There are two types of herpes viruses–herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). While HSV-1 primarily causes sores (fever blisters) to develop on the mouth or face, it is estimated that 30 percent of all genital herpes infections are caused by HSV-1. These cases are sometimes transmitted through genital-to-genital contact, but more often through oral to genital contact. Like those with HSV-2 infections, approximately two-thirds experience no symptoms and are not aware they have herpes.
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Early signs of a type 1 genital herpes infection usually appear within two to three weeks of exposure to a partner who has the virus. The early symptoms of an oncoming herpes outbreak include itchiness, tingling or pain in the genital or anal area. Some people may experience some swelling and unusual redness in the affected area, as well. For women, the symptoms may develop in the vaginal area, cervix, anus, or external genitals and buttocks. Men can develop symptoms externally on the penis, scrotum, buttocks or thighs, or inside the urethra or anus.
Symptoms of Blisters
Soon after the first signs of tingling and pain, one or more small red bumps appear. These bumps become ulcerated blisters filled with liquid. The blisters then open, leaving them feeling wet, raw and often quite painful to the touch. They may ooze fluid or a reddish, bloody liquid. Men and women may experience burning during urination if the sores are in a location that comes into contact with the urine stream. Redness, swelling, pain and tenderness in the area persist in the region of the outbreak while the sores are open, and women may also experience a vaginal discharge.
The first genital herpes outbreak may also sometimes be accompanied by flu-like symptoms, including muscle aches, fever, headache, and swollen lymph nodes in the groin area. In some cases, a second crop of sores may appear along with continued flu-like symptoms.
Herpes sores will eventually stop oozing and will develop a dry crust or scab where the wet ulceration once was. New skin forms beneath the scab, and eventually the crust falls off to complete the healing process. Though the new skin may be slightly tender and redder in appearance than the surrounding skin, other painful symptoms will have subsided.
After the herpes sores have healed, it is possible that genital herpes outbreaks may recur. However, genital HSV-2 outbreaks recur ten times more often than genital HSV-1. Research studies have shown the average number of recurring outbreaks in those with HSV-1 genital to be between zero and one. Thus, many people with HSV-1 genital herpes may never have another outbreak after the initial outbreak, and those who do may experience relatively minor symptoms compared to the first outbreak.
Many people do not know they have type 1 genital herpes because they do not notice overt symptoms. However, even in the absence of symptoms, HSV-1 can “shed” itself through the skin’s surface and increase the likelihood of passing it on through oral-to-genital or genital-to-genital contact. This is commonly known as viral shedding.
Genital herpes caused by HSV-1 produces much less viral shedding than genital herpes caused by HSV-2. Only about 25 percent of people with genital HSV- 1 shed any virus in the absence of symptoms, compared to 55 percent of people with HSV-2. Over time, rates of viral shedding decrease even further. Nevertheless, using latex condoms and avoiding sexual contact several days before and after an outbreak can help to minimize the risk of passing on the virus.