Recurrent Oral Herpes Infection. Most patients experience only a couple of outbreaks a year, although up to 10% of patients experience more frequent recurrences. (HSV-2 oral infections recur less frequently than HSV-1.) Recurrences are usually much milder than primary infections and are known commonly as cold sores or fever blisters (because they may arise during a bout of cold or flu). They usually show up on the outer edge of the lips and rarely affect the gums or throat. (Cold sores are commonly mistaken for the crater-like mouth lesions known as canker sores, which are not associated with HSV.)
Specific Symptoms of Genital Herpes
Genital herpes, which typically affects the penis, vulva, or rectum, is usually caused by HSV-2, although the rate of HSV-1 genital infection is increasing. Studies now report, in fact, that the cases of new symptomatic genital infections are equally split between HSV-1 and HSV-2. Some studies even report a higher incidence of genital HSV-1 cases. (The distinction may not matter, however, since there is no difference in treatments.) Initial genital infections due to HSV-1 may be more severe than those caused by HSV-2. Recurrences tend to be milder and less frequent than with HSV-2, however.
Primary Genital Herpes Infection. The first outbreak usually occurs in or around the genital area between 3 days and 2 weeks after exposure to the virus. If there is a long duration between the initial infection and the first outbreak of symptoms, the episode may be quite mild because the immune system has produced antibodies to the virus by that time. Also, such primary infections are less transmissible, heal faster, and produce fewer symptoms.
In about 80% of initial outbreaks of genital herpes, patients develop diffuse symptoms (flu-like discomfort and fever). The virus sheds for about 3 weeks. Symptoms in men and women are very different from each other.
In women, the pattern of a first infection is often more complicated and severe than in men with some or all of the following events:
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