Symptoms:

For people with no prior contact with HSV-1 or HSV-2, initial infection involves both whole body (systemic) and local symptoms.

Generalized symptoms include:

• Decreased appetite
• Fever
• Malaise
• Muscle aches

Local symptoms include repeated eruptions of small, painful blisters filled with clear, straw-colored fluid on the genitals, around the rectum, or covering nearby areas of skin. Before these blisters appear, the person may experience increased skin sensitivity, tingling, burning, itching, or pain at the site where the blisters will appear.

When the blisters break, they leave shallow ulcers that are very painful. These ulcers eventually crust over and slowly heal over 7 - 14 days.

Enlarged and tender lymph nodes in the groin may accompany an outbreak. Women also may develop vaginal discharge and painful urination. Men can develop painful urination if the lesion is near the opening of the urethra.

Once a person is infected, the virus hides within nerve cells, making it difficult for the immune system to find and destroy it. Within the nerve cells, the virus can remain dormant for a long period of time, which is called "latency."

The infection can reactivate at any time, at which point painful blisters again cover the genitals, anus, inner thigh, or mouth. A variety of events can trigger latent infection to become active, including:

• Fatigue
• Mechanical irritation
• Menstruation
• Stress

Attacks can recur as seldom as once per year, or so often that the symptoms seem continuous. Recurrent infections in men are generally milder and shorter in duration than those in women.

Signs and tests:

• Viral culture of blister fluid from lesion is positive for herpes simplex virus. The herpes simplex virus can grow within 2 - 3 days.
• PCR from the blister fluid detects small amounts of DNA and can tell whether the herpes virus is present in the blister.
• Tzanck test of skin lesion may show results consistent with herpes virus infection. This test involves staining human cells within the blister fluid with a dye. If the cells from the fluid contain viral particles, they become visible. However, the test cannot determine which strain of virus is in the blister.

Recently developed antibody tests can determine whether a person has HSV-1 or HSV-2. These tests can also tell if a person has ever been exposed to either of these strains in the past (IgG test) or was just recently exposed to one of them (IgM test).