Genital Herpes: Signs, Symptoms & Diagnosis

Many people who have genital herpes don't experience symptoms, but symptoms that appear during the first outbreak can be severe. Symptoms may show up days after you contract the virus ?- or weeks, months or years later. A person's first outbreak usually occurs within two weeks after the virus is transmitted and typically lasts two to three weeks.

Early symptoms (prodromal phase) may include:

  • Itching or burning in the genital or anal area
  • Flulike symptoms, such as fever and muscle aches
  • Swollen glands
  • Pain in the legs, buttocks or genital area
  • Vaginal discharge
  • A feeling of pressure in the area below the stomach

Within a few days, sores appear near the site where the virus entered your body, such as your mouth or genitals. They can also occur inside the vagina and on the cervix in women and in the urinary passage (urethra) in men.

The sores are small red bumps that can turn into blisters or painful open sores. Over time, the sores become crusted and usually heal without scarring in 2 to 12 days. Later symptoms may include headache and painful urination. You may also experience mild symptoms that are often mistaken for insect bites, yeast infections, razor burn, ingrown hairs or hemorrhoids. In fact, most people with genital herpes are unaware that they have it.

Because the virus remains in your nerve cells, you can have future outbreaks. Most people who experience a first episode of genital herpes have several more within a year, although symptoms tend to be less severe and last only a week.

The frequency of your outbreaks may vary. Some people have one outbreak and never experience another, while others have outbreaks several times a year. In general, the frequency of outbreaks tends to decrease over time.

Diagnosing genital herpes

Genital herpes can be difficult to diagnose because signs and symptoms vary widely among individual patients.

Herpes can be diagnosed during a gynecological examination if sores are visible to the naked eye, but a laboratory test may be needed to confirm a diagnosis or if symptoms are not present.

A viral culture is a test commonly used to diagnose genital herpes. During this procedure, a new sore is swabbed or scraped, and the sample is added to a laboratory culture that also contains healthy cells. If you have herpes, the cells will show changes that indicate the herpes virus when examined under a microscope after several days. A major disadvantage of the test is that the specimen must be collected from a new sore. Cultures should be obtained within 48 hours after sores appear because as the sore begins to heal, there is not enough of the virus left on the skin to culture. As a result, the test may be unreliable.

Blood tests are also popular because they can detect evidence of infection when sores are not present. Such tests requires that a small amount of blood be taken from your arm or finger. Because they detect antibodies (proteins used by the immune system to identify and neutralize substances foreign to the body such as bacteria and viruses), blood tests may not be positive until several weeks after your exposure to the virus.

Last updated 24 March 2012

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