Herpes recurrences explained

Herpes recurrences (also called outbreaks, episodes, flare-ups) are repeat symptoms (sores, blisters, patches of red skin or tiny splits) which appear at or close to the place where the infection was first noticed. These are often fairly minor and may be no more than a small spot that heals in a few days. They may be accompanied by sensations – itches or nerve twinges. They are unlikely to be as severe as first symptoms and may be almost unnoticed.

A recurrence of genital herpes is expected to be just on ONE SIDE ONLY. Other things like thrush, BV, eczema and other vulval conditions are going to be equally on both sides. But herpes is one-sided when it is a recurrence.

There are many different things that may trigger herpes recurrences. Sometimes, a person can learn to recognise why outbreaks appear – but for other people there does not seem to be any particular reason for it.

Between recurrences the virus travels from the skin along the nerve to the nerve ganglion (a junction for several nerves supplying the same area) where it remains. Once you have been infected, the virus remains in the body, just as chickenpox and some other viruses do. Recurrent symptoms occur when the virus is reactivated or ‘triggered.’ The symptoms normally appear in the same area as the first time. For some people they may move a short distance, e.g. from genitals to buttocks, but always within the same dermatome (nerve region).

Some people feel aching, tingling, burning or sharp pains in the area affected (leg, genitals or buttock) preceding a recurrence. These are called prodromal symptoms or prodromes. They are a sign that the virus is trying to reactivate and there may be virus on the skin surface.

Tingles do not always turn into a recurrence. Sometimes they last for a few days then disappear without any symptoms appearing on the skin.

Some people get tingling so continuously that they will ask for medication. The medication will usually be the same as that used for shingles.

Researchers know the average number of outbreaks – but you are not average! Does knowing how many children a woman has ‘on average’ tell you how many you will have?

However, we know that outbreaks are about 6 times more frequent with a type 2 genital infection than when it is caused by type 1. So a person who is having a lot of genital herpes recurrences is more likely to have herpes simplex type 2. (And a person with type 1 on the genitals is not expected to have many recurrences at all.)

Some people get no further episodes, while a few get frequent recurrences. If you do, you could ask your doctor for antiviral pills to prevent outbreaks – see antiviral treatment, or you can try self-help treatments. There are two pages of suggestions on our “Tips to prevent recurrences” leaflet. It is available to subscribers. Outbreaks normally decline in frequency and severity over time.

Research has found a gene which helps some people control the virus so they get no further episodes. So if you get a lot of outbreaks, you can blame a parent! However, good or bad genes, you can still help your body to prevent outbreaks – see antiviral treatment, or you can try self-help treatments. There are two pages of suggestions on our “Tips to prevent recurrences” leaflet. It is available to subscribers. Outbreaks normally decline in frequency and severity over time.