Symptoms of Herpes

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Both herpes simplex viruses (HSV) can cause internal and external symptoms, like sores. HSV type 1, which is normally transmitted through kissing or sharing objects like toothbrushes, normally causes sores on the mouth or tongue (cold sores).

Sores from HSV type 2 are usually on the genital area, as this type of herpes is sexually transmitted. However, it's possible no symptoms will occur with infection or that sores may come and go.

Internal herpes may cause pain, flu-like symptoms, and swollen lymph nodes. This article explains the common and less common symptoms of HSV infection, as well as related complications and reasons to visit a healthcare provider.

herpes symptoms
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Frequent Symptoms

The first herpes outbreak usually starts about two to 20 days after you contract the infection. However, not everyone gets symptoms. Both natal males and females can have asymptomatic infection. In fact, most HSV infections are either asymptomatic or unrecognized.

There are some similarities between the symptoms of HSV-1 and HSV-2, including:

  • Severity: Cold sores and genital herpes tend to cause more noticeable and extensive symptoms during the first infection. Generally, recurrences are milder.
  • Asymptomatic intervals: Cold sores and genital herpes are caused by viruses that enter through the skin and travel to the nerves, where they remain dormant (inactive) before recurring. These asymptomatic intervals can last for weeks, months, or even years.
  • Warning signs of reactivation: Pain, tingling, or burning can occur prior to a recurrent episode of herpes. This is due to inflammation and irritation of the nerves in the infected area. These warning signs of another outbreak (often referred to as prodromal symptoms) mean that you are very contagious even if you do not have any visible sores.

Most of the time, HSV types 1 and 2 cause superficial symptoms of the skin in the specific areas mentioned. In exceptional circumstances, more severe symptoms can involve other parts of the body.

Symptoms from a herpes outbreak can last between 10 and 21 days. The first outbreak is typically the most intense and can last two to four weeks.

Symptoms disappear in 10–21 days. Recurrent attacks usually affect the same area but are less severe. Some people with herpes can feel a symptom flare-up coming on a few hours or days before an outbreak. Common warning signs include itching, burning, or a tingling sensation on or around the genitals.

The main way symptoms of the two types of herpes virus differ is where the sores occur.

Cold Sores (HSV-1)

Cold sores, or fever blisters, can appear on the outside of the mouth or lips, inside the mouth, or on the tongue. Symptoms of HSV-1 include:

  • Open, blistery, or crusted sores
  • Pain with chewing, swallowing, or talking
  • Itchiness of the sores and the area around them

The symptoms may last for about three to 10 days, and recurrent sores generally affect the same area.

Genital Herpes (HSV-2)

Typical symptoms of genital herpes include:

  • Internal and external blisters and sores that are small, fluid-filled, and often occur in clusters
  • Itching or burning feeling in the genital or anal area
  • Pain in the legs, buttocks, or genital area
  • Pain when urinating
  • Unexplained penile discharge
  • Unusual vaginal discharge

Male symptoms of the infection can involve the penis, anal opening, buttocks, and/or thighs. With female symptoms, the sores can occur in the vaginal area, cervix, urethra (the tube that carries urine), area around the buttocks, anal opening, and/or the thighs.

Females may be more susceptible to a genital herpes infection primarily because a female genital area is more likely to be moistened with body fluids, which allows the virus to easily enter the skin.

Natal females tend to have higher rates of complications during the first genital herpes outbreak.

Less Common Symptoms

In general, herpes simplex infections cause sporadic recurrences of sores, often with a preceding trigger, such as a cold or a fever—and sometimes without any trigger at all.

An infection may cause other, though less common, internal symptoms as well. These include:

  • Severe pain at the site of the sores: The sores can cause extreme pain, usually as the result of repeated abrasion. For example, HSV type 1 can occur on the tongue near the teeth, which can cause extra irritation. HSV type 2 can occur near an area where there is repeated rubbing from the fabric of clothes, or an area that is aggravated by walking or sitting, which can worsen symptoms.
  • Enlarged and painful lymph glands: Glands near the infection can become enlarged or painful when you have an active herpes infection. They may include lymph nodes in the neck, under the arms, or in the groin.
  • Flu-like symptoms: The infection may cause a fever and generalized flu-like symptoms such as muscle aches and fatigue. This can happen due to the body's immune system response to HSV infection.

