Initial & Recurrent Outbreaks of Genital Herpes


An outbreak of genital herpes may occur as an initial or first outbreak, or it may be a recurrent infection. Read on to learn more about each of these types of outbreaks, as well as what triggers an outbreak.

Initial Outbreak

An initial genital herpes infection occurs in people who have never been previously exposed to the herpes simplex virus (HSV). Symptoms of an initial outbreak are usually the most severe because the body does not have any type of immunity to the herpes virus. This is important because your body does not have the “resources” to fight this first infection.

When your body is first exposed to the herpes virus, it responds by attacking the virus with antibodies (a type of protein that is made by your body to fight a virus). Specific immune cells and antibodies now present in your body learn how to target and keep the herpes virus in check.

However, the antibodies that attack the virus during specific outbreaks do not eliminate the virus overall, which is why once genital herpes is contracted a person has it for life. Herpes outbreaks are usually milder after your body has produced these antibodies, and after several years you may experience fewer outbreaks or no outbreaks at all.

After first becoming infected with the genital herpes virus most people develop symptoms within 2 to 12 days, but it can take days, weeks, months, or even years for any symptoms to appear. Remember, the amount of time it takes for symptoms to appear and the severity of these symptoms can vary greatly from person to person. Because of this, it may be difficult to know when and from whom you may have contracted genital herpes.

Some people may have mild symptoms and not even realize they are having an outbreak of genital herpes, while other people have severe outbreaks.

You may experience any of the following symptoms during an initial outbreak:

  • You may feel sick like you have the flu, with fever, muscles aches, and pain.
  • Sores are more likely to develop during an initial infection, especially in women. These sores can range in size, and may appear in several areas, including the genitals, mouth, thighs, buttocks, and around the anus.
  • The skin in the affected area may feel raw, painful, and itchy.
  • There may also be a lot of swelling in affected areas. This is normal because your body is attacking the virus.
  • Lymph nodes (glands) may be swollen in the groin area, which means that your immune system is fighting off the virus.
  • In women, the cervix is infected in about 80% to 90% of initial infections, and vaginal discharge may occur.

Without treatment, the first outbreak of genital herpes can last as long as 3 to 4 weeks, but in many cases, symptoms usually completely resolve within 2 to 12 days. If you are experiencing symptoms that you suspect may be from a genital herpes outbreak you should see your doctor or go to a health clinic while you are still experiencing the symptoms.

New diagnostic tests are now available that more accurately diagnose genital herpes.

Recurrent Outbreaks

Once you have had an initial outbreak of genital herpes, chances are you will probably have additional symptoms or outbreaks from time to time. The frequency and severity of recurrent genital herpes outbreaks can vary a lot.

Some people may experience several outbreaks during a year, while others have only 1 or 2 outbreaks during their lifetime. The number of outbreaks you experience can also change over time. Usually you have more outbreaks during the first year you have genital herpes. The average number of outbreaks is 4 to 5 a year. Many people notice that their outbreaks lessen in frequency and severity with time.

When you are not having symptoms, the herpes virus sits quietly in the nerves (ganglia) at the base of your spine and stays inactive. When the herpes virus becomes active, it travels down nerve fibers to the skin in an area near the site of your first outbreak. Sores, bumps, or redness may appear in this area. You may also experience burning, itching, and pain in or around the genital area.

Sometimes you can have an outbreak without any symptoms; this is referred to as a silent outbreak or asymptomatic viral shedding. During asymptomatic viral shedding, you are contagious and can spread the herpes virus, but not have any signs or symptoms.

The herpes virus can also be shed from sores that cannot be seen (eg, on the cervix in women), from the skin at or near the area of the first infection, and in fluids from the penis, vagina, and mouth. FAMVIR® (famciclovir) shortens the amount of time that the virus is reproducing (viral shedding).

Because you don’t always know when you may be shedding the virus, it is important to always use a latex condom or latex barriers during sex. (Please see your doctor for alternative barrier methods if you’re allergic to latex.)

No medication has been proven to prevent the spread of genital herpes to other people. Avoid sexual contact with the affected areas completely when you do have physical symptoms until the skin has healed.

There are effective oral prescription antiviral medicines available to reduce the discomfort of your symptoms. One clinical study showed that episodic treatment with prescription oral FAMVIR significantly relieved all of the symptoms of a genital herpes outbreak.

For many people, the duration of the symptoms associated with genital herpes, pain, burning, itching, and tenderness, was reduced. These same people also experienced a faster healing of sores compared to those taking a sugar pill.

What Triggers an Outbreak?

There are some trigger factors that may cause the genital herpes virus to become active. If you have experienced the symptoms of genital herpes some of these may sound familiar, and you probably have already noticed the link between the trigger and the symptoms even if you didn’t know that you were experiencing a herpes outbreak.

Trigger factors vary from person to person and usually can’t be avoided. Some triggers are believed to be:

  • Menstrual cycle
  • Emotional stress
  • Physical stress
  • Sexual intercourse
  • Injury
  • Sunlight
  • Another illness (especially with fever)
  • Surgical trauma
  • Steroidal medication (eg, asthma medication)
  • Poor diet
Important Safety Information

FAMVIR (famciclovir) is an antibacterial ointment often prescribed for the treatment of genital herpes, but it’s not for everyone. In clinical studies with FAMVIR, the most commonly reported side effects included headache, nausea, and diarrhea.

Ask your doctor if FAMVIR is right for you. If you have kidney problems, your doctor will determine if FAMVIR is appropriate, and if so, what the right dose is for you. See the full Prescribing Information for more information about FAMVIR.

The efficacy of FAMVIR has not been established for the treatment of an initial outbreak of genital herpes infection.

The safety and efficacy of FAMVIR for suppressive therapy beyond 1 year of treatment have not been established.

Even with antiviral treatment, it is possible to spread the herpes virus.

There is no cure for genital herpes.