• image.alt
  • With Mayo Clinic women's health nurse practitioner

    Lois McGuire, R.N., M.S.N., W.H.N.P.

    read biography

Mayo Clinic Health Manager

Get free personalized health guidance for you and your family.

Get Started

Free

E-Newsletter

Subscribe to receive the latest updates on health topics. About our newsletters

  • Housecall
  • Alzheimer's caregiving
  • Living with cancer

  • Safe sex blog

  • Dec. 5, 2008

    Herpes symptoms, diagnosis and how it spreads

    By Lois McGuire, R.N., M.S.N., W.H.N.P.

92 comments posted

I started the discussion on herpes in my last blog. Today, I want to address herpes symptoms, diagnosis and spreading the virus. The symptoms can vary depending on the category of herpes. The categories are primary, non-primary and recurrent. I described these in more detail last week.

Herpes symptoms

Primary outbreak symptoms: Many people do not have symptoms. Others may have symptoms so mild that they do not recognize the symptoms as being from herpes. Still others may have painful attacks with whole body involvement and can feel very ill for a few weeks.

The symptoms may be flu-like including; headache, aching joints, tiredness, fever or pain in the legs. The lymph nodes in the groin are often enlarged and tender and may feel like large peas under the surface of the skin. Genital symptoms may include sores (often on both sides of the genitals), painful urination, itching and a discharge from the penis or vagina.

The sores begin as blisters and are often grouped in clusters. After the blister stage, they break open and form ulcers in the skin or mucous membranes. Crusts or scabs form over the ulcers and eventually fall off and the tissue heals. Women will usually have sores on the cervix and men may have them inside the penis. Infected cells are sloughed off from the cervix and inner penis causing a discharge in men and women. Frequently, a new crop of herpes lesions will appear 5-7 days after the first batch is seen. The typical primary outbreak will last 2-3 weeks.

Non-primary outbreak symptoms: Remember, this group already had HSV-1 or oral herpes and now is exposed to HSV-2 or genital herpes. The existing antibody to HSV-1 allows the symptoms of HSV-2 to be less severe or nonexistent. The sores will usually cover a smaller area. The whole body symptoms, described above, are less likely to occur. The time to recovery is generally shorter.

Recurrent outbreak symptoms: Most people do not experience the whole body symptoms like headache, fever, etc. with recurrent outbreaks. The sores cover a still smaller area; often the person will experience only one sore. Many people do not experience pain with their outbreaks. The average recurrence last about 2-10 days. Frequency of recurrence varies greatly.

Because the symptoms can be so mild or vague, men often self diagnose thinking one of these are the cause of his symptoms:

  • Jock itch
  • Zipper burn
  • Hemorrhoids
  • Acne
  • Tight jeans
  • Bug bites
  • Irritation from sex
  • "It's normal to itch"
  • Allergy to condoms (this is scary because then they don't use condoms and expose their partners to herpes)
  • Bike seat rubs

Women often self diagnose thinking one of these is the cause of her symptoms:

  • Yeast infection or some type of vaginitis
  • Bladder infection
  • Hemorrhoids
  • Irritation from sex
  • Heat rash
  • Irritation with her period
  • Allergy to sperm, condoms, spermicide, pantyhose or hygiene products
  • Bike seat rubs
  • Irritation from shaving

Herpes diagnosis

It is difficult to make a diagnosis of herpes by symptoms or looking at the sores. Sometimes the sores have a different look; they may be a small crack or fissure in the tissue or present as itching without a sore. Conversely, sometimes a sore can look very suspicious for herpes but is not herpes. Here are the most frequently used laboratory tests for herpes:

  • Culture or swab of the sore: This has a high false negative rate, which means it often reports a negative culture when the person really does have herpes.
  • Polymerase chain reaction (PCR): This test is very similar to a culture but it has a much higher sensitivity. It is 4 times more sensitive than a traditional culture. The PCR is more expensive than a traditional culture.
  • Blood tests: Herpes blood tests look for an antibody to herpes virus. The body develops antibodies to fight the virus but these antibodies can take a while to develop in the blood. It is important to wait 3-4 months from the time you think you were exposed to get a blood test. The newer blood tests are accurate and can tell the difference between HSV-1 and HSV-2.

