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The First Genital Herpes Outbreak

The First is Worse than the Rest


Updated July 03, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Most people who are infected with the herpes simplex virus do not have symptoms. Of those who do develop symptoms, the first outbreak of genital herpes is worse than recurrences. The first outbreak is also associated with general symptoms aside from the rash. Women are at risk of having a herpes infection that does not cause the usual symptoms.

Genital Herpes and Herpes Simplex Viruses
In the past, genital herpes was caused mainly by the herpes simplex virus type 2 (HSV-2). But now, new genital herpes infections are caused equally by the herpes simplex virus type 1 (HSV-1) and the herpes simplex virus type 2 (HSV-2). The majority of people who are going to get a primary outbreak will do so between 3 days to 2 weeks after exposure.

The First Genital Herpes Outbreak
The rash of herpes is a cluster of vesicles on a red base. In moist areas like the vagina, herpes may cause ulcerations instead of blisters. In women, the first outbreak of genital herpes can occur on the vulva, cervix, vagina, urethra, anus, buttocks, or thighs. Men usually get an outbreak on the tip of the penis or the shaft, but rarely around the base. Men who have sex with men may also get blisters in or around the anus. The rash in men is usually mild -- only 6 to 10 blisters. The blisters in men and women are painful and contain a large number of viral particles; therefore, they are very contagious.

Other Symptoms With the First Genital Herpes Outbreak
Seventy-nine percent of people get general symptoms with the first outbreak that usually resolve within a week. Some common general symptoms include:

  • Fever to 102 degrees
  • Headache
  • Muscle aches
  • Fatigue
  • Swollen lymph nodes

Women and the First Genital Herpes Outbreak
Women are four times more likely to be infected with HSV-2 than men. For some reason, women have more severe disease and more complications during the first infection than men. If a woman gets a herpes outbreak on the cervix or vagina and not externally, she may develop vaginal discharge, pelvic pain, or burning with urination. With the first outbreak, some women may get a second round of blisters or ulcers in the second week.

How Long the First Genital Herpes Outbreak Lasts
The first herpes infection usually lasts for 2 to 3 weeks, but skin pain can last for 1 to 6 weeks. The blisters dry out and crust over. When the crusts fall off, the area is usually not contagious anymore. There is evidence that some people have low levels of virus present even when they do not have symptoms.


CDC. "Sexually Transmitted Diseases Treatment Guidelines, 2006." Morbidity and Mortality Weekly Report. 55(2006): 16-20.

Habif, Thomas. "Warts, Herpes Simplex, and Other Viral Infections" Clinical Dermatology, 4th Edition. Ed. Thomas Habif, MD. New York: Mosby, 2004. 381-388.

Yeung-Yue, Kimberly. "Herpes simplex viruses 1 and 2." Dermatologic Clinics 20(2002): 1-21.

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  7. The First Genital Herpes Outbreak - What to Expect

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