When a person is first infected with HSV-1 or HSV-2 the immune system is not well developed and the virus can multiply more quickly and spread to more places than it might later. First symptoms can be uncomfortable and usually happen within two weeks after the virus is transmitted. However, some people have a first episode so mild they don't notice it. Some people have no symptoms. When a symptom does occur, it could be a later episode or "reactivation"--noticed months or years later.

First Episodes:

• Can take 4-6 weeks to heal fully
• May be the most extreme outbreak a person will ever have
• May cause small pimples or blisters (lesions), which will crust over and scab like a cut
• Can have a second crop of lesions that appear
• May cause flu-like symptoms: fever, swollen glands in lymph nodes near groin
• Vary with each person: may be obvious or hard to see, painful or unrecognized

Signs and symptoms will vary person by person, and from one episode to the next. Some people who have latent herpes infection never experience signs or symptoms. Some people have such mild symptoms that they may not recognize the infection for many years. For others, outbreaks can be repeated often and cause extreme discomfort. These are some common signs of recurrent outbreaks.

Recurrent Outbreaks:

• Breaks or irregularities in the skin, such as a cut, red bump or rash
• Small sores or classic blisters that form a crust
• May occur anywhere in the region between the legs--thigh, buttocks, anus, or pubis
• Healing occurs in half the time as the first outbreak

Researchers have learned that the herpes virus can become active without causing signs or symptoms. This is called "asymptomatic shedding" and "subclinical" shedding. Another term is simply "unrecognized" herpes. Even people who know they have recurring outbreaks also can have outbreaks that are unrecognized--and not be aware that the virus has reactivated.

Unrecognized herpes is important because:

• Some lesions are unnoticed because they occur in spots we never look;
• Some lesions are mistaken for something else--such as an ingrown hair; and
• Some lesions are so small they can't be seen with the human eye.

Many people can have very subtle forms of recurring herpes that heal quickly, in a matter of days. These can be found on the penis, vulva, near the anus, on the thigh, on the buttocks--anywhere in or around the genital area. People mistake herpes outbreaks for:

• Insect bites
• Jock itch
• Abrasions or razor burn
• Yeast infections
• Hemorrhoids
• Ingrown hair follicles

In the early phase of a recurring episode, many people feel an itching, tingling or painful feeling in the area where the lesions will develop. This can include pain in the buttocks, back of legs or even lower back. The prodrome often happens a day or two before an outbreak.

How often a person gets a herpes outbreak depends upon the HSV type and how long the infection has resided in the body. Herpes triggers are poorly understood by scientists and appear to be highly individual. Research shows that lengthy exposure to strong sunlight can trigger oral herpes. Triggers for genital herpes include surgical trauma and excessive friction in the genital area. With time, people begin to recognize what will trigger an outbreak in their own bodies.

HSV-2: People who have a strong first episode usually can expect to have several recurrences a year with typical symptoms. The average number of recurrences or outbreaks is four to five. People with HSV-2 can also expect to have unrecognized outbreaks. These unrecognized outbreaks probably occur less often than symptomatic outbreaks, but account for about one-third of all reactivation. Usually, the first year has the most viral activity.

HSV-1: With type 1 infection, people may have a marked first episode in the genital area, but they are much less likely to have outbreaks in the first year. Recurrences are usually once a year and the rates of unrecognized herpes reactivation are lower, too.