Do Genital Herpes sores change during different stages?

Experiencing the symptoms of an STI can be very stressful. It can be extra stressful when those symptoms change over time. And the symptoms experienced during a Herpes infection are no exception.

In this blog, we’ll plot out what a Herpes sore might look like, and how this might change over time. Keep reading to find out more.

If you’re concerned about a recent sexual encounter, get tested as soon as possible with Better2Know.

What is Herpes?

Herpes is a sexually transmitted infection caused by the Herpes Simplex Virus (HSV), which comes in two main types: Herpes Simplex Virus Type 1 (HSV-1) and Herpes Simplex Virus Type 2 (HSV-2). HSV-1 is primarily associated with oral herpes, leading to cold sores or fever blisters around the mouth and lips. Most people get HSV-1 through kissing, but you can also get it through oral sex if your partner has a genital-based HSV-1 infection.

HSV-2, on the other hand, is predominantly linked to Genital Herpes and is usually transmitted through sexual contact. This virus causes outbreaks of blisters and sores in the genital and anal areas, which can be painful and uncomfortable. Like HSV-1, HSV-2 infections can be asymptomatic, meaning many people may carry the virus without showing any signs, but generally are not infectious to other people in this state. Most people get Genital Herpes infections through unprotected sex, such as vaginal sex, anal sex, oral sex, and sharing sex toys with people who are having an active attack of Herpes.

Both HSV-1 and HSV-2 are lifelong infections, as the virus remains dormant in the body and can reactivate, causing recurrent outbreaks. While there is no cure, antiviral medications can help manage symptoms and reduce the frequency of outbreaks, if need be.

What do Genital Herpes sores look like?

When the dormant virus wakes up, here is what a Herpes sore might look like but it depends on the different stages of an infection.

Prodromal symptoms

The prodromal phase of Genital Herpes is when vague or nonspecific symptoms appear before the more characteristic signs of the infection.

These early symptoms can develop a few hours to a day before the actual outbreak. You might experience:

• Electric shocks
• Tingling
• Burning
• Itching sensations around the site of infection

During the primary infection, these prodromal symptoms will not occur. For future outbreaks, prodromal symptoms can serve as a warning sign that an outbreak is imminent, allowing you to start treatment early when it is most effective.

Blistering

During the primary infection, that is to say the first time you get infected, HSV rapidly replicates readily in squamous epithelial cells on the skin’s surface as your body has no protective immunity against the virus. As more viruses are produced, some move down to the spinal nerve roots where they become embedded, while those near the surface trigger an extreme inflammatory response. This inflammation causes fluid leakage from affected tissues along with systemic symptoms.

During this phase, you may develop:

• Clusters of tiny, painful fluid-filled blisters on the genitals, redness and heat on surrounding tissue
• Pain in the surrounding around or pain that radiates down nerves
• Swollen lymph nodes, especially in the groin
• Generalized body aches
• Fever
• Headache

Genital Herpes blisters are generally small, usually no more than 3 millimetres in size, and this blistering phase typically lasts from one to three days.

Rupturing

As the virus continues to replicate and the immune system fully kicks in to fight the infection, the blisters become larger as they fill with fluid, cellular debris, and dead immune cells. Unlike some blistering skin conditions where blisters emerge, those caused by HSV tend to be nearer to the surface and covered with a thinner layer of tissue, making them more prone to rupture.

Symptoms of this stage include:

• Spontaneous rupture of blisters, often on their own or when abraded by clothing
• A clear or yellowish fluid discharge
• Red, flat, and significant pain, especially when touched.

The pain can be heightened when passing urine or during sex. This phase can also last from one to three days and is without a doubt the most unpleasant part of the Herpes cycle.

In a very few people, the blisters are not replaced by ruptured sores, and the skin just returns to normal.

Crusting and healing

As the blisters rupture and the fluid dries, a crust forms around the perimeter of the sore. This crusting helps with healing by preventing bacteria from entering the exposed tissues.

On moist tissues, like those in the vagina or anus, crusting may be minimal and take longer to heal. The crusting can cause itching, and using a cold compress or over-the-counter anti-inflammatory drugs can ease symptoms and help prevent scratching.

As healing progresses, the crusts will fall off, typically leaving no scars. To prevent scarring from herpes sores on dry areas of skin, small amounts of Vaseline can be applied.

But without treatment, Genital Herpes symptoms typically go away after two to four weeks when the infection is primary, and if it’s a secondary outbreak the whole process takes about 10 days.

This process may be prolonged in people with poor immunity, and can even start from zero again with a second cycle occurring on top of the other.

Latency

Genital Herpes doesn’t go away after the initial infection. It remains in your body for life, but not on the skin.

During the latency stage, the virus embeds itself in nerve cells called ganglia, present in your spinal column, which serve as relay stations in the nervous system. Once embedded, the virus can remain dormant for weeks, months, or even years. The duration of latency can vary, with flare-ups occurring frequently after the primary infection but gradually tapering off as the immune system better recognizes and responds to early reactivation. Some people, however, will never have a secondary outbreak their whole life.

Over time, the replication capacity of HSV tends to decrease, and in some people, flare-ups may stop altogether. This is especially true for Genital Herpes caused by HSV-1, where the concentration of the virus in the sacral ganglia is lower and less prone to reactivation.

Generally, it’s therefore true to say that HSV 2 outbreaks are more frequent than HSV 1. The average amount of genital outbreaks is approximately two per year.

Does the appearance of the sores change over time?

Over the course of several Genital Herpes outbreaks, the appearance of sores can change significantly. Initially, during the first outbreak, the sores tend to be spread over a wider area, more severe, with larger, painful blisters that take longer to heal.

In subsequent secondary Genital Herpes outbreaks, the sores generally become less severe. There are usually less of them and clustered together in a smaller area. Outbreaks tend to occur more or less in the same area each time. The blisters may be smaller and less painful, and the healing process is typically faster. The prodromal symptoms, such as tingling and itching, may occur. Over time, the frequency and severity of outbreaks tend to decrease as the body becomes more adept at managing the virus.

Despite these changes, it’s important to note that Herpes sores can still vary widely from person to person and outbreak to outbreak. Factors such as stress, illness, and overall health can influence the appearance and severity of sores.

What should I do if I think I have Herpes?

If you think you have Herpes, it’s important to get tested. A PCR tests for Herpes while symptoms are present is vastly superior to the blood tests for Herpes. You may have a Herpes infection if you’re experiencing the following symptoms.

Symptoms of Oral Herpes:

• An outbreak that consists of painful blisters or sores on the lips, gums, tongue, or inside the mouth
• Tingling or burning sensation on the lips before the outbreak
• Fever and general discomfort during an outbreak

Additional symptoms may include:

• Sore throat and swollen lymph nodes
• Difficulty swallowing or eating
• Headache and body aches

Symptoms of Genital Herpes:

• Pain or itching around the genitals
• Small bumps or blisters around the genitals, anus, or mouth
• Painful ulcers that form when blisters rupture and ooze or bleed
• Scabs that form as the ulcers heal
• Painful urination
• Discharge from the urethra or vagina
• Fever, headache, and body aches during the first outbreak of blisters
• Swollen lymph nodes in the groin

Final thoughts

Better2Know is here to help if you have any sexual health concerns. Book your appointment at a sexual health clinic near you if you’re concerned about any aspect of your sexual health.

Don’t leave your sexual health to chance. Book an appointment at a sexual health clinic near you.

This article was medically reviewed by Dr. Steve Chapman, 16/07/2025.