Clarification on Genital Herpes Symptoms - General Info

[AnonymouslyAnonymous]

There seems to be a plague of misinformation out there regarding this disease - I have received conflicting information from multiple doctors (Canadian and American doctors, in person), and from forum sites like this one (although in general this one is pretty good) and of course on the web.  Let me start by saying I have checked through this forum considerably for similar posts before writing this question, but I still believe it's should be asked or at least summarized in one spot. If I missed it somewhere please let me know where I can find it.

My question is in regards to what, exactly, are the symptoms of genital herpes.  I realize physiology is complicated and everyone is different - but there must be a more pragmatic way to describe symptoms other than the generic descriptions we've all seen 100 times.  I think doing so would help ease a lot of people's minds and help to eliminate the constant repetitive posts titled "Does this sound like herpes...", etc.

Specifically:

Onset of Symptoms - Most sources seem to indicate that symptoms (if they're going to occur) will occur within 2-10 (or 4-14) days after exposure. From reading the forum it seems that it is exceedingly unlikely for symptoms to occur outside of this window.  Is that accurate?  Can anyone roughly quantify what "exceedingly unlikely" means (e.g. has a doctor only seen a few cases where it was confirmed symptoms started after 14 days?).  There is also a lot of talk of the disease laying dormant for months or years before showing symptoms - is this primarily due to people missing the initial symptoms?

Lack of Symptoms - I keep reading that "80% of infected people never experience symptoms". Is this accurate?  Since IgG testing is almost never recommended by doctors without visual symptoms how could this ever have been confirmed? Is it more true to say that most or all people experience symptoms but many don't contribute them to be herpes?

Flu-like Symptoms - an incredible vague description that I've seen time and time again.  Is this the full repertoire of runny nose, headache, fever, muscle aches, malaise, upset stomach, etc?  Or is this primarily just fever and malaise? Is the fever normally severe or mild (mild being between 99 and 100.4 or just above)?

Prodrome - What are they exactly? Are they almost always the itchiness or tingling sensation, or shooting pains in legs/back?  Is the itchiness localized to only the small area where lesions will appear or is it all over the genital area?  How common is it to have prodromal symptoms and NOT have lesions?  Are prodromes only for primary outbreaks, initial outbreaks or recurrent outbreaks?  I had an STI clinic specialist tell me they ONLY happen during the primary outbreak, but everything I've read indicates they're only for recurrent outbreaks. When do they start and how long do they normally last? I've read that they last anywhere between a couple hours to a couple days before lesions appear - how accurate is this?

Rash - What does this mean?  Is it localized redness? Splotchy? Itchy? Painful? Are they referring to the lesions themselves or something else?

Itchiness - Is it usually mild or intense?  Constant? Preceding lesions or only when lesions are present? Localized or general? Again, lots of conflicting info on this one. Is it an itch than can sometimes be ignored or is it persistent and noticeable.  Do over-the-counter creams help or no?

Lesions - How common is one bump vs. several?  How large are they typically (can they be so small that you'd never notice them or are they almost always large and noticeable if you looked?) Are they raised or not? Firm or not? Filled with white fluid, yellow fluid or clear fluid? Do they almost always burst?  Do they almost always hurt? Again, TONS of conflicting info on all of these.  Making people suspicious of every hair follicle and pimple.  How can we differentiate between these visually (obviously a swab test is the best way to know for sure).

Recurrent Outbreaks - Do outbreaks typically recur very frequently when first contracted (assuming HSV2 strain). Like within weeks of eachother? Months? Do they typically look and feel the same at the beginning or change each time?

Transmission - How important is abrasion of the skin to contract?

If you have any insight, either from personal experience or from medical experience, please shed some light on the above and tell us WHY or HOW you know what you know if possible.  I would really appreciate it and I know there's lots out there that would as well. Again if this type of post already exists somewhere, please let me know (I've looked, really!).

Thank you for your time!

[auntiejessi]

I'll do my best, but please understand that often there are no hard and fast rules.

1 - Onset of Symptoms - Most sources seem to indicate that symptoms (if they're going to occur) will occur within 2-10 (or 4-14) days after exposure. From reading the forum it seems that it is exceedingly unlikely for symptoms to occur outside of this window.  Is that accurate?  Can anyone roughly quantify what "exceedingly unlikely" means (e.g. has a doctor only seen a few cases where it was confirmed symptoms started after 14 days?).  There is also a lot of talk of the disease laying dormant for months or years before showing symptoms - is this primarily due to people missing the initial symptoms?

The average incubation period for an initial herpes infection is 4 days (range, 2 to 12) after exposure. (https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm) Different sources may have some varience on this - I've seen up to 20 days, but it doesn't really matter much.

It's hard to say why people suddenly notice symptoms later on - if they didn't get symptoms, or if they didn't notice them. It's hard to quantify something that people aren't aware of. Some might say they thought they had a yeast infection or a fungal infection, and that may have been herpes, but it also may have been yeast or another fungal infection, and obviously, no one can go back in time to find out for sure.

