The Herpes Outbreak Timeline: How Often Do Herpes Outbreaks Occur, and When?

If you’re having a herpes outbreak for the first time, it’s natural to have a lot of questions. Whether the first sign was a cold sore on your lip or blisters from genital herpes, the first question you may ask is how to make them go away. 

The second question is probably about when (and how often) they’ll come back.

Herpes outbreaks are a lifelong affliction, and there’s no cure yet. But while some people may have outbreaks constantly, others may only see one or two throughout their lifetime.

Below, we’ve explained how long herpes takes to show up, how long outbreaks will last, and how often you can expect to deal with them in the future.

After you’re infected with herpes, there’s no exact timeline in which you should expect your first outbreak to occur. Some people may see lesions within a few days. For other people, it may take months or even years for an outbreak to happen after the initial herpes infection.

Some lucky folks might never get symptoms at all. 

However, there’s typically a range of time in which people who experience an oral or genital herpes infection could expect a first outbreak to occur.

• Cold sores (also known as oral herpes) can take three days to one week 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. 

How often herpes outbreaks occur varies from person to person and depends on the type of herpes virus you have. 

There are two types of herpes: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). HSV-1 often causes oral herpes, while HSV-2 often causes genital herpes.

• Oral HSV-1 (cold sore) outbreaks may happen several times a year or once every couple of years. In other words, it varies.

• Genital or HSV-2 outbreaks occur more often. For 70 to 90 percent of people with the virus, HSV-2 causes an average of four genital herpes outbreaks a year.

FYI: 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.

Recurrence can also depend on the affected area.

According to the Centers for Disease Control and Prevention (CDC), recurrent outbreaks of genital HSV-1 are less frequent than outbreaks of genital HSV-2. So, about 20 to 50 percent of people with genital herpes caused by HSV-1 may have one additional outbreak a year vs. those with cold sores caused by HSV-1. 

The good news is that you may get more outbreaks in your first year of having the herpes virus, then fewer and fewer as time passes. 

The number of outbreaks you get can also depend on your herpes triggers.  

There’s not much research into what triggers a recurrent herpes outbreak. However, it’s thought an outbreak could be caused by:

• Emotional stress

• Sunlight

• The common cold 

• Physical exertion

• Skin injuries

• Menstruation

• Wearing tight clothes

• Wearing rough fabrics

So, if you’re stressed while training for a marathon in tight shorts, outbreaks may happen more frequently.

When you get a herpes outbreak, you may develop lesions (small blisters or ulcers) around your mouth, genital area, or rectum. These lesions all have different healing times, and the herpes outbreak timeline will look different for everyone. 

• Cold sore duration. A cold sore lesion can take seven to 10 days to heal. In some people, lesions and symptoms may take two to six weeks to clear up entirely.

• Duration of genital herpes outbreak. After the initial infection, lesions can take two to four weeks to heal.

If you have a compromised immune system, herpes outbreak symptoms may last longer and be more severe.

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.

Just like your first break-up, your first outbreak of herpes is usually the worst. 

In your first outbreak, lesions may take longer to clear up. If left untreated, it could take about 20 days for an initial outbreak to go away, but your next episode may only last ten days.

During your first episode, you might experience increased viral shedding — when your body produces infectious particles. 

You could also 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.

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 on 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. 

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 experience symptoms at all. It can also be effective for people with less frequent outbreaks, although it’s not clear if it’s effective for people with HSV-1 genital herpes.

Herpes treatments approved by the Food and Drug Administration (FDA) include: 

• Acyclovir

• Valacyclovir

• Famciclovir

A healthcare provider can recommend the best dosage for you. 

For example, if you have less than ten HSV-1 outbreaks a year, you might be prescribed a daily 500-milligram dose of valacyclovir. If you have more than ten episodes a year, you might be given a 1-gram dose of valacyclovir.

If you’re immunocompromised, your doctor may prescribe a 500mg daily dose of valacyclovir or two to three daily doses of acyclovir. 

Learn more about how valacyclovir works in our blog.

In addition to these medications, topical peppermint oil has been studied as a treatment option for herpes. However, it may be more effective as a suppressive treatment rather than for treating herpes symptoms. 

If you have one of the herpes viruses, symptoms like painful sores and blisters may never appear. 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.

That’s because it’s tricky to diagnose people with asymptomatic herpes. However, if you think you may have been infected, 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 pretty common. As many as nine out of ten infected people will either have barely noticeable symptoms or no symptoms of genital herpes at all.

If you do see signs of herpes, you’re not guaranteed to have massive sores. You might get mild symptoms that could be mistaken for something innocent like a pimple or an ingrown hair.

Herpes can also 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), so if you’re looking for a fact sheet on what to expect, know that you’re not alone.

Here’s the TL;DR on herpes outbreaks:

• 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 outbreaks 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.