Can someone contract genital herpes for the first time years after initial sexual contact?

Can Someone Get Genital Herpes for the First Time Years After Sexual Contact?

Yes, a person can absolutely develop their first clinical episode of genital herpes years after the initial sexual contact that transmitted the virus, because most HSV infections (80-90%) progress subclinically after acquisition but can become symptomatic at any time. 1

Understanding the Timeline of Herpes Infection

The critical distinction here is between infection acquisition and symptom onset:

Subclinical Infection is the Norm

• In 80-90% of cases, genital herpes progresses subclinically after initial acquisition, meaning the person becomes infected but develops no visible symptoms at the time of transmission 1
• The virus establishes latency in the sacral ganglia immediately after infection, regardless of whether symptoms appear 1
• These subclinically infected individuals can remain asymptomatic for months, years, or even their entire lifetime 1

First Clinical Episode ≠ Recent Infection

The first episode of visible genital lesions may indicate either recent OR long-lasting infection 1. This is a crucial counseling point because:

• A person could have been infected years ago during a previous relationship but only now develops their first visible outbreak 1
• The appearance of symptoms does not prove recent sexual contact or infidelity 1
• The incubation period for symptomatic disease is typically 2-10 days (up to 4 weeks), but this only applies to those who develop immediate symptoms 1

Clinical Implications for Patient Counseling

Key Messages for Patients

When counseling patients about this scenario, emphasize:

• It is difficult to determine how or when a person became infected with HSV 1
• Many people acquire genital herpes from partners who don't know they have the infection or who were asymptomatic at the time of sexual contact 1
• Even individuals with only one lifetime sex partner can have the infection 1
• The first visible outbreak could represent reactivation of a virus acquired years earlier during any previous sexual contact 1

Viral Shedding Persists Long-Term

Viral shedding continues at high rates years after initial infection, which explains both late symptom onset and ongoing transmission risk:

• Total HSV-2 shedding occurs on 16.7% of days even ≥10 years after first clinical episode 2
• Subclinical shedding occurs on 9.3% of days ≥10 years after first episode 2
• HSV-2 may be transmitted to sexual partners many years after initial infection, even when the source partner is asymptomatic 3

Common Pitfalls to Avoid

Don't Assume Timeline Based on Symptoms

• Never assume that a first clinical episode indicates recent acquisition 1
• The severity of first episode does not correlate with timing of acquisition 1
• Type-specific serologic testing can help determine if this is truly a new infection (seronegative) versus reactivation of old infection (seropositive), but even this has limitations 1, 4

Relationship Counseling Considerations

• Patients should be counseled to inform current sex partners about having genital herpes 5, 6
• However, the appearance of first symptoms years into a monogamous relationship does not prove infidelity 1
• HSV-1 genital infections can occur in stable, monogamous relationships through oral-genital contact 7