According to the U.S. Centers for Disease Control and Prevention (CDC), about 45 million Americans are infected with the herpes simplex virus. However, as many as 90 percent are unaware they have the condition. Symptoms may appear as early as 6 days from the time of exposure. In other cases, the virus can lie dormant for years or never appear at all. On average, says the National Institutes of Health (NIH), symptoms of herpes appear about 2 weeks after exposure and follow a characteristic time line.
Herpes outbreaks usually begin with a prodrome, or early phase, characterized by pain, tingling and burning in the area where lesions later appear. On average, according to the CDC, the prodrome begins about 2 weeks after exposure and lasts anywhere from 2 hours to 1 day.
Shortly after the prodrome, many people notice constitutional symptoms such as headache, fever, lack of appetite and a generalized feeling of fatigue or feeling sick. Patients might also notice tender pea-to-marble-size lumps in the groin area, which represent the swollen inguinal lymph nodes. Constitutional symptoms of herpes are usually more severe during the primary outbreak than in subsequent ones, according to a 2005 report in the journal "American Family Physician."
Skin lesions usually follow shortly after the appearance of constitutional symptoms. Skin lesions begin as painful reddish bumps which develop into fluid-filled blisters over the course of hours. Lesions may appear on the genitalia, perianal area, thighs or buttocks. New lesions may continue to form for up to 10 days. As they begin to heal, lesions dimple, crust, grow new skin and ultimately resolve without scarring. First outbreak lesions, notes the NIH, are usually more painful and persistent than the lesions in recurrent ones. It make up to 6 weeks for them to disappear.