For people with no prior contact with HSV-1 or HSV-2, initial infection involves both whole body (systemic) and local symptoms.
Generalized symptoms include:
- Decreased appetite
- Fever
- Malaise
- Muscle aches
Local symptoms include repeated eruptions of small, painful blisters filled with clear, straw-colored fluid on the genitals, around the rectum, or covering nearby areas of skin. Before these blisters appear, the person may experience increased skin sensitivity, tingling, burning, itching, or pain at the site where the blisters will appear.
When the blisters break, they leave shallow ulcers that are very painful. These ulcers eventually crust over and slowly heal over 7 - 14 days.
Enlarged and tender lymph nodes in the groin may accompany an outbreak. Women also may develop vaginal discharge and painful urination. Men can develop painful urination if the lesion is near the opening of the urethra.
Once a person is infected, the virus hides within nerve cells, making it difficult for the immune system to find and destroy it. Within the nerve cells, the virus can remain dormant for a long period of time, which is called "latency."
The infection can reactivate at any time, at which point painful blisters again cover the genitals, anus, inner thigh, or mouth. A variety of events can trigger latent infection to become active, including:
- Fatigue
- Mechanical irritation
- Menstruation
- Stress
Attacks can recur as seldom as once per year, or so often that the symptoms seem continuous. Recurrent infections in men are generally milder and shorter in duration than those in women.
