The challenge with herpes is that you can't always tell if you have it. Often, people don't know if they are infected with the herpes virus. It's estimated that only about 20% of those who have herpes are even aware they have it. When there are symptoms, they appear in the form of painful blister outbreaks on the skin near the genital area. Initial herpes outbreaks may also feel like the flu with swollen glands, muscle aches, headache, fever, and pain or difficulty during urination.
If you get a first outbreak, it would happen anywhere from 2 days to 12 days after exposure. Blisters or sores may return from time to time, but they're usually less severe and heal more quickly than the first outbreak. Most people say that recurrent outbreaks begin with itching or burning on the skin in the area where blisters or sores are about to appear.
NOTE: These photos represent symptoms of advanced disease.
Most people who feel symptoms feel what’s called a "prodrome", which is an early warning signal that comes before an outbreak. This is often a tingle where you’ve had previous sores and can last anywhere from 2 hours to 2 days. For 25% of the people who so get recurrent outbreaks, the prodrome will be the only symptom they actually feel. When the prodrome actually develops into sores, the tingling, itching, burning or pain is followed by the appearance of painful red spots which, within a day or two, evolve through a phase of clear, fluid-filled blisters which turn yellowish. The blisters burst, leaving painful ulcers that scab over and heal in about 10 days. For women, the blisters can form inside the vagina, so it can be painful to urinate. Women who experience this find that it's helpful to load up on fluids to dilute the urine and lessen the stinging.
Nobody is sure what causes the infection to rise from the nerve cells and infect the surface of the skin and mucous membranes. For instance, while outbreaks are often associated with periods of weak immune systems caused by sickness or stress, people get them when they appear at full health. Other triggers connected to herpes recurrences are skin wounds, menstruation, sunburn, heat, cold, dental work or wind.
Unfortunately, there is no current cure for herpes. Some people experience a chronic form of herpes outbreaks. People with recurring symptoms average about four in the first year of infection and then less and less each year following. The average person has a recurrence a couple of times per year. Less than 10% of the people living with herpes experience frequent outbreaks, around 6 per year.
Cold sores and fever blisters that people get around the lips (and sometimes inside the mouth on initial outbreaks) are different than canker sores. Canker sores are ulcers that are white or gray with red rims found inside the mouth. These usually last 2 weeks. Here are some of the differences between oral herpes and canker sores: