Most people infected with HSV do not even know that they are infected because they never experience any symptoms. Others may not know because the symptoms they experience are so mild. When symptoms do occur, the initial outbreak occurs within two weeks of exposure to HSV and it is that period which usually has the most severe symptoms; it usually resolves without treatment in two to four weeks.

The symptoms of an initial genital herpes outbreak usually start with pain or itching in the genital or anal region, followed by the appearance of small red blisters that then rupture and become oozing sores. The sores then scab over and heal marking the end of the outbreak. During a recurrent outbreak, the symptoms may include itching, tingling, vaginal discharge, and a burning feeling or pain in the genital or anal area but do not always include visible sores.

Some people never experience a recurrence of symptoms after the initial outbreak while most people experience recurrent outbreaks that may continue to occur for up to 40 years following the initial infection. The frequency of recurrence is highly variable among patients with some people experiencing symptoms several times a year. People with genital herpes caused by an HSV-2 infection are more likely to experience recurrent outbreaks than those infected with HSV-1. Recurrent outbreaks are usually much milder than the initial symptoms and their frequency diminishes with time. Certain triggers may make outbreaks more likely including stress, menstruation, illness, surgery, friction (such as that caused by vigorous sexual intercourse), and fatigue. During an outbreak it is possible to spread herpes to another person through sexual contact but herpes may also be transmitted during a period of remission (no symptoms).