Once you've had a symptomatic outbreak of herpes, you often can tell when another one is coming on. And, many, aware of the warning signs - burning, pain, itching - start therapy with an antiviral drug.
After this prodrome, a person with genital herpes often has an outbreak of ulcers or blisters in the genital area.
However, how many of you have treated what you thought was a herpes outbreak for a month or two and it STILL won't go away? If this is you, read on.
While it is possible for a herpes outbreak to last a week or two, it's unusual for a healthy person with a healthy immune system to have a protracted outbreak of herpes.
Do NOT assume that all genital symptoms are related to herpes. Here are some other genital problems that may mimic a herpes outbreak:
1. Yeast infection. People with herpes get yeast infections, which can cause itching, vaginal discharge, redness and irritation in the genital area.
2. Bacterial abscess. A bacterial infection can cause a lump or abscess in the genital area that may resemble a herpes vesicle or blister. They can be very painful.
3. Genital warts. Genital warts, which are caused by Human Papilloma Virus (HPV), usually cause and can mimick a herpes outbreak. The warts growths range from a few millimeters to a few centimeters and are painless, but may itch or burn. They can cause vaginal discharge and bleed with intercourse in women.
4. Urinary tract infection. A urinary infection can cause burning on urination... if you have vaginal or penile herpes, you often have the same symptoms.
5. Chlamydia. Chlamydia, the most common sexually transmitted disease in the United States, usually is asymptomatic, but can cause burning during urination, similar to some herpes lesions.
6. Pubic lice. Pubic lice or "crabs" is a parasitic infection that causes burning or itching in the genital area.
7. Gonorrhea. Though asymptomatic about 40% of the time, Gonorrhea may cause pain or burning when urinating, as well as itchiness of the vagina or penis.
8. Syphilis. Though not as common as in past decades, syphilis still does occur and it causes symptoms that can often be confused with genital herpes. The primary infection causes a sore or chancre at the site of infection.
9. Scabies. This is a very contagious skin infection caused by a mite. It causes extreme itching. It can often affect the genital area and buttocks.
10. Molluscum contagiousum. This infection, caused by a poxvirus, causes groups of bumps to occur. They can appear around the mouth, neck, eyelids, under arms or in the groin or genital area. The lesions are often asymptomatic.
Also, if you are having a protracted herpes outbreak, it is time to get an HIV test. HIV infection weakens the immune system increasing the likelihood of having an ongoing herpes outbreak.
Lastly, it's rare, but there are some cases of resistant herpes infections. That means that the infection doesn't respond to the antiviral drugs. If you want to be tested for one of these, you'll probably have to go to a large academic medical center to be tested.
The antiviral drugs, acyclovir, Valtrex and Famvir are effective at reducing herpes outbreak frequency by 70%. And in healthy adults with normal immune systems, these medicines always improve symptoms related to herpes.
So, if your antiviral meds don't seem to be working, it's time to see your doctor to see what else may be happening.