Transmission occurring from individuals with obvious symptoms is well documented, but many people are unaware they are infected with HSV because they have no symptoms, or very minor ones that may go unnoticed. The first episode usually takes 2 to 20 days to occur after infection, but occasionally symptoms may not occur until months or years later. Recurrent episodes occur in most, but not all people and can happen years after the first episode. The interval between episodes varies greatly between individuals. The same is true for herpes type 2 around the mouth.
Recurrences occur when the virus inside the nerve cell is re-activated.
For many people there does not seem to be a pattern to their recurrences while others notice that recurrences occur when they are premenstrual, tired, stressed, sunburnt, or consume excessive alcohol or other drugs. HSV is not transmitted by sperm, nor does it affect fertility. Women should advise their obstetrician or midwife that they have had genital herpes just in case a recurrence is experienced at the time of childbirth. In this case she may be advised to have a caesarean section to avoid transmission of herpes to the baby. For people having a first episode of herpes or who have frequent or more severe recurrent outbreaks there are tablets, which may be appropriate.