First Outbreak of Genital Herpes: What to Expect

The first outbreak of herpes is often the worst, but treatment is available

Table of Contents
View All
Table of Contents

Genital herpes is a sexually transmitted infection (STI) that affects about 1 in 6 American adults. It's caused by the herpes simplex virus type 2 (HSV-2) or herpes simplex virus type 1 (HSV-1) and can trigger the formation of painful lesions in the groin area.

For many people, the first outbreak of genital herpes is the worst and longest-lasting.

Continue reading to learn more about what a first outbreak of genital herpes is like, including symptoms and treatment. 

Man talking with his doctor

Hero Images / Getty Images 

Genital Herpes Symptoms

Not everyone with genital herpes has detectable symptoms. Those who do will usually notice small, red, itchy, and fluid-filled blisters around the genitals and rectum. These blisters can also be internal, along the urethra or vagina, for example. They eventually rupture and crust over, leaving behind painful ulcers.

Other symptoms you may experience include:

  • Itching or burning around the genitals or anus
  • Pain in the leg, buttocks, and groin
  • Pain during urination
  • Unexplained or unusual vaginal or penile discharge

How Is the First Outbreak Different?

The first outbreak of genital herpes is the most severe because your body hasn’t previously encountered the virus and has no immune response. You’ll likely have more sores, pain, itchiness, and burning during your first outbreak than during future outbreaks. The first outbreak is also the longest, with symptoms sticking around for two to four weeks.

Some people experience additional whole-body symptoms during their first outbreak, including:

  • Fever
  • Body aches
  • Swollen lymph nodes
  • Headache

After the first outbreak, the virus lays dormant in your nerve cells. When it reappears, your body can mount an immune response, fighting the virus. Because of that, subsequent outbreaks of genital herpes are less severe, and most people experience fewer outbreaks over time.

During your first outbreak, you’re most likely to spread genital herpes, so it’s important to abstain from sex for the entire time that you have lesions.

What to Expect

The symptoms of genital herpes appear two to 12 days after exposure to the virus, in most cases.

A healthcare provider can diagnose genital herpes by swabbing the lesions to check for the virus. Once you've been diagnosed with genital herpes, your healthcare provider will likely start you on prescription medication to get the outbreak under control.

If you have been exposed to genital herpes, you can call a clinic even before symptoms occur. A blood test can diagnose genital herpes even if you're asymptomatic

Treatment

The first outbreak of genital herpes is treated with oral antiviral medications. When you visit your healthcare provider, you’ll likely get a seven to 10 day prescription of one of the following medicines:

  • Zovirax (acyclovir), taken three times a day
  • Famvir (famciclovir), taken three times a day
  • Valtrex (valacyclovir), taken twice daily

Over-the-Counter (OTC) Relief

In addition to prescription antivirals, OTC options can help keep you comfortable during your first outbreak, including:

  • Numbing gels containing lidocaine
  • Pain relievers, including Tylenol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil or Motrin (ibuprofen) or Aleve (naproxen)
  • Hydrocortisone cream to fight itch

Home Remedies

Even with antiviral medications and topical creams to relieve itching and pain, you’ll still likely be uncomfortable during your first outbreak. Scratching can increase the risk of secondary infection. Instead of scratching, apply a cold compress to the area.

Although it’s difficult, managing your stress is important. Stress can make outbreaks worse. 

Summary

Genital herpes is a common STI. If you’ve been exposed, you may experience your first outbreak within two to 12 days. Although some people never notice symptoms, for most people, the first outbreak is the worst. Prescription antivirals and over-the-counter medications can help manage your symptoms, which will likely last two to four weeks. While you have lesions, abstain from sex, since the risk of passing herpes is highest during the first outbreak. 

A Word From Verywell 

Experiencing your first genital herpes outbreak can take an emotional toll. It’s important to remember that genital herpes is very common and is nothing to be ashamed of. Getting treatment quickly can reduce your risk of passing on the virus and help you feel better fast. 

Frequently Asked Questions

  • How long after first exposure is the first genital herpes outbreak?

    Most people experience their first outbreak two to 12 days after they were exposed to the herpes virus. However, some people never have symptoms. So, if you believe you were exposed, it’s important to talk to your healthcare provider, even if you don’t have lesions. 

  • What are the first symptoms of genital herpes?

    The first outbreak of genital herpes can start with a general feeling of being unwell. You might experience headache or fever. Itching or pain in the genital or anal area generally starts just before the appearance of lesions. 

  • How long does the first herpes outbreak last?

    The first outbreak of genital herpes usually lasts between two to four weeks. The first outbreak is the longest, and subsequent outbreaks will often be shorter and less severe.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. John Hopkins University. Genital herpes.

  2. Planned Parenthood. What are the symptoms of herpes?

  3. Sauerbrei A. Herpes Genitalis: Diagnosis, Treatment and Prevention. Geburtshilfe Frauenheilkd. 2016;76(12):1310-1317. doi:10.1055/s-0042-116494

  4. Centers for Disease Control and Prevention. Genital herpes — CDC fact sheet (detailed).

  5. Legoff J, Péré H, Bélec L. Diagnosis of genital herpes simplex virus infection in the clinical laboratoryVirol J. 2014;11:83. doi:10.1186/1743-422X-11-83

  6. U.S. Department of Health and Human Services. Sexually transmitted infections. summary of CDC treatment guidelines.

  7. MedlinePlus. Genital herpes - self-care.

  8. American Academy of Family Physicians. What should I know about genital herpes?

By Kelly Burch
Kelly Burch is has written about health topics for more than a decade. Her writing has appeared in The Washington Post, The Chicago Tribune, and more.