Sexual Health STIs Herpes First Outbreak of Genital Herpes: What to Expect The first outbreak of herpes is often the worst, but treatment is available By Kelly Burch Kelly Burch Facebook LinkedIn Twitter Kelly Burch is a freelance journalist who has covered health topics for more than 10 years. Her writing has appeared in The Washington Post, The Chicago Tribune, and more. Learn about our editorial process Published on August 22, 2022 Medically reviewed by Chioma Ndubisi, MD Medically reviewed by Chioma Ndubisi, MD Chioma Ndubisi, MD, is a board-certified OB/GYN who specializes in sexual and reproductive health in New York, New York. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms The First Outbreak What to Expect Treatment Frequently Asked Questions 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. Evgeniia Siiankovskaia / 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 anusPain in the leg, buttocks, and groinPain during urinationUnexplained 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: FeverBody achesSwollen lymph nodesHeadache 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. John Hopkins University. Genital herpes. Planned Parenthood. What are the symptoms of herpes? Sauerbrei A. Herpes Genitalis: Diagnosis, Treatment and Prevention. Geburtshilfe Frauenheilkd. 2016;76(12):1310-1317. doi:10.1055/s-0042-116494 Centers for Disease Control and Prevention. Genital herpes — CDC fact sheet (detailed). Legoff J, Péré H, Bélec L. Diagnosis of genital herpes simplex virus infection in the clinical laboratory. Virol J. 2014;11:83. doi:10.1186/1743-422X-11-83 U.S. Department of Health and Human Services. Sexually transmitted infections. summary of CDC treatment guidelines. MedlinePlus. Genital herpes - self-care. 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. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit