSV-2.

Since a herpes infection is transmitted through contact with the virus (for example, touching a sore), a person can get genital herpes from HSV-2 during sexual intercourse, or from HSV-1 if someone has a cold sore and engages in oral sex. Most people who get a primary genital herpes outbreak get it two days to 20 days after initial exposure.

The challenging part about herpes transmission is that you can still get the virus, even if your partner does not have any obvious signs or symptoms, like sores or ulcers. This phenomenon is called asymptomatic viral shedding.

Symptoms and Signs

The first genital herpes infection usually lasts for two to six weeks, according to the American Academy of Dermatology. However, there is evidence that some people have low levels of the virus present, even when they do not have symptoms.

Those who have contracted genital herpes may get a genital rash which presents as a cluster of vesicles on a red base.

In moist areas such as the vagina, herpes may cause ulcerations instead of blisters. 

In women, the first genital herpes outbreak can occur on the vulva, cervix, vagina, anus, buttocks, or thighs. Men usually get an outbreak on the tip of the penis or the shaft, but rarely around the base. Men who have sex with men may also get blisters in or around the anus.

Some people also develop whole-body symptoms with the first genital herpes outbreak. These may include:

It's worthwhile to note that women are more likely to be infected with HSV-2 than men, and if a woman gets a herpes outbreak on the cervix or in the vagina, she may develop vaginal discharge, pelvic pain, or burning with urination.

Protecting Your Partner

In order to avoid transmitting the virus to your sexual partners, abstain from sex entirely during a genital herpes outbreak. Also, during future genital herpes outbreaks (recurrences), a person may experience prodromal symptoms, like tingling at the site where a vesicle will arise. Abstaining from sex during a prodrome is also important to prevent transmission to your partner.

While you can use a latex condom for protection, remember that a condom does not protect the herpes virus from spreading 100 percent.

This is because the condom may not cover all areas of the skin that carry the virus. 

Also, remember that the herpes virus can still be transmitted in the absence of an active outbreak, due to asymptomatic viral shedding. 

Treatment

Genital herpes is a chronic condition. Once infected, the virus travels to your nervous system where it lies dormant in your nerve cells. But, when triggered (for example, by stress, illness, or menstruation), the virus can cause another outbreak.

While there is no cure for genital herpes, the good news is that it is treatable with anti-viral oral medications. In fact, because the first genital herpes outbreak can be severe or prolonged, the Centers for Disease Control and Prevention recommends that all people take an antiviral therapy for their first episode.

The three available options include:

  • Zovirax (acyclovir)
  • Famvir (famciclovir)
  • Valtrex (valacyclovir)

These medications can lessen the duration and symptoms of an outbreak. In addition, a person can take one of these medications every day to help prevent future genital herpes outbreaks from occurring, which will also lessen the chances of infecting a partner. 

Finally, while having a diagnosis of genital herpes can be a psychological burden, it's important to learn how to tell your current partners that you have herpes (or future partners before a sexual relationship begins).

A Word From Verywell

Genital herpes is common, so do not be embarrassed to get tested if you or your partner has it. Remember: There is medicine to treat and suppress (but not cure) genital herpes, but you can only get that help if you see your doctor. 

If you are pregnant, it's especially important to tell your doctor if you have genital herpes or your partner does. It's possible for you to pass herpes on to your baby during delivery, which can cause a very serious infection called neonatal herpes. To reduce this risk, you may be given a medication towards the end of your pregnancy.

Sources:

American Academy of Dermatology. (2017). Herpes Simplex

Center for Disease Control and Prevention. (2015). Genital HSV Infections

Groves MJ. Genital Herpes: A Review. Am Fam Physician. 2016 Jun 1;93(11):928-34.

Schiffer JT, Corey L. New Concepts in Understanding Genital Herpes. Curr Infect Dis Rep. 2009 Nov;11(6):457-64.

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