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What are the symptoms of herpes break out?

DOCTOR OF THE MONTH - Dec 2013
Dec 2013
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Questions RE herpes: 1 in most cases are first outbreaks accompanied by flulike symptoms? 2 if you had a first outbreak within weeks to 3 months would this most likely be a severe outbreak? 3 what does a first outbreak look like? 4 if you were exposed and engaged in oral and anal sex is it likely that an outbreak would only occur in the rectal area? 5 if you had anal itching, if this was herpetic and a first outbreak would it most likely be followed by blisters? 6 if so, how long after itching or other early symptoms before blisters appear? 7 once blisters appear, how long does it take from them to rupture and sore? 8 when blisters rupture and sore is it and are they painful?
Posted Thu, 20 Mar 2014 in Sexually Transmitted Diseases
 
 
Answered by Dr. Sanjay Kumar Kanodia 1 hour later
Brief Answer: vesicles are sore & quite painful in first episode Detailed Answer: Hi, I can understand your concern towards herpes. Before I answer each of your query let me tell you simply about herpes: Herpes is a viral infection and is of two types - type 1 and type 2. Type 1 is mainly causing oral infection and type 2 is for sexually transmitted one. In your query the main type concerned is type 2. Both type 1 and type 2 HSV are acquired by direct contact with, or droplets from, infected secretions entering via skin or mucous membrane. So you can get that this can occur during both oral and anal sex. Once a person is infected there can be asymptomatic state if immunity is present or there can be a primary infection in which symptoms typically occur within 3 to 7 days after exposure. A prodrome (initial symptoms) of tender lymphadenopathy, malaise, anorexia and fever, as well as localized pain, tenderness and burning, often occurs before the onset of mucocutaneous lesions. Initially there is appearance of painful vesicles on an erythematous base followed by progression to pustules and/or ulcerations. Multiple grouped and scattered vesicles typically develop. Crusting of lesions and resolution of symptoms occur within 2 to 3 weeks. A similar prodrome can precede recurrent lesions, but the latter are often decreased in number, severity and duration compared with those of a primary infection. So getting all the above informations let me answer all of your queries one by one accordingly: 1 in most cases are first outbreaks accompanied by flulike symptoms? @ You can get that in most of cases of first outbreak there are flu like symptoms as described above. 2 if you had a first outbreak within weeks to 3 months would this most likely be a severe outbreak? @ Yes the first outbreak is always the most severe one and latter episodes have decreased severity and many a times is only accompanied by mild soreness and pain only. 3 what does a first outbreak look like? @ You can get that the first outbreak appears as multiple vesicles with deep redness and pain. These rupture in day or two and forms ulcers which in most cases heal in 2–3 weeks if untreated. 4 if you were exposed and engaged in oral and anal sex is it likely that an outbreak would only occur in the rectal area? @ As I said previously that genital herpes is caused by type 2 virus and have propensity to affect the local mucosal site. Therefore if oral or anal sex is done then it can definitely affect anal mucosa as well as oral mucosa both. But an important point is that the anal mucosa is more vulnerable for trauma so there is more chances of involvement of anal mucosa. 5 if you had anal itching, if this was herpetic and a first outbreak would it most likely be followed by blisters? @ Though there can be multiple causes of anal itching but considering it to be related to first outbreak, there is more tendency of pain and soreness rather than itching. If it is an outbreak for the first time then is most often followed by vesicles in genital herpes. 6 if so, how long after itching or other early symptoms before blisters appear? @ The typical symptoms of pain or itching and other prodromal symptoms can develop as early as 3 to 7 days to maximum 2 weeks of exposure and the vesicles follow these symptoms with in a day or two only. 7 once blisters appear, how long does it take from them to rupture and sore? @ As You read earlier that once the vesicles appears it takes only day or two to rupture and become sore ( as these vesicles are of superficial nature so rupture very rapidly). 8 when blisters rupture and sore is it and are they painful? @ Yes the vesicles are sore and quite painful in first episodes, though intensity gets reduced in further episodes. I hope these informations will help you. I will be glad to answer any further of your queries. With regards, Dr Sanjay Kumar Kanodia MD- Dermatology & Sexually Transmitted Diseases
Above answer was peer-reviewed by
 
