Many HSV-infected people experience recurrence within the first year of infection. Prodrome precedes development of lesions. Prodromal symptoms include tingling (paresthesia), itching, and pain where lumbosacral nerves innervate the skin. Prodrome may occur as long as several days or as short as a few hours before lesions develop. Beginning antiviral treatment when prodrome is experienced can reduce the appearance and duration of lesions in some individuals. During recurrence, fewer lesions are likely to develop and are less painful and heal faster (within 5–10 days without antiviral treatment) than those occurring during the primary infection. Subsequent outbreaks tend to be periodic or episodic, occurring on average four or five times a year when not using antiviral therapy.
HSV-1 and HSV-2 are transmitted by direct physical contact with a sore on an infected person. Facial or lip herpes is most often contracted by kissing someone with a cold sore. Genital herpes is most often contracted during sexual intercourse with a person who has an active genital sore. Genital herpes can also be contracted during or genital sex if a partner has labial herpes.
Although the cause is unknown, outbreaks are often associated with periods of weakened immune systems, skin wounds, menstruation, fever, nerve damage, tissue damage from surgery, or exposure to extreme climate situations. A genital herpes outbreak or episode occurs when the HSV-1 or HSV-2 virus is reactivated from its dormant stage. Genital herpes is an incurable disease, and once you contract it, you may experience outbreaks throughout your lifetime. Those who are experiencing their first herpes episode of genital herpes can expect to have several (typically four or five) outbreaks within a year. Over time these recurrences usually decrease in frequency and severity. The first outbreak of herpes is often the longest outbreak experienced. After that, short and inconsistent episodes can be managed and treated with antiviral medication.
A 2004 study in the New England Journal of Medicine found that suppressive therapy decreases the risk of HSV-2 transmission from symptomatic, infected partners to uninfected partners by 48%. So “the risk of transmission is significantly reduced, but cannot be eliminated even with suppressive therapy,” Johnston explains, and she stresses that the virus can be passed along even without signs or symptoms.