Most individuals infected with HSV-1 or HSV-2 are asymptomatic, or have very mild symptoms that go unnoticed or are mistaken for another skin condition. This is why 81.1% of infected individuals remain unaware of their infection. When symptoms do occur, the classic presentation is that of one or more vesicles on or around the genitals, rectum or mouth. These vesicles break, leaving behind painful ulcers that may take a few weeks to heal. Experiencing these symptoms is referred to as having an "outbreak," or episode.
Clinical manifestations of genital herpes differ between the first and recurrent outbreaks of HSV. During the first outbreak, the lesions usually remain for a longer duration, there is increased viral shedding (making HSV transmission more likely) and systemic symptoms including fever, body aches, swollen lymph nodes, and headache. Recurrent outbreaks of genital herpes are common, mainly during the first year of infection. About 50% of patients who experience recurrences have prodromal symptoms, such as mild tingling or shooting pains in the legs, hips and buttocks occurring hours to days before eruption of herpetic lesions. Symptoms of recurrent outbreaks are typically shorter in duration and less severe than the first outbreak of genital herpes. Although the virus, once it infects an individual, it remains in the body indefinitely, the number of outbreaks tends to decrease over time. Recurrences are much less frequent for genital HSV-1 infection than for genital HSV-2 infection.