For patients who have symptoms, the first outbreak can be the worst. During primary infection, patients may experience multiple genital ulcers that can cover larger areas of skin. It can be on both sides of the groin and be quite painful. They often experience burning during urination in addition to the local pain. They can have fever, headaches, muscle and joint pain, and their lymph nodes in the groin can be swollen and painful as well. With no therapy, the lesions will clear and heal without scarring (typically) in about 21 days. Therapy can shorten that period significantly. The reason an initial outbreak can be so severe is that there are no antibodies to herpes when the virus first enters the body, (though a prior history of herpes type 1 can give someone antibodies that work a little bit to fight herpes type 2 and may make an outbreak a bit less severe.)
An initial outbreak can be caused by Herpes 1 and in developed countries like the US, the most common cause of an initial attack of herpes is actually herpes 1. Most people do not realize that someone infected with oral herpes from type 1 can perform fellatio or cunnilingus (oral sex) on a partner and transmit herpes 1 from their mouth to their partner’s genitals. The problem is that many people don’t know they have oral herpes. It may be easier to see but not many people remember the cold sore they had when they were 3.
Understanding how herpes can remain in the body yet be kept at bay to some degree is pivotal. Herpes enters the sacral plexus of nerves during an initial infection. The virus remains safe from attack by antibodies and the immune system as long as it is tucked away in the nervous system. That little trick, entering the nervous system where it neither damages the nerves nor can be attacked, makes herpes a particularly stubborn infection. It can slide down the nerves that go from the sacral plexus to the skin and cause more outbreaks in the future. These are called recurrences.
This information is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.