According to the Centers for Disease Control and Prevention (CDC), one in five American adults is infected with herpes. Between 500,000 and 700,000 people have a primary outbreak each year. Primary outbreak symptoms differ from recurrent outbreak symptoms in several respects.
Prodrome
"Classic" outbreaks of primary genital HSV infection begin with a prodrome which may last for two to 24 hours, according to the CDC. This prodrome is characterized by pain, tingling and burning in the area where lesions later appear. During the primary outbreak, patients are usually unaware that they have contracted herpes, and the prodrome is rarely recognized as such.
Constitutional Symptoms
In 80 percent of patients with herpes, the primary outbreak is also associated with constitutional symptoms such as headache, fever, lack of appetite and a generalized feeling of fatigue or feeling sick. Patients may also notice tender bumps in the groin area, which represent the swollen inguinal lymph nodes. According to the National Institutes of Health (NIH), constitutional symptoms of herpes are usually more severe during the primary outbreak than in subsequent ones.
Skin Lesions
The skin lesions of herpes usually begin as painful reddish bumps, which soon give way to fluid-filled blisters on a red base. Lesions may appear on the genitalia, perianal area, thighs or buttocks. Compared to the lesions in recurrent outbreaks, primary outbreak lesions are more likely to appear in clusters and are usually more numerous and widely distributed. In a primary outbreak, new lesions may continue to form for up to ten days. As in recurrent outbreaks, these lesions crust then heal without scarring. However, in primary outbreaks, lesions are usually more painful and persistent, lasting two to six weeks, versus an average of one week for recurrent lesions, according to the NIH.
Cervical Ulceration
According to a 2005 article in the journal American Family Physician, bleeding and vaginal discharge in women are usually signs of cervical ulceration. Cervical ulceration is common during the primary outbreak of herpes, says Dr. John G. Beauman of the U.S. Army, but it rarely recurs. Women may need to refrain from intercourse for up to two weeks to allow time for healing
References
- Centers for Disease Control and Prevention: Genital Herpes
- National Institutes of Health National Institutes of Allergic and Infectious Disease: Genital Herpes
- American Family Physician; Genital Herpes: A Review; J.G. Beauman; Oct 15 2005
