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What Happens in a Recurrence

In a recurrence, the genital herpes virus reactivates on the skin and may cause damage to the affected cells until the immune system can get the infection under control. Recurrent episodes are usually mild, with vesicles or ulcers only lasting a few days. They can be so mild that a person may not even recognize he or she is having a flare-up. But whether or not ulcers are noticed or present, a person having a recurrence can transmit HSV to a sexual partner.

Silent, or Asymptomatic, Episodes

In a silent, or asymptomatic, episode, there are no noticeable physical symptoms. In fact, there is either a very mild warning sign (prodrome) or none at all. Silent episodes are of great concern, because even though there is no sign of an outbreak, the virus is still active on the surface of the skin and can be transmitted to another person. One study showed that women with HSV-2 infection had a silent outbreak an average of every 50 days, with some having silent episodes as often as every 20 days. This is why regular condom usage during sexual intercourse is often suggested to help prevent the spread of genital herpes.

Signs of an Outbreak

This was discussed in Issue 2, but we'll review it again because it is of primary importance to those who have HSV. Ninety percent (90%) of people with genital herpes report that before an outbreak they get a warning sign (prodrome). A prodrome usually occurs 1-2 days before an outbreak, and can include any or all of the following signs:

• Tingling, itching, or burning in the genital area
• Pain or increased sensitivity in the genitals
• Pain, increased sensitivity, or unusual sensations in the groin, scrotum, back, thighs, calf, or foot
• Irritability
• Tiredness
• Metallic taste in the mouth

These warning sensations usually last 24 hours. If, however, you become sensitive to your warning signs you can begin taking antiviral medication at the onset of an episode to help reduce the symptoms associated with an outbreak. This treatment approach is called "episodic treatment," and we'll talk more about that in the second article

To avoid spreading herpes to your partner, you should avoid sexual contact during an outbreak.

Causes of an Outbreak

The truth is that the reasons why people with genital herpes have recurrences aren't very well understood. But there are some common causes, or triggers. These include stress, exhaustion, lack of sleep, poor nutrition, menstruation, trauma, illness, and sun exposure. Friction at the site may also provoke a recurrence, whether it is from having sex, riding a bike, or wearing tight clothing.