Can You Get a Fever with Genital Herpes?
Yes, fever is a common systemic symptom of primary genital herpes infection, occurring alongside other constitutional symptoms such as malaise, headache, and localized lymphadenopathy. 1, 2, 3
Primary vs. Recurrent Infection
Primary genital herpes (first-time HSV infection in a seronegative person) typically presents with the most severe manifestations:
- Fever, malaise, and lymphadenopathy are characteristic systemic symptoms that accompany the painful genital lesions during primary infection 1, 2, 3
- The primary episode is usually the most severe manifestation of HSV infection, whether caused by HSV-1 or HSV-2 1
- Constitutional symptoms including fever, headache, malaise, and anorexia occur in some cases of primary infection 4
- Symptoms of primary infection may include malaise, fever, or localized adenopathy alongside the visible genital lesions 2
Recurrent genital herpes (reactivation of latent virus) presents very differently:
- Recurrent episodes are much milder in expression and typically do not cause fever or systemic symptoms 1, 5
- Recurrences are characterized mainly by localized symptoms: itching, burning, and/or paresthesia prior to lesion appearance 1
- The recurrent form has much less frequent complications and minimal systemic involvement 5
Clinical Distinction
The presence or absence of fever helps distinguish between primary and recurrent infection:
- Initial non-primary infection (when someone with HSV-1 antibodies acquires HSV-2) causes less severe genital infection than true primary infection, though recurrences still occur 1
- The incubation period for both HSV-1 and HSV-2 is typically 2-10 days (up to 4 weeks) before symptoms including fever may appear 1
Important Clinical Caveat
Most genital herpes cases (80-90%) progress subclinically without any symptoms, including fever, but may become symptomatic at any time 1. This means many patients never experience fever even during their initial infection because they remain asymptomatic throughout.
In immunocompromised patients, episodes are usually longer and more severe, potentially with more pronounced systemic symptoms including fever 6, 7.