Recognizing a Herpes Outbreak

Medically Reviewed By William C. Lloyd III, MD, FACS
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Herpes positive

Herpes is a common disease. Still, it can be surprisingly hard to detect. For instance, about one of every five or six people has genital herpes, but perhaps as few as 10% are aware of it. One reason is many people have no symptoms, while other people have very mild symptoms. Sometimes people think their symptoms are from something else. They mistake herpes for an ingrown hair, an insect bite, a pimple, or a rash.

What happens with a herpes infection varies a great deal from person to person. Some people have an outbreak within days of exposure to the virus. For others, symptoms may not begin for years.

No matter when it happens, there are some common signs and symptoms to watch for so you can get the proper treatment for a herpes infection.

First Warning Signs

Sores or blisters on the skin are the most common signs of herpes. However, you might have some subtle warning signs before any blisters appear. The skin in the affected area might tingle or itch for a day or two. Some people describe this as a burning or painful feeling. This is not always a sign of herpes. Still, it could mean that an outbreak is on the way. Often this early symptom occurs if you've had a herpes outbreak before and the sores are about to “reactivate.”

What to Look For

There are two types of herpes: oral herpes (usually caused by a virus called HSV-1) and genital herpes (usually caused by a slightly different virus called HSV-2). Oral herpes sores are often called cold sores or fever blisters. They usually form on the lips. They can also appear on the tongue, around the mouth and elsewhere on the face. Genital herpes blisters are usually found on the buttocks, on the penis, on the anus, and around or inside the vagina.

These are not the only places where herpes sores can appear. They can show up almost anywhere on your skin, depending on where the virus entered the body. You can also spread the virus from one area of your body to another. For instance, if you touch an active lesion and then rub your eyes, you can infect your eyes.

No matter where they are, herpes sores usually start as small red blisters or pimples. The number can vary from one to a large cluster. In almost all cases, the blisters break open and release fluid. A crusty scab forms over the top. Then they begin to heal and go away.

An outbreak of oral herpes often lasts two to three weeks. Genital herpes can last as long as six weeks.

Often, the first outbreak is the worst. Most of the time you can expect later outbreaks to be less severe. They're also usually less widespread, and they heal more quickly than the first one. After the first one, herpes outbreaks usually last two to 12 days.

Other Symptoms You May Experience

Some people get flu-like symptoms during a herpes infection. They ache and have a fever. Having swollen lymph nodes around the area of the outbreak also is common. People with genital herpes may have a burning sensation when urinating. Sometimes they have trouble urinating.

If you have pain or a gritty feeling in your eyes, it's possible that the herpes infection has spread to your eyes. Fluid leaking from the eye or sensitivity to light are other signs of an eye infection related to herpes. Get immediate medical attention if you think you have a herpes infection in your eyes. Permanent damage is possible.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jul 4
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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