How do you get herpes?

Most children with HSV of the mouth have acquired it very innocently. They have probably just kissed a family member that had a sore. Many people with "cold sores" don't realize it is herpes and can easily be spread from one person to another by kissing or sharing towels, etc. They also do not realize they are able to spread the virus without having a "cold sore" or other symptoms.

Genital herpes is spread through sexual contact, including:

  • Intercourse
  • Outercourse or rubbing genital areas together with direct skin contact or no clothing between partners.
  • Autoinoculation or transmitting the virus from one body part to another. For instance, if a person touched his or her mouth and then wiped his or her own genital area after urinating without good hand washing, he or she could spread the infection to another body part. This does not happen frequently.
  • Oral to genital contact: HSV-1 or oral herpes can be spread to a partner's genital. In this situation, the receiver of oral sex does not get HSV-2. The receiver will have HSV-1 of the genital area. The cold sore can recur in the genital area, acting the same way as HSV-2. Because oral sex has become more common, spreading herpes this way has increased significantly in the last 10 years. If you have HSV-1 of the mouth, it is important that you prevent an outbreak happening in the genital area to your partner.
  • Genital to oral contact: In this case, a person can acquire HSV-2 of the mouth. Once again, it is important to protect your partner.

In 70 percent of patients, transmission or spreading the disease happened when the person known to have HSV had no symptoms! The virus can be spread through microscopic breaks in the skin. This is called asymptomatic viral shedding. The next blog will cover treatment and prevention of spreading HSV.

Please share your questions or experiences with us.

92 comments posted

blog index

  • June 12, 2009 2:47 a.m.

    Can I get it if I use a condom

    - No name given

  • June 11, 2009 11:49 p.m.

    I would like to know why is it that for the past 22 years (I've had 11 partners) of me going to the doctor yearly for my pap and asking them to do STD and aids test that the blood herpes test is not included? Isn't HSV1 & 2 considered a STD? I don't care about the cost of doing the test, what about the fact that 1 in 4 people have herpes in the US including children. What about the people who don't know they have it because they don't have known symptoms and are spreading it. Why can't HSV blood test be a standard test to help control this incurable disease? I'm mad because I went to the doctor after my boyfriend told me of a sore he had and I tested positive for HSV1 then I went to another doctor six months later and said I tested positive for HSV2. The doctor apologized and said the first doctor was wrong that I was positive 6 months ago. Now the disheartening thing is my 2 year old has tested positive for HSV2 and has contracted it within the past 6 months. Her level is .234. What do the levels mean like 3.94 or 5? How devastating to have to explain to your child they have a disease from eating off your fork, drinking from your glass, a kiss from their mother or could it be from using the same tooth paste? Educate please. If I never asked for the blood test I would never know I have HSV. What can be done to change the process for testing? Why is the test so expensive? Why isn't it included in standard STD testing? Are there support groups? What can I do to make a cha

    - Jen

  • May 28, 2009 9:22 a.m.

    Dear Macka, I am not sure about your original diagnosis. It could be that you cleared the genital warts on your own and no longer need treatment. The sore you described that had puss is not a genital wart. It sounds more like a inclusion cyst. That is similar to a pimple on your face. There are many glands around the vagina that sometimes get plugged. If that happens again, just put a warm wash cloth on it for 10 minutes three times a day. This may allow it to open, drain the puss and release the pressure. If it gets very painful, then you need to see a medical provider. I would encourage you to stop pinching them. These are not serious and usually can be self treated. They are not usually sexually transmitted.

    - Lois McGuire

  • May 20, 2009 6:17 p.m.

    I am 27 years old, but when I was 19 or 20 I got a swab test done and I tested positive to genital warts... I was waiting on an appointment to go and have treatment , (which took about 2 months ), In the mean time I was offered a job abroad , and I took it so never made the appointment. In the past few years I have had out breaks round the vigina area nothing severe except for one time when I got this really big red lump that stung, after about a week a yellow head came on it so I poped it and alot of puss came out over a few days???"some help me"!!!! I have not had anything like that again but I do sometimes have little ones that I also pop and they go within a day or so...but the thing is I travel alot and usally not in a country for more than 8 months, I know that is enough time to get it checked out but (I dont speak the language) so can someone please tell me if I am putting myself at risk of getting cervical cancer....???Please....this has been going on for 7 years now.

