Herpes. The word is itself enough to make most of us break into a nervous sweat. And the scary thing is, herpes doesn’t just strike once.
Whether you’ve got your first cold sore or you’ve been battling genital herpes for years, you might be wondering how often herpes outbreaks occur.
There’s no easy answer to that question. Herpes outbreak frequency is different for everyone and depends on the type of herpes virus you have.
In general, if you have the virus that mostly causes cold sores, you may get several outbreaks a year. If you have the virus that causes genital herpes, you may get four outbreaks a year on average.
Keep reading to find out how long herpes takes to show up, how long it hangs around and how often you can expect it to rear its ugly head.
You just made out with someone with a cold sore. Whoops.
How long after an exposure to herpes can you expect to see an outbreak? It varies from person to person.
For oral herpes (aka cold sores), it can take three days to one week for the infection to show up after exposure.
For genital herpes, it can take an average of four days for lesions to show up after you’ve been infected with the virus. But this can range from two days to 12 days.
For some people, it may take months or even years for an outbreak to happen after the initial genital herpes infection. And some lucky folks might never get symptoms at all.
How often herpes outbreaks occur varies from person to person and depends on the type of herpes virus you have.
Here’s a quick science lesson to help you understand the different types of herpes.
Herpes is caused by two types of the virus: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). HSV-1 often causes oral herpes while HSV-2 is often the cause of genital herpes.
If you receive oral sex from someone with HSV-1, you can get genital herpes caused by HSV-1. Learn more about this in our guide to HSV-1 and HSV-2.
Now for the answers:
How often do cold sores occur? Oral HSV-1 (cold sore) outbreaks may happen several times a year or once every couple of years. In other words, it varies.
How often do genital herpes outbreaks occur? HSV-2 outbreaks occur more often. HSV-2 causes an average of four genital herpes outbreaks a year. This is true for 70 to 90 percent of people.
Recurrent outbreaks of genital HSV-1 are less frequent than outbreaks of genital HSV-2. Those with genital herpes caused by HSV-1 may have one additional outbreak a year. This is true for 20 percent to 50 percent of people.
The good news here is you may get more outbreaks in your first year of having the herpes virus, then fewer and fewer as time goes on.
The number of outbreaks you get can also depend on your triggers.
There’s not much research into what triggers a recurrent herpes outbreak. However, it’s thought an outbreak could be caused by:
The common cold
Wearing tight clothes
Wearing rough fabrics
So if you’re stressed training for a marathon in tight shorts, outbreaks may happen more frequently.
You can take daily medication to reduce how often a herpes outbreak happens. This is known as suppressive therapy. For folks who experience frequent outbreaks of genital herpes, suppressive therapy can reduce outbreaks by a whopping 70 to 80 percent!
With suppressive therapy, you might not get an outbreak with symptoms at all. It can be effective for people with less frequent outbreaks, too.
FDA-approved herpes treatments include:
A healthcare provider can recommend the best dosage for you.
For example, if you have less than 10 HSV-1 outbreaks a year, you might be prescribed a daily 500-milligram dose of valacyclovir. If you have more than 10 episodes a year, you might be given a 1-gram dose of valacyclovir.
For immunocompromised people, a 500-milligram daily dose of valacyclovir or two to three daily doses of acyclovir may be prescribed.
Learn more about how valacyclovir works in our blog.
Topical peppermint oil has been studied as a treatment option. It may be more effective as a suppressive treatment rather than to treat herpes symptoms.
When you get a herpes outbreak, you may develop lesions (small blisters or ulcers) around your mouth, genital area or rectum. How long can you expect these lesions to hang around? The herpes outbreak timeline will look different for everyone.
Cold sore duration. It can take seven to 10 days for a cold sore lesion to heal. In some people, it may take two to six weeks for lesions and symptoms to fully clear up.
Genital herpes outbreak duration. For genital herpes, it can take two to four weeks for lesions to heal after the initial infection.
If you have a compromised immune system, herpes outbreak symptoms may last longer and be more severe.
Just like your first break-up, your first outbreak of herpes is usually the worst.
During your first outbreak, lesions may take longer to clear up. It could take about 20 days for an initial outbreak to go away if left untreated, but your next episode may only last 10 days.
You might also experience increased viral shedding (when your body produces infectious particles) during your first episode. And you could get flu-like symptoms, such as a fever, body aches, swollen lymph nodes or a headache. You may or may not have the same symptoms with your next outbreak.
Antiviral medicine can shorten how long genital herpes outbreaks last by a few days. As for cold sores, research shows valacyclovir can reduce how long they last by one day. The quicker you start treatment, the better the result.
Check out our blog on how fast valacyclovir works for more insight.
We hate to break it to you, but herpes is always contagious.
During an outbreak, cold sores can be passed through saliva — when kissing or sharing a drink with an infected person, for example.
Genital herpes can be passed if you have skin-to-skin contact or sex with herpes. If you touch a herpes sore — wherever that might be — you can catch the virus.
But, unfortunately, herpes can still be contagious even when the outbreak has passed. There’s no cure for the herpes virus, so it’s always in your system.
For those with asymptomatic HSV-2, genital HSV shedding happens on about 10 percent of days. For people with symptoms, shedding happens on about 20 percent of days. So you’re less likely to pass it on when you don’t have symptoms, but it can still happen.
A daily antiviral medication can reduce your chances of passing the herpes virus to sexual partners. You should also use a condom during sex and avoid sexual contact altogether when an outbreak strikes.
For people with genital HSV-1 herpes, genital shedding rapidly decreases during the first year of infection. It’s unclear if daily meds are effective for these folks.
If you have one of the herpes viruses, symptoms like painful sores and blisters may never show up — score! This is known as asymptomatic herpes.
Most people with HSV-1 — the cold sore culprit — don’t get any symptoms at all. Some folks with HSV-2 don’t have any symptoms and may not even know they have genital herpes.
It’s tricky to diagnose people with asymptomatic herpes. You can get a blood test to check if you have antibodies from the herpes simplex virus infection in your bloodstream.
Not getting herpes symptoms sounds like winning the lottery, but it’s actually pretty common. As many as nine out of 10 infected people will either have hardly noticeable symptoms or no symptoms of genital herpes at all.
If you do see signs of herpes, you’re not guaranteed massive sores. You might get mild symptoms that could be mistaken for something innocent like a pimple or an ingrown hair.
It’s not just sores, either. Herpes can cause painful urination in women, and you might get tingling in your genitals (hello) or pain in your butt, hips or legs. As you can imagine, all this can be mistaken for other health issues.
Genital herpes is the most common sexually transmitted disease (STD). We all know someone who rocks a cold sore every now and again.
Here’s the TL;DR on the virus:
Herpes outbreaks may happen one to four times a year. It’s different for everyone and depends on the type of virus you have. For HSV-1, you might get one outbreak a year. For HSV-2, you may get four.
Medication can reduce how long outbreaks last. Acyclovir, valacyclovir and famciclovir are FDA-approved meds that can shorten how long outbreaks last by a few days.
Meds can reduce how many outbreaks you get. If taken daily, antiviral meds can reduce the number of herpes outbreaks you experience.
Learn more about these herpes-fighting meds in our comparison of valacyclovir, acyclovir and famciclovir.
While you’re at it, check out our range of online sexual health services to improve your love life both during and after a herpes outbreak.
Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.