Follow-up: What are the symptoms of herpes break out? 52 minutes later
Thank you for your response and information! I have some more questions: 1 When writing about initial exposure what does it mean if immunity is present? 2 Would the pain be more near the vesicles? What if the pain was found more near the anus and not near the blisters is this likely to be herpes? 3 In laymen’s terms what is the appearance of the initial painful vesicles, pustules and ulcerations? 4 What are the most common characteristics of herpes blisters or would these be considered the vesicles and therefore answered above? 5 What are the most common characteristics of herpes sores or would these be considered the pustules and therefore answered above? 6 is discharge or blood usually noticeable with ruptured sores or would these be considered the ulcerations and therefore answered above? 7 if you touched an infected area and then without washing hands touched another body part, would that place now be infected? 8 if without treatment how long would the flulike symptoms last? 9 would a good night’s sleep alone be enough to remedy flulike symptoms same day? 10 if exposed and infected near the mouth are dry and chapped lips a symptom? 11 is it common in herpes to have anal discharge that may appear to be like sweat in the rectal region but not necessarily near the blisters? 12 Is an upset and/or bloated stomach and/or irregular bowels and/or diarrhea a characteristic of herpes? 13 if you had an outbreak in one area, is it likely in the next outbreak you would not have an outbreak there but in another area? 14 would XXXXXXX (diaper rash cream) relieve some of the symptoms of herpes? 15 if exhibiting more symptoms of redness, sore anal region when initially exposed to water (after scratching and wiping) and no blisters and no sores, is it likely this is herpes? Background on patient: high fiber (100% or more daily requirement) and coffee (5 to 8 cups daily) diet, takes multivitamin and calcium vitamin d pills and raspberry ketone diet supplement (usually 3, sometimes 4 times daily when recommended dosage is 2 a day, also some reviews for the supplement point to clear/orangey oily discharge) pills daily, loose stools 3 to 4 times, described as a vigorous wiper (7 to 8 wipes or until sees no fecal matter on toilet paper), shaved and shaves anal region (hair grows in within a week), wears jeans without underwear 1 to 2 times a week and wears same underwear without washing 2 to 3 times a week. 16 Do the pictures attached (apologize for the graphic content) look like initial herpes blisters? The white near the redness is residue from rash cream. These are small and red, no white or clear-ish head, and are not painful or itchy to the touch. Background I recently was completely shaved and hair has begun to grow back. This is the first time I have experienced this and on Wednesday I felt a little sick, heartburn, nausea, upset stomach, had been drinking a little the night before and had only 9 hours sleep total the 3 nights prior combined. After a full nights sleep weds into thurs night I felt fine. The itchiness has been present for about a week and I have been scratching a lot as well as putting diaper rash cream on and some evenings without showering first. The main issue I have is the itchiness and redness. I feel some pain in the anus (not on the red spots) but should note in the last week I have used (with water based lubricant) an anal sex toy 4 to 6 times which can sometime cause discomfort afterward (I apologize for the graphic detail). I am wondering if given this info and the images I could have herpes. Can provide more pictures and information.
 
 
Answered by Dr. Sanjay Kumar Kanodia 44 minutes later
Brief Answer: Symptoms an pictures not related to herpes Detailed Answer: Hello young fellow, I have gone through the whole series of problem as well as your anxious queries regarding possibility of herpes. After reading the complete query with diligence and thoroughly analyzing the pictures let me first reassure you that your condition does not seem to be herpes at all. It is the mild irritation over the anal mucosa. Now answering your queries again: 1When writing about initial exposure what does it mean if immunity is present? @ It means that our body fights back the infection in most cases. If you are exposed to a virus it does not mean that you will 100 % be having the clinical symptoms. It depends from one person to the other on the basis if immunity of the body to whether to get the infection or not. 2 Would the pain be more near the vesicles? What if the pain was found more near the anus and not near the blisters is this likely to be herpes? @In any manner there is always presence of painful vesicles. These vesicles are actually synonymous to blisters. Pain near the anus without blister does not mean herpes. 3 In laymen’s terms what is the appearance of the initial painful vesicles, pustules and ulcerations? @ As told before vesicles is the medical term for small fluid filled structures (which when enlarges forms blisters). Once pus is filled in these then forms pustules and when skin is removed then forms ulcers. 4 What are the most common characteristics of herpes blisters or would these be considered the vesicles and therefore answered above? @ Herpes blisters (vesicles) are always painful and quite sore. 5 What are the most common characteristics of herpes sores or would these be considered the pustules and therefore answered above? @ As told before herpes blisters are first to be formed and then the skin gets removed due bursting of these forming painful sores. 6 is discharge or blood usually noticeable with ruptured sores or would these be considered the ulcerations and therefore answered above? @ In general there is little of discharge and the most important characteristic is red, raw ulcers. 7 if you touched an infected area and then without washing hands touched another body part, would that place now be infected? @ Yes if it is herpetic lesion frankly then touching infected to non-infected area can lead to further spread. 8 if without treatment how long would the flulike symptoms last? @ these may last to 3-5 days. 9 would a good night’s sleep alone be enough to remedy flulike symptoms same day? @No, as told above these remains for 3-5 days, so can not be reduced overnight by sleep or medications. 10 if exposed and infected near the mouth are dry and chapped lips a symptom? @No, dry chapped lips is not a symptom. 11 is it common in herpes to have anal discharge that may appear to be like sweat in the rectal region but not necessarily near the blisters? @ No herpes never manifest as sweat like discharge. 12 Is an upset and/or bloated stomach and/or irregular bowels and/or diarrhea a characteristic of herpes? @ No herpes never manifest as upset and/or bloated stomach and/or irregular bowels and/or diarrhea. 13 if you had an outbreak in one area, is it likely in the next outbreak you would not have an outbreak there but in another area? @ It takes almost minimum of 4 weeks of period for two outbreaks. It may occur at same site or another site. There are no fixed criteria for its occurrence. 14 would XXXXXXX (diaper rash cream) relieve some of the symptoms of herpes? @ No, Diaper rash cream has no role in treating symptoms of herpes. For your query no 15 I already gave the answer that your symptoms do not seems to be due to herpes. I can make out that you are quite anxious regarding the possibility of herpes. Reduce your anxiety for the same. If you want you can go for simple tests of HSV IgM and IgG for herpes which will relieve all your anxiety related to herpes. I hope these informations will help you. I will be glad to answer any further of your queries. With regards, Dr Sanjay Kumar Kanodia MD- Dermatology & Sexually Transmitted Diseases
Above answer was peer-reviewed by
 
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