    - macka

  • May 19, 2009 11:37 p.m.

    I am a 66 year old woman and just been told by my Dr. i have herpes .I was married for 30 years and then in a long term relationship for 11 years and then no one for 5 years until this man i met a year ago ,, he has never had any symtoms and i have the worst , painful , case i could think of , my whole body hurts as well as the sores and pain . I have never even had a cold sore in my life ,, i don`t believe he has cheated on me but where did it come from ,, i feel so emotionaly drained and can`t tell my family ,it seems like a bad dream ,, where does one turn .Why did this happen .

    - Anne

  • May 12, 2009 6:31 p.m.

    i have been married for eleven years both of us never had sex outside of marriage.recently my wife's doctor told her she had herpes.This is because she had sores on her vagina,betwen her legs,bottom.She also was itching.We are somewhat baffled and doubtful because if it is that one of us had it before marriage why are these signs just showing up in this very visible way and not before.How could she/we check to verify if it is so or not.NB i HAVE NO SIGNS.

    - tego

  • May 5, 2009 2:39 p.m.

    my bstfriend had unpretected sex with a girl who he found out had herp. well nither one of us knew unil two days ago. i went down on him after they had sex one time and not after . so what are my chances on getting it? this was 1 month ago and i have had no sym, and he has.

    - james

  • April 28, 2009 11:58 p.m.

    i have itch in my genitals since my partners and i quit using condoms 2 weeks ago, at first i thought that a have an allergy to sperm.... so i used a medicated feminine wash but the itch wont go away is it possible that i have herpes?

    - just asking

  • April 12, 2009 2:26 p.m.

    Can herpes be spread through spit when the herpes victim is NOT having an outbreak?

    - anonymous

  • April 5, 2009 11:02 p.m.

    I really need some help. I am 73 years old and I have what looks like a half inch slightly pimpled and slightly raised area near my vagina on the outside. Could it be genital herpe?. I have not had sex since 2/14/09. I have never had any cold sore or outbreak before. My partner was with another person six months ago for a period of several months. Can you tell me if I can see pictures somewhere? Do my symptoms sound like a possibility for herpes? Is there a way to get genital herpes from being in a public hot tub fully covered? Please, please help me. I am very appreciative of your advice. I also wonder if you can get genital herpes from kissing your partner? I so need to hear from you. This is not painful. What type of test should I ask to have from my gyn? Thanks you so very much.

    - janice

  • March 31, 2009 7:04 p.m.

    hello i am 17 yr. old female. i contracted hsv-2 when i was 14.i really didnt know how to handle it, but through time and with support from my family. im am now comfortable enough to live with the fact that i will have it for the rest of my natural life. i does bother me sometimes becase i know that no one wants a std, let alone hsv-1/2.but i just try to keep friends around.i cant lie sometimes i once again feel like onone is going to love me.i feel like they may run off and never return because i have herpes.then again i try to tell myself that its ok,maybe someone with herpes may come along.i learned a couple of things by reading the main post iof the information blog,and i thank you,and i wish all of you who are experiancing the same thing to continue to enjoy life without hurting peolpe.....peace and blessing to you all

    - "too young to know"

  • March 25, 2009 9:46 p.m.

    I think I hsave genital herpes. If you go to your doctor do they let the health department know, are you on a list? The sad thing is I recently got remarried, and I have to tell my husband. I didn't know i had this until it was to late i think my husband has it to. i was in a long term relationship, before I remarried, and he cheated on me, I am sure that is were it came from.I Know I have to talke with my husband about this, and get it seattled, and take the chanch he will stay with me. Should I get tested and get all faxes before I go to him. You might guess we do not have sex often, because i am afraid to. he has had lip sores, and I never had them before, but I do get them now. I was blowen away when you talked about the oral sex. I am so scared, and do not know what to do. Thxs

    - May#5

  • March 23, 2009 11:06 p.m.

    the main thing i want to know is can genital herpes be contracted any other way than sexually with another person?....maybe masturbation or having the cold sore virus and not knowing it...would that cause genital herpes...thx

    - po

  • February 27, 2009 8:42 p.m.

