Pending clinical review. This page describes the commonly reported symptom picture and has not yet been reviewed by a named clinician. It is orientation, not diagnosis, and no page can tell you whether you have herpes. If you have symptoms now, be seen while they are present — a sexual health clinic is free, and the swab works best early.
The first one is usually the worst one.
That is worth knowing at the start, because if you are in the middle of a bad first episode it is easy to assume this is what the rest of your life looks like. It very rarely is.
A first episode commonly involves several of the following, though almost nobody gets all of them:
- Warning sensations first. Tingling, itching, burning or general soreness in one area, often a day or two before anything is visible.
- Blisters, then shallow sores. Small blisters that break to leave tender open sores, which crust and heal — usually without scarring. They can appear on the vulva, around the vaginal opening, on the buttocks, thighs or around the anus.
- Pain passing urine. Often the symptom that sends people to a doctor, and often the reason it gets treated as cystitis first. Urine passing over open sores stings sharply.
- Changes in discharge. Which is the other reason it is commonly mistaken for thrush.
- Feeling generally unwell. Fever, aching, headache, swollen glands in the groin — a genuine flu-like illness, because your immune system is meeting something new.
- Sores on the cervix. Not something you would see or necessarily feel, and something a clinician may find on examination.
A first episode can take two to three weeks to settle fully. That is longer than most people expect, and it is not a sign that something has gone wrong.
Recurrences are usually much smaller events.
Later episodes tend to be milder, shorter and more local — often a small patch in one spot, healing within days rather than weeks, without the flu-like part. Many people learn to recognise their own prodrome and know an episode is coming before it appears.
Frequency varies enormously and generally declines over time. Some people have several episodes in the first year and then very few. Some have almost none from the start. There is no standard pattern to measure yourself against.
Why this gets missed.
The overlap is real, and being misdiagnosed once or twice before getting an answer is a very common story.
Thrush
Itching, soreness and discharge overlap. The distinguishing feature is blistering and open sores, which thrush does not cause.
Cystitis or a UTI
Pain passing urine points people towards a urine infection. If a urine test comes back clear and it still stings badly, that is worth mentioning.
Shaving irritation
Ingrown hairs and razor rash produce bumps that can look similar at a glance. The full comparison is here.
Many people have no symptoms at all.
A large proportion of people carrying herpes simplex never notice a thing, or have symptoms so mild they are put down to friction, a spot, or an off week. That has two consequences worth holding on to.
The first is that a diagnosis does not tell you when you acquired it. The virus can sit quietly for years, so a first noticed outbreak is not the same as a first infection — and it cannot establish who you got it from.
The second is that having no symptoms is not the same as being in the clear, which is part of why it is so widespread and why so few people know.
Seek help urgently if you cannot pass urine at all, if the pain is severe, if you feel seriously unwell, or if you are pregnant and think this may be a first episode. Contact a sexual health clinic, your GP, or NHS 111. Retention of urine during a first episode is uncommon but is a genuine reason to be seen the same day.
This page is educational and is not medical advice. Interval’s care service is not yet open, and we do not diagnose. This page is written by non-clinicians from the sources listed at the foot of the page, and has not been independently reviewed by a clinician.
If it turns out to be this, the first weeks are the hardest part.
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- NHS. Genital herpes. www.nhs.uk
- Patel R et al. British Association of Sexual Health and HIV UK national guideline for the management of anogenital herpes, 2024. Int J STD AIDS. pmc.ncbi.nlm.nih.gov
Last checked 10 August 2026. Read our editorial policy for how we source and review these pages.