How Long Does a Herpes Outbreak Last?

If you’ve just had a herpes outbreak, or think you might have, the first question is usually how long it will last. The short answer is about one to two weeks for most sores, with the first outbreak often lasting longer and being harder going than later ones. Here is what MedlinePlus, the NHS and the CDC say, and what to expect at each stage.

How long does a herpes outbreak last?

It depends on where the sores are and whether this is a first outbreak or a later one.

• Genital herpes, first outbreak. MedlinePlus says the blisters break and leave shallow ulcers that crust over and heal in 7 to 14 days or more. The CDC says the painful sores may take a week or more to heal.
• Oral herpes and cold sores. MedlinePlus says oral herpes most often goes away by itself in 1 to 2 weeks. The NHS says cold sores should start to heal within 10 days. A first oral infection can last longer, up to 3 weeks according to MedlinePlus.
• Later (recurrent) outbreaks. Usually shorter and less severe than the first, according to the CDC, WHO and MedlinePlus. Over time, people usually get outbreaks less often and the symptoms become milder.

These are typical ranges, not promises. If you’re unsure what is normal for you, a clinician who knows your history is the best person to ask.

What are the stages of an outbreak?

A typical outbreak moves through these stages, although not everyone has all of them:

• Early warning. Tingling, itching or burning in the area, often before anything is visible. For cold sores, the NHS says one or more painful blisters usually appear over the next 48 hours.
• Blisters. Small blisters form, filled with clear or straw-coloured fluid, and they are typically painful.
• Open sores. The blisters break open and ooze, leaving shallow, painful ulcers.
• Crusting. The sores crust over. For a cold sore, the NHS says the blisters burst and crust over into a scab.
• Healing. The sores heal, and the skin returns to normal.

Why is a first outbreak often worse?

A first outbreak can cause a prolonged clinical illness, with severe genital sores. The CDC says flu-like symptoms such as fever, body aches or swollen glands may also occur during the first outbreak. MedlinePlus says the first outbreak, when it causes symptoms, most often happens within 2 days to 2 weeks of being infected.

Not everyone has a noticeable first outbreak. Most people with herpes have no symptoms or only mild ones, and many people don’t know they have the infection. Mild symptoms can be mistaken for other skin conditions like a pimple or an ingrown hair.

How long do recurrent outbreaks last?

Recurrences are usually shorter and less severe than the first outbreak. MedlinePlus says a second outbreak can appear weeks or months later, and that it goes away sooner than the first. The NHS says outbreaks tend to happen less often over time, and that some people never have outbreaks.

Recurrences are much more frequent with HSV-2 genital herpes than with HSV-1. Some people notice a trigger before an outbreak, such as an illness or fever, sun exposure, a menstrual period, injury, emotional stress or surgery. Others see no clear pattern.

Can I help an outbreak heal faster?

The main proven option is antiviral medicine prescribed by a clinician. It can decrease how long symptoms last and how severe they are, and it works best when started early. The CDC says it is most effective when started within one day of the sores appearing or during the warning stage. The NHS puts the gain at 1 or 2 days for a genital outbreak, and notes that outbreaks usually settle by themselves, so you may not need treatment. People with frequent outbreaks may be offered daily suppressive medicine to make outbreaks less frequent. This guide doesn’t cover doses, which a clinician sets for your situation.

For comfort, WHO suggests a warm bath for 20 minutes without soap and loose-fitting clothes for genital herpes, plus over-the-counter pain medicines. For oral herpes, cold drinks or popsicles can help.

Avoid sexual contact while symptoms are present. Herpes can also spread when no sores are visible.

What can make a sore last longer?

People with weakened immune systems can have prolonged or severe episodes of genital, perianal or oral herpes, according to the CDC. If sores persist or keep returning even on antiviral treatment, the CDC advises considering antiviral resistance and seeing a clinician who can test for it.

When is a sore lasting too long?

For a cold sore, the NHS advises seeing a doctor if it has not started to heal within 10 days. For oral herpes, MedlinePlus advises contacting a provider if symptoms are severe or don’t go away after 2 weeks. For genital sores, the sources give a range rather than a cut-off, so see a clinician if a sore isn’t starting to heal, keeps getting worse, or outbreaks keep coming back very often or are very painful.

Also see a clinician if you have a weakened immune system, since outbreaks can be prolonged or severe, or if you are not sure it is herpes. A swab test of a fresh sore is the most sensitive way to confirm herpes, and a clinician can help you plan for future outbreaks.