Symptoms in Other Areas of the Body

HSV type 1 can occur in the genital area and HSV type 2 to occur on or in the mouth. Either case is usually a result of spread through oral sex.

You cannot always know which type of herpes virus you have by looking at it, as the sores caused by both viruses look the same. 

HSV-1 can also affect other areas of the body, such as the neck, arms, and torso. Symptoms include pain, itching, and blisters or sores. This is most often associated with wrestling and is described as herpes gladiatorum when it occurs in that setting.

Complications

Most of the time, herpes only causes superficial sores. Herpes can result in serious complications that affect other parts of the body, but this is rare.

Generally, complications of herpes are most likely to occur in two situations: When a baby is born with herpes transmitted maternally during delivery, and when a person's immune system is not functioning properly (as with human immunodeficiency virus, or HIV, infection).

Disseminated Herpes

Disseminated herpes occurs when a herpes virus infection spreads from the initial area of infection. For example, HSV type 2 herpes sores can recur, affecting multiple areas of the vagina. HSV type 1 sores can recur, affecting multiple areas of the tongue.

Disseminated herpes can be more severe, as the herpes virus can spread to other parts of the body, including the brain.

Ocular Herpes

Herpes infection can affect the eyes. It can cause eye symptoms when you first become infected or years later when the latent virus is reactivated. Ocular herpes can produce painful sores on the eyelid or in the eye itself.

The following symptoms may indicate ocular herpes:

  • Pain in and around the eye
  • Redness, rash, or sores on the eyelids, around the eyes, or on the forehead
  • Eye redness
  • Swelling and cloudiness of the cornea
  • Tearing
  • Blurred vision
  • Light sensitivity
  • Discharge

Hearing Loss

Herpes has been associated with sudden hearing loss in children and adults, as well as with newborn hearing loss. This complication can occur if the herpes virus affects the nerves that control hearing.

Encephalitis

Encephalitis is an infection of the brain. This is a serious infection that can cause developmental delays in children or cognitive (thinking) deficits in adults. HSV encephalitis is mainly associated with HSV-1, but it can be caused by HSV-2 as well.

Neonatal Herpes

Neonatal herpes is a rare form that occurs when an infant is exposed to HSV during childbirth. However, it is a serious condition that can cause permanent neurologic disability or death. The risk is greatest when the pregnant person gets HSV for the first time in late pregnancy.

When to See a Healthcare Provider

If you have a cold sore, you do not necessarily need to make an appointment with your healthcare provider right away. The sore will likely go away on its own within a few days.

Make an appointment for an evaluation if you have signs and symptoms of cold sores that are persistent and/or extremely painful, especially if they are associated with fevers, swelling, bleeding, or oozing. Though cold sores are generally not serious and rarely cause complications, you'll want to get outbreaks under control.

If you have any signs of genital herpes, however, you should see a healthcare provider within a few days, before the lesions go away. Herpes symptoms will clear up, but the virus that causes herpes remains in your system and can cause future outbreaks.

Sores on or near the genital area can herald a sexually transmitted infection (STI), or they may be the result of some other type of irritation. Most STIs are treatable, but it is difficult to know which one you may have (or if you have one at all) unless you are trained in diagnosing them.

Having a partner with signs and symptoms of herpes is also a reason to see a healthcare provider for an evaluation. Many people do not freely communicate with sexual partners when it comes to STI status or may not even know they have an STI. It's best to get a definitive answer on what's causing your symptoms.

If you have pain or bleeding with urination, pain with sexual activity, or if you notice that lesions in the genital area seem to be inflamed, you should call your healthcare provider, even if you have already been diagnosed with and treated for herpes.

Summary

People who have herpes may not have any symptoms or may mistake symptoms for something else. In addition, internal symptoms are not as noticeable as external ones like sores. Internal herpes can cause pain, flu-like symptoms, and swollen lymph nodes. Paying attention to your body may help you know if you have internal herpes.

Contact a healthcare provider if you think you may have herpes or suspect your partner does. Get tested to find out if you do and what type it is. Herpes is treatable. By being well-informed, you can prevent the spread of herpes and other STIs.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Jerry Kennard
 Jerry Kennard, PhD, is a psychologist and associate fellow of the British Psychological Society.