    Question--Yes, HSV2 can be transferred to the mouth through oral sex.

    - No name given

  • February 27, 2009 11:41 a.m.

    I've read that "if you already have one type of HSV, it is harder to get the other type... because the virus causes the body to produce antibodies that provide some crossover protection against the other type should it entering the body. " & HSV1 prefers latency near nerves near the ears while HSV2 is latent near the nerves @ the base of the spine. So say both partners have HSV2, if oral sex is performed, can it be transferred to the mouth? THANKS

    - question

  • February 27, 2009 2:18 a.m.

    My husband had an affair shortly after the birth of our first child. His doctor said he has oral herpes on his penis. We have used condoms for 6 years but I have read in the blogs about 'suppression'. My husband claims he doesn't need the drugs to suppress outbreaks because he has only had two in the six years. When I read the information, though, it sounds like him being on suppressive drugs would help me to stay safe. Please advise ...??

    - Questions on Suppression

  • February 24, 2009 12:38 p.m.

    i was first diagnosed with shingles, then after a culture was done i was told i had herpes simplex and i have suffered with severe nerve pain in my buttocks, legs and right arm for 5 yrs. i also get severe headaches and fevers and sometimes neck pain ad i have been told by my dr. that this is normal but it sure has left me in a dibilitated condition.

    - No name given

  • February 17, 2009 12:38 p.m.

    I am in a realtionship with someone who has HSV 1 & 2. He has never had an outbreak and has never had any symptoms. He was also married for several years and never infected his ex. He wasn't aware that he had it until we both decided to get tested for STD's. Since then - I have been tested and my blood test came back negative. He is currently on supressive therapy and we use condoms. I am still concerned about possibly contracting the virus. Are we fairly safe with what we are doing? Concerned?

    - C

  • February 11, 2009 7:50 a.m.

    Herpes spread very easily from sex contac. For you worry, i think you can ask the online STD counselor on a STD dating site" HerpesLoving. com". He will be help you

    - hier

  • February 10, 2009 9:36 p.m.

    I'm 36 and was just told today I have herpes and I am devastated. I am more worried about passing it to my daughter. I have a meeting with the Dr. on Thursday, and started Valtrex tonight. Why why why? Why did I not know that you can have it and not have symptoms?!!

    - W

  • February 8, 2009 2:26 p.m.

    My brother just told the family that he has genital herpes in his mouth. I am concerned how easy it is for him to transmit herpes to us (or to other partners). Can he pass it through kissing? If my children are playing with him and put a whistle or toy instrument in his mouth and then put it in their mouth, can they catch herpes? If he blows up a balloon, will it have genital herpes on it?? If we accidentally drink after him would we catch it? I don't want to be too alarmed, but I don't want me or my children to catch genital herpes in their mouth. How much protection would there be if he is taking antiviral medication regularly - will this prevent him spreading the virus? I want to stay safe.

    - want to stay safe

  • February 6, 2009 11:21 a.m.

    I posted the last comment. Today, I went to my doctor and was advised it is yeast infection and is more present in males with diabetes. I am writing this to advise others, please do not jump the gun- see your doctor.

    - Si

  • February 5, 2009 6:49 p.m.

    I just saw little blisters on my penis, and I am scared. I will go and see my doctor in the morning. The only place, I can think is a public toilet seat as I did not have any sex outside my marriage.

    - -Si

  • February 4, 2009 7:11 a.m.

    SM, YES, you can spread HSV1 if you have it genitally and someone performs oral sex on you.-

    - Deb

  • February 3, 2009 1:19 p.m.

    If you have HSV 1 in you genitals, if some one perform oral sex can you pass it on to them.

    - SM

Post a comment
Previous page Next page

Text Size: smaller largerlarger