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How Long Does It Take for Herpes Symptoms to Show Up?

by | Jun 11, 2024 | Blog, Sexual Health, STD

Herpes symptoms often appear 2-20 days after exposure, with an initial outbreak lasting 2-4 weeks. Testing is most accurate after the incubation period, when the symptoms are present.

Herpes is a common viral disease caused by Herpes simplex virus (HSV) 1 and 2. HSV 1 gives rise to herpetic lesions mainly in and around your mouth while HSV 2 mainly involves the genital area. Both types of herpes can be transmitted through direct contact with an infected person’s sores, mucous membranes, or bodily fluids, making it a significant sexually transmitted infection. In 2020, a meta-analysis by James et al. showed how common this disease is worldwide:[1]

  • 8165 billion women (66.1%) had oral HSV-1
  • 7670 billion men (61.2%) had oral HSV-1
  • 9 million people (0.6%) had genital herpes with HSV-2

The interesting fact is, it will not always cause visible symptoms like blisters, ulcers or sores. Therefore, correct knowledge about when symptoms typically emerge helps in reducing the spread, severity of outbreaks, preventing unnecessary panic and ensuring better health outcomes.

 

Herpes Simplex Virus (HSV) Incubation Periods

The incubation period is the time between infection (having the virus enter your body) and the start of symptoms.[2] In other words, during the incubation period you would have the virus in your body without you or anyone else being aware of it. The Herpes virus incubation period is usually 2 to 20 days, with an average of 7 days.[3] During this period, symptoms are absent, and your body has not yet started making antibodies, an immune component that helps to fight against specific viruses. Therefore, in certain tests like herpes antibody test, it is impossible to detect that you are infected. So, knowing the incubation period helps you decide when exactly to get tested to accurately detect whether you are infected.

Timeline of Herpes Symptom Development

Once the incubation period is over, you may see the symptoms. The appearance of symptoms in a person for the first time is called first outbreak.

 

First outbreak

The Herpes simplex virus typically infects during childhood, showing symptoms in 10-25% of cases, while most are symptom-free.[4] So, the first outbreak can happen in one of two ways.

  • Primary infection: when the virus first enters your body, it is called primary infection. The first outbreak after primary infection is when symptoms appear after the person gets infected for the first time.
  • Non-primary infection: a person gets infected, remains symptomless until a later stage in life, when the symptoms appear after the virus is reactivated. This is a result of latency and reactivation. Symptoms usually last 8-12 days before healing fully.[3]

 

Latent stage

Latency is a special feature in herpes viruses. After the primary infection, they can persist for lifelong by remaining dormant in nerves of infected people. This stage would not give rise to any symptoms and cannot spread the infection another person.[3]

 

Reactivation

The dormant virus can become active periodically, becoming infectious to others.[3] This reactivation can happen with or without symptoms.

  • Asymptomatic viral shedding – reactivation without any symptoms
  • Recurrent/ recrudescent episodes – reactivation of the herpes virus giving rise to symptoms. (clinically apparent disease)

Various triggers can cause reactivation, leading to recurring outbreaks of symptoms throughout a person’s life. Reactivation occurs naturally and can be stimulated by factors such as ultraviolet light, fever, trauma and stress.[3]

 

How Long Does It Take for Herpes Symptoms to Show Up?

From the above description, it is clear the time taken for appearance of symptoms vary. Also, even symptomatic individuals may miss the symptoms completely, because they can be very mild. You would not see any symptoms during the incubation period, which falls between 2 to 20 days. The first outbreak is seen immediately following this period, or a variable time later in life.

In oral herpes, the first symptom to appear is a sensation of tingling and itching in or around the mouth. Then the skin will become swollen and red, with tenderness and worsening itching. Then small clear blisters appear and turn yellowish with time. Blisters burst giving rise to painful sores. After a few days, these sores become flaky and crusted, resembling a scab. Crust flakes off and this marks the end of the infectious period.

Genital herpes follows a similar course, but it may be associated with General feeling of being unwell or discomfort, fever, swollen lymph nodes, vaginal discharge or inflammation of the urethra (tube that carries urine out of the body) causing pain or burning during urination. First time infection is the worst, and the repeated infections are less severe.[3] People with low immunity (e.g. HIV patients, patients on immunosuppressive drugs) can experience Herpetic geometric glossitis, a condition where painful linear crack with branching will appear at the center of the tongue.[5]

 

Can You Have Herpes and Not Know?

There is a huge possibility for people to have herpes viral infection without knowing. HSV 1 might be mistaken for another condition such as pimples because of its mild symptoms, and when it comes to genital herpes, the majority of people are symptomless. In reactivation episodes these people may spread the disease to others as well.

 

Types of Tests for Herpes Diagnosis

It can be diagnosed by one of two ways; detecting the virus in lesions or antibodies in the blood, using both laboratory and point-of-care tests.[6] Therefore, different sets of tests are recommended for symptomatic and asymptomatic people.

