Stages of Genital Herpes

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Genital herpes can be categorized into 8 phases, or stages, depending on the symptoms you’re experiencing. It’s important to know that you may experience a few of the stages and not all of them. Not every stage occurs in every person with genital herpes.

  1. Warning (prodrome)
  2. Early redness
  3. Small blisters (vesicles)
  4. Swelling (edema)
  5. Wet ulcers
  6. Dry crust
  7. Healed
  8. Asymptomatic

You may be able to sense when the genital herpes virus has become active and an outbreak is about to occur. This is called the prodrome, or warning stage. Warning signs can occur for a few minutes or a few days before an outbreak occurs.

WARNING SIGNS OF GENITAL HERPES

Warning signs may occur at the site where the outbreak will appear, or in other parts of the body. These signs are different for everyone. You may experience some of the following warning signs:

  • Tingling, itching, or burning in one area of the genitals (vagina, vulva, anus, penis, or scrotum)
  • Pain in the leg or buttocks
  • Burning on the side of the leg or bottom of one foot
  • Flu-like symptoms such as headache, fever, and swollen glands (lymph nodes) in the groin
  • Feeling emotionally irritable or depressed

During the prodromal stage, 20% to 25% of people begin to have the active herpes virus present on the skin. When the virus is present on the skin it can be spread to another person.

During the next few phases, one or more genital herpes sores begin to develop on the skin. The virus is active on the skin during this time. Remember, not all people with genital herpes experience visible sores during an outbreak.

Sores develop in the following stages:

  • Early redness may be seen in a small area of skin. This area may be sensitive, itchy, or painful to the touch.
  • Small area of swelling, which may not be noticed.
  • Small blisters filled with fluid (clear, whitish, or red) form on top of the area that had early redness and/or swelling. There may be one blister, a few blisters, or groups of blisters.
  • Wet ulcers appear when the tops of the blisters come off. They may look like red, swollen areas or small cuts. These sores may feel tender and/or raw to the touch. There may be one tiny sore, a group of sores, or several large ulcers.
  • Dry crust (scab) forms over the wet ulcer as the sore begins to heal. The crust hardens as the sore dries, and new skin grows underneath the scab.

Healing is complete when the crust falls off or the sore dries without forming a crust. The area where the sore appeared may be red or look different than the surrounding skin.

During the asymptomatic phase, the genital herpes virus is usually dormant, which means it’s not active on the skin and there are no symptoms. However, even if your body does not sense an outbreak, there is a risk that the virus may be actively replicating—this is called viral shedding.

During asymptomatic viral shedding, a person can spread the herpes virus, but not have any signs or symptoms. Asymptomatic viral shedding is sometimes referred to as a “silent outbreak.” No medication has been proven to prevent the spread of genital herpes to other people.

While the virus is not always active during the asymptomatic phase, it is impossible to know when it is inactive. Unfortunately, people can still pass the virus during this phase, even when they don’t have any symptoms of genital herpes.

This is important to remember because no treatment can totally prevent the spread of genital herpes. This is why people with genital herpes should always use a latex condom or latex barriers during sex. (Please see your doctor for alternative barrier methods if you’re allergic to latex.)

Even though condoms have been shown to reduce transmission, they are not always effective. While the virus cannot get through the latex condom, it is important that it covers the infected area so as to avoid the skin-to-skin contact.

It may be days, weeks, months, or years between outbreaks. If and when the virus “wakes up” and becomes active again, you might experience symptoms of another outbreak. Unfortunately, no one can predict when another outbreak will occur. Outbreaks that occur after the first one are called recurrent genital herpes.