Genital herpes symptoms vary from person to person, although they usually include the formation of painful lesions, or ulcers. The initial outbreak is usually the most severe, with subsequent outbreaks being milder; in some cases blisters don’t even form.The First Outbreak. An initial outbreak of herpes often happens quickly: symptoms usually appear between two to ten days after infection, and tend to last for two to three weeks. Lesions first appear as small red bumps that develop into blisters. The blisters then burst and turn into painful open lesions, or ulcers. After several days the ulcers scab over and heal without scarring.
Blisters develop wherever the virus entered the body: the penis, testicles, vagina, vulva and anus may all be affected, as can the buttocks and thighs. If the infection was passed through oral sex, lesions may develop in the mouth. Both sexes can develop symptoms in the urinary passages.
A herpes ulcer can often be mistaken for something else. If an outbreak is mild, it’s not unusual for ulcers to be dismissed as insect bites, ingrown hairs or irritation from shaving. At times, symptoms have also been mistaken for yeast infections, jock itch and hemorrhoids. If you have the slightest suspicion than you’ve been infected with HSV 2, consult your doctor.
Even before the first lesion develops, people may experience itching or burning in the genital area, or pain in the legs or buttocks. Women may experience vaginal discharge. Abdominal pressure is also common.
Other symptoms that occur during the first outbreak can include fever, headaches, painful urination, or swollen inguinal lymph nodes (those in the genital region). These symptoms do not usually present themselves in future outbreaks.
Subsequent Outbreaks. After the initial infection, the virus goes into remission. It withdraws into nerve cells at the bottom of the spinal cord and lies dormant until the next outbreak. Most people experience three or four outbreaks of the virus every year. (This statistic varies wildly: some people experience much more frequent outbreaks, while a rare few may only have one or two outbreaks throughout their lives). Outbreaks vary in severity—some lucky people have outbreaks so mild that they don’t even notice any symptoms—and usually last a week.
Taking a Herpes Test. A herpes test is not infallible: a negative result does not always mean that the virus isn’t present, only that the test didn’t detect the virus. If symptoms are present, fluid may be drawn from a blister and tested. Ideally, the fluid should be drawn within 48 hours of the viral outbreak, before the blister bursts and becomes an ulcer or lesion. The fluid is used to attempt to culture the virus.
Herpes tests are usually very accurate if they yield a positive result, but growing viral cultures is a difficult task. Often the virus will not grow, leading to a negative result even though the virus is present. Attempts may be made to isolate herpes simplex 2 DNA from the blister fluid, but again, a negative test only reveals that there was no herpes DNA in the sample, not that the virus isn’t present in the body.
Doctors may also attempt a Tzanck test on blister fluid. The human cells in the fluid are stained with dye, so any cells infected with the virus can be detected. Unfortunately, the test cannot actually determine the type of virus present.
If actual symptoms are not present but you suspect you may have contracted genital herpes, certain blood tests can detect the virus. Some tests cannot, however, differentiate between HSV 1 (oral herpes) and HSV 2 (genital herpes).
Newer tests are becoming increasingly sensitive and specific for diagnosis. Reporting any unusual lesion or ulcer in the genital region can help your doctor make a better diagnosis.