Often, people with an existing hsv1 infection have milder hsv2 symptoms, so that may be why some miss it earlier.

Again, we can't go back to figure out why for sure. It's all supposition.



2 - Lack of Symptoms - I keep reading that "80% of infected people never experience symptoms". Is this accurate?  Since IgG testing is almost never recommended by doctors without visual symptoms how could this ever have been confirmed? Is it more true to say that most or all people experience symptoms but many don't contribute them to be herpes?

This comes from this study - https://www.webmd.com/genital-herpes/news/20000322/shattering-genital-herpes-myth#1



3 - Flu-like Symptoms - an incredible vague description that I've seen time and time again.  Is this the full repertoire of runny nose, headache, fever, muscle aches, malaise, upset stomach, etc?  Or is this primarily just fever and malaise? Is the fever normally severe or mild (mild being between 99 and 100.4 or just above)?

I despise this description because it's so misleading. It's maybe fever (and it would be mild in most cases), some sore muscles, general malaise, maybe headaches. It is NOT runny nose, upset stomach, etc.



4 - Prodrome - What are they exactly? Are they almost always the itchiness or tingling sensation, or shooting pains in legs/back?  Is the itchiness localized to only the small area where lesions will appear or is it all over the genital area?  How common is it to have prodromal symptoms and NOT have lesions?  Are prodromes only for primary outbreaks, initial outbreaks or recurrent outbreaks?  I had an STI clinic specialist tell me they ONLY happen during the primary outbreak, but everything I've read indicates they're only for recurrent outbreaks. When do they start and how long do they normally last? I've read that they last anywhere between a couple hours to a couple days before lesions appear - how accurate is this?

Prodrome varies from person to person. My ex, who I got herpes from, got a very specific ache in his thigh before an outbreak. If I have prodrome, I've never noticed a pattern.

Prodromes happen before all outbreaks, but it's more noticeable for some than others.



5 - Rash - What does this mean?  Is it localized redness? Splotchy? Itchy? Painful? Are they referring to the lesions themselves or something else?

I haven't any idea what a herpes rash is, unless they are referring to outbreaks? Where did you see this?



6 - Itchiness - Is it usually mild or intense?  Constant? Preceding lesions or only when lesions are present? Localized or general? Again, lots of conflicting info on this one. Is it an itch than can sometimes be ignored or is it persistent and noticeable.  Do over-the-counter creams help or no?

Itchiness is usually with sores, and while they are healing. I use Dermoplast spray (the one without antibiotics) to help, but others find other things.

Some people may get itching as a prodrome, but it certainly isn't a constant thing without lesions.



7 - Lesions - How common is one bump vs. several?  How large are they typically (can they be so small that you'd never notice them or are they almost always large and noticeable if you looked?) Are they raised or not? Firm or not? Filled with white fluid, yellow fluid or clear fluid? Do they almost always burst?  Do they almost always hurt? Again, TONS of conflicting info on all of these.  Making people suspicious of every hair follicle and pimple.  How can we differentiate between these visually (obviously a swab test is the best way to know for sure).

Herpes isn't bumps, it's blisters. (They can also look like paper cuts.) The size and number vary from person to person. Fluid is clear. Yellow fluid can indicate bacteria, which herpes is not.

Pain varies from person to person, and can often depend on where the sores are, if they have a pre-existing hsv1 infection, etc. Some say it's discomfort, others say it's pain. Pain is subjective, so it's hard to say.

Doctors can't often differentiate between herpes and infected hair follicles, etc., so you probably can't unless you get diagnosed and learn what is normal for you. This is why testing is so important, and visual diagnoses suck.



8 - Recurrent Outbreaks - Do outbreaks typically recur very frequently when first contracted (assuming HSV2 strain). Like within weeks of eachother? Months? Do they typically look and feel the same at the beginning or change each time?

Again - this really varies from person to person. I had a terrible time with outbreaks when I first got it, but I don't have hsv1, and after months of suffering, found out I had a secondary infection with bacterial vaginosis. Once I got that cleared up, things really calmed down.

Some people with hsv2 get one outbreak a year, others get several, others get none.

If you have a true primary outbreak (no previous hsv infections), nothing after the first one is as bad. You'll develop antibodies that help keep things in check, making subsequent outbreaks a breeze compared to the first one.



9 - Transmission - How important is abrasion of the skin to contract?

Very. Without an outbreak present, a simple quick touch isn't going to transmit. Even with an outbreak, it isn't likely.



If you have any insight, either from personal experience or from medical experience, please shed some light on the above and tell us WHY or HOW you know what you know if possible.  I would really appreciate it and I know there's lots out there that would as well. Again if this type of post already exists somewhere, please let me know (I've looked, really!).

I know this because I have hsv2, have had it for 15 years-ish, and because I've worked in the field for a long time.

My best info/insight? Test. Testing isn't always easy to wade through, but it's the best way we have to know for sure.

A lot of this info can be found in the Herpes Handbook, written by Terri Warren, who is one of the leading experts on herpes. https://westoverheights.com/herpes/the-updated-herpes-handbook/ It's free :)