On average, herpes symptoms appear four days after exposure to the virus. This is the same for both herpes simplex virus type 1 (HSV), the type commonly associated with cold sores, and herpes simplex virus type 2 (HSV-2), the type commonly associated with genital herpes.
That being said, the timeline can vary from one person to the next, and it can anywhere from two to 21 days for the herpes rash to show up.
This article describes the timeline of a herpes infection, including the incubation period, the stages of infection, and the length of time the virus is contagious. It also outlines the current testing recommendation and how to prevent getting or passing on the herpes virus.
What Does a Herpes Rash Look Like?
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How Long Does It Take for Herpes Symptoms to Appear?
If you are having your first herpes outbreak, the time between exposure to the virus and the outbreak of rash can be anywhere from two to 21 days. This is called the incubation period.
The actual outbreak can occur anywhere within this timeframe, though most develop four days after exposure to the virus, according to the Centers for Disease Control and Prevention (CDC).
The incubation period for HSV-1 and HSV-2 is the same.
Symptoms of a herpes outbreak include:
- A cluster of blisters that quickly merge and rupture, forming open ulcers
- Oozing and crusting
- Itching and pain
- Pain with urination (with genital herpes)
It is important to note that not everyone who gets HSV-1 or HSV-2 develops symptoms. Some may remain entirely asymptomatic (without symptoms) but still be able to affect each other as a carrier of the virus.
Prodromal Symptoms
Prior to the outbreak, you may experience mild to moderate flu-like symptoms, especially if this is your first outbreak. These early signs are referred to as prodromal symptoms (meaning non-specific signs that precede the outbreak of rash).
Prodromal symptoms for herpes develop anywhere from two hours to two days before the outbreak of rash and may include:
- Tingling or itching at the site of the impending outbreak
- Shooting pains in the legs, hips, or buttocks (with genital herpes)
- Mild fever
- Muscle aches
- Joint pain
- Swollen lymph nodes
- Tiredness
Herpes Outbreak Timeline
While the outbreak and duration of herpes symptoms can vary, the general timeframe remains the same. There are variations, however, based on whether this is your first or subsequent outbreak, and whether the infection is active or latent (dormant).
First Outbreak
A first outbreak typically occurs when you have been recently exposed to HSV-1 or HSV-2. But, there are also times when a "first outbreak" is not recent.
First herpes outbreak can be classified in one of two ways:
- Primary infection: This is a new exposure that causes symptoms. This type of outbreak lasts an average of 20 days.
- Non-primary infection: This occurs when symptoms appear for the first time after a previous asymptomatic (symptom-free) infection. On average, these last for 17 days and tend to be far milder.
Latent Stage
After the symptoms of the first outbreak have cleared, the herpes virus will implant itself in the nerve cells of the spine root. It will then go into a latent (dormant) state where it is invisible to the immune system. There, it will remain for the rest of your life.
Some people may never have a repeat episode after the resolution of the first outbreak. Others may have frequent recurrences for years on end.
Recurrent Outbreaks
While the immune system can usually keep the herpes virus in a prolonged state of latency, the virus can suddenly reactivate whenever the immune system is weakened or the spinal roots are irritated.
The triggers known to reactivate the virus include:
- Illness
- Fever
- Stress
- Fatigue
- Surgery
- Ultraviolet (UV) radiation from the sun
- Changes in hormones (such as with menstrual periods)
Recurrent outbreaks tend to be less severe than the first. This is because the body will have developed immune proteins, called antibodies, to defend itself should the virus reactivate.
Over time, the outbreaks may become weaker and weaker and, in some people, stop altogether.
Is it HSV-1 or HSV-2?
Although HSV-2 is the most common cause of genital herpes, HSV-1 can also be passed to the genitals through oral sex. When this happens, there is no way to tell if HSV-1 or HSV-2 is the cause without a lab test.
Can You Have Herpes and Not Know It?
It is possible to have herpes and not know it. In fact, the vast majority of HSV-2 infections in the United States are asymptomatic. In such cases, a person may have no idea that they have been infected and are a carrier of the virus.
Others with HSV-1 or HSV-1 have symptoms that are either mild or mistaken for other conditions. Because of this, they are less likely to seek a diagnosis and may unknowingly infect others when the virus reactivates.
Herpes Transmission Without Symptoms
It is also possible to pass herpes to another person when there are no signs of a rash. This is due to a process known as asymptomatic viral shedding in which the virus reactivates and sends viral particles to the surface of the skin. Even if there is no rash, the virus particles can leach through tissues and be passed to someone else by skin-to-skin contact.
When herpes is symptomatic, viral shedding can continue for seven to 12 days before the lesions have healed. When herpes is asymptomatic, viral shedding may persist for three to seven days.
When Is the Best Time to Get Tested?
Herpes simplex infections are very common. Worldwide, it's estimated that 90% of people have HSV-1, HSV-2, or both. Because it is so common, testing recommendations vary based on whether you have symptomatic or asymptomatic HSV.
Symptomatic Testing
If you are symptomatic, your healthcare provider may want to test you to confirm that you have herpes and not another blistering skin condition like shingles. But arguably more importantly, they may want to tell if a genital herpes outbreak is caused by HSV-1 or HSV-2.
This is because a genital HSV-2 infection is most likely to recur and may sometimes benefit from antiviral drugs on an ongoing basis. By contrast, genital HSV-1 infections are unlikely to recur and are treated more conservatively.
Herpes is mainly diagnosed with a nucleic acid amplification test (NAAT). The NAAT is performed on a swab of fluid from an open sore. It can spot even minute quantities of the virus by generating copy upon copy of the virus's genetic material through a process called amplification.
Asymptomatic Testing
Asymptomatic testing may be performed if you have a suspected recent exposure to the virus, such as having sex with someone with HSV or someone with genitals sores.
In this case, an HSV antibody blood test may be used to look for proteins, called antibodies, that are produced by the immune system in response to the virus. While the test is highly accurate in detecting recent infections, it is less able to do so if the exposure occurred a long time ago.
Generally speaking, asymptomatic testing is not recommended because it wouldn't alter how the treatment is approached even if the test were positive. In the end, having HSV doesn't mean you will get HSV symptoms.
At the same time, asymptomatic testing has not been proven to alter risk behaviors associated with infection or decrease the infection rates in vulnerable populations.
How Herpes Is Diagnosed
How to Prevent Herpes Flare-Ups
Herpes simplex is a chronic (life-long) condition. It can't be cured, but it can be effectively managed with the guidance of a healthcare provider. In addition to antiviral medications, everyday activities that support overall health can help prevent flare-ups. These include:
- Getting enough quality rest
- Managing stress levels
- Eating foods with plenty of nutrients
- Protecting yourself from extreme temperatures or sun exposure
- Getting vaccinations to prevent flu and other infections
How to Recognize and Deal With Herpes Discharge
Summary
The incubation period for herpes simplex virus is between two and 21 days, with an average of four days. Symptoms of an initial outbreak include flu-like symptoms and fluid-filled blisters that appear in clusters.
After the initial outbreak, the virus goes dormant in the body. If triggered, the virus may reactivate and may cause additional outbreaks. Transmission to others is possible whether you have symptoms or not.
Testing for HSV depends on whether you are experiencing symptoms or not. Treatment includes antiviral medications and self-care strategies. While there is no cure, herpes can be effectively managed so that it does not interfere with your daily life.