 

Symptomatic testing

Your health care provider will collect a sample of blister fluid or swab sample from ulcer base and perform tests to directly detect the virus. Viral culture and PCR from swab samples are the most widely used clinical tests due to their high accuracy.[6] Another advantage of this nuclear amplification testing is its ability to differentiate HSV1 and HSV2. This matters because genital HSV-2 infections are more prone to reoccurring and might benefit from ongoing antiviral treatment. In contrast, genital HSV-1 infections rarely recur and are often managed with a more conservative approach.[7]

 

Asymptomatic testing

If you suspect you have been exposed to herpes virus, yet do not have any symptoms, the tests that can be done are serological assays. Your healthcare provider will collect a sample of blood and detect antibodies your immune system has produced, to fight against the herpes virus. Some of the serology tests available include Passive Agglutination or Hemagglutination Assay, Western Blot Assay, ELISA and Fluorescence Immunoassay.[7] However, serological screening for HSV infections is not recommended because of the low accuracy of widely used commercial HSV-1 and HSV-2 IgG tests.[8]

 

How Soon Can You Tested for Herpes?

Early detection of HSV is important to stop its spread, but testing should be done at the right time to ensure accurate results. If you suspect you have been exposed to the virus, (e.g.: sexual contact with a symptomatic individual) you might panic and try to get tested as soon as possible. But remember, unless you have had an initial outbreak, the test available is serology for antibody detection. This gives accurate results after the incubation period is over, because your immune system needs time to produce antibodies against herpes virus. This can take between two weeks to three months.[9] So, testing too early will give you a false negative result. Therefore, it is best to wait at least 2 to 4 weeks before doing a blood test for antibody detection.[9] Most reliable time to get tested would be when symptoms like blisters or ulcers are present, since more accurate direct viral detection tests can be performed at this stage.

References

First Derm ensures the highest quality and accuracy in our articles by using reliable sources. We draw from peer-reviewed studies, academic research institutions, and reputable medical journals. We strictly avoid tertiary references, linking to primary sources such as scientific studies and statistics. All sources are listed in the resources section at the bottom of our articles, providing transparency and credibility to our content.

 

  1. James C, Harfouche M, Welton NJ, Turner KM, Abu-Raddad LJ, Gottlieb SL, Looker KJ. Herpes simplex virus: global infection prevalence and incidence estimates, 2016. Bull World Health Organ. 2020 May 1;98(5):315-329. doi: 10.2471/BLT.19.237149. Epub 2020 Mar 25. PMID: 32514197; PMCID: PMC7265941.
  2. Nishiura H. Early efforts in modeling the incubation period of infectious diseases with an acute course of illness. Emerg Themes Epidemiol. 2007 May 11;4:2. doi: 10.1186/1742-7622-4-2. PMID: 17466070; PMCID: PMC1884151.
  3. Barer MR, Irving W, Swann A, Perera N. Medical Microbiology: A guide to Microbial infections : Pathogenesis, immunity, laboratory investigation and control. 19th ed. elsevier; 2018.
  4. Radoi CL, Cristea OM, Vulcanescu DD, et al. Seroprevalence of Herpes Simplex Virus Types 1 and 2 among Pregnant Women in South-Western Romania. Life (Basel). 2024;14(5):596. Published 2024 May 7. doi:10.3390/life14050596
  5. Cohen PR. Clinical features of atypical presentations of mucocutaneous herpes simplex virus infection observed in immunosuppressed individuals. Part I: herpetic geometric glossitis. Dermatol Online J. 2024;30(1):10.5070/D330163280. Published 2024 Mar 15. doi:10.5070/D330163280
  6. Nath P, Kabir MA, Doust SK, Ray A. Diagnosis of Herpes Simplex Virus: Laboratory and Point-of-Care Techniques. Infect Dis Rep. 2021;13(2):518-539. Published 2021 Jun 2. doi:10.3390/idr13020049
  7. Centers for Disease Control and Prevention. Herpes – STI Treatment Guidelines. www.cdc.gov. Published 2022. https://www.cdc.gov/std/treatment-guidelines/herpes.htm
  8. Crawford KHD, Selke S, Pepper G, et al. Performance characteristics of highly automated HSV-1 and HSV-2 IgG testing. J Clin Microbiol. Published online April 30, 2024. doi:10.1128/jcm.00263-24
  9. LeGoff J, Péré H, Bélec L. Diagnosis of genital herpes simplex virus infection in the clinical laboratory. Virol J. 2014 May 12;11:83. doi: 10.1186/1743-422X-11-83. Erratum in: Virol J. 2015 Oct 13;12:167. doi: 10.1186/s12985-015-0382-5. PMID: 24885431; PMCID: PMC4032358.

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