There is no "typical presentation" of herpes. Some people after exposure will develop outbreaks or recurrences with a vesicular, painful rash. Others never see lesions or rashes. Even others - fall somewhere in between with localized pain coming first, followed by a rash. According to a recent study, some people with genital herpes may find that they have serious neuropathic pain (pain that follows nerve pathways) even if a rash or lesions never appear.
This study looked at 17 patients who complained of generalized chronic pain and had no signs of lesions. The majority of these patients were known to have herpes simplex virus. The researchers came to the conclusion that when some people get infected with the herpes virus, it may actually alter the pain processing mechanism in the central nervous system. Once these patients in the study were given anti-herpetic medication (like Acyclovir), the pain lessened considerably. So people with herpes need to realize that this generalized pain can signal reactivation of the virus WITHOUT ever seeing the physical sign of a rash or lesions. That means - when you have pain you should clearly be cautious and even refrain from sexual activity with a partner.
Another conclusion from this study was the fact that there is a strong correlation between HSV activity in the brain and central nervous system and generalized pain. What is probably going on is that the herpes virus causes central nervous system dysfunction so the result that you get is this very generalized but non-specific pain throughout you body - and who will get this presentation can't be predicted. And you can get the pain without ever seeing lesions in the brain on an MRI.
The moral of this story is that the herpes virus presentation can be really unpredictable from patient to patient and whether or not you see physical signs of the virus - you may have localized pain or really severe generalized pain, or, if you are lucky, you can be someone with HSV who has relatively little discomfort. In all cases, though, you do need to use safe sexual practices for the benefit of your partner.
Published On: July 24, 2008