How many outbreaks will you get?

HSV affects everyone a little differently. Some people are bothered by frequent cold sores and/or genital herpes outbreaks, and others are not.

How much of a physical impact the virus has on someone’s body is primarily the result of four factors:

how well a person’s immune system is able to combat the infection,
how long the person has had the infection,
Whether or not the virus is established in its site of preference,
and viral type.

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Your Immune System

The immune system’s ability to respond to and suppress HSV triggers is a key factor in whether or not someone will experience frequent outbreaks. Differences in immune response may be the main reason that some people are bothered by frequent cold sores or genital herpes outbreaks while others are not. It’s also the reason that both HSV-1 and 2 can pose serious challenges for infants, who have a limited immune response; and for people with compromised immune systems, including people with cancer, AIDS, severe burns, and people taking immunosuppressant medications.

For example, infants and people with compromised immune systems (those with cancer, HIV/AIDS, severe burns, or who are taking immunosuppressant medications) tend to experience severe recurrent outbreaks, because their immune system is weaker or weakened.

The healthier your immune system, the less likely you are to suffer from severe or numerous symptoms.

How Long You’ve Been Infected

In time, the severity, the duration, and the number of outbreaks a person with HSV experiences tends to decrease. That is true for both HSV1 and HSV2.

A larger number of people with oral HSV1 contracted the virus when they were children, so by the time those people reach adulthood, very few are bothered by their oral outbreaks enough to seek help or consider their symptoms a medical issue. That is because, over time, their immune systems formed antibodies to fight the virus, and they no longer have either severe and/or frequent outbreaks.

In contrast, the majority of Americans who are infected with genital HSV2 acquired the infection as teenagers or adults, so their bodies haven’t yet developed a significant level of antibodies necessary to combat the virus, and thus, they still experience severe and/or recurrent outbreaks. However, as with oral HSV1, the number of outbreaks one experiences with HSV2 usually reduces the longer they’re infected.

Type of Herpes and Where It’s Located

Both HSV1 and HSV2 can infect a person orally and/or genitally, however, both infections will cause milder symptoms when they are outside of their preferred location. HSV1 prefers to infect above the waist, and HSV2 prefers to infect below the waist.

Experts estimate that around 30% of genital herpes infections are caused by HSV1, but only 2-5% of those infections cause recurring genital outbreaks. Therefore, most people infected with HSV1 genitally have very few, if any, genital herpes outbreaks. To further emphasize the difference in recurrence between a genital HSV2 infection and a genital HSV1 infection, one study showed that genital HSV2 causes physical symptoms 10 times more often than genital HSV1.

Average Outbreak Rate

During the first year of infection, those with recurring outbreaks of HSV1 orally or HSV2 genitally experience an average of 4 to 6 episodes.
For those with genital HSV1, on average, studies have shown about one outbreak per year.
When an oral HSV2 infection occurs, recurrent outbreaks are uncommon. In one study, oral HSV2 recurred an average of 0.01 times a year in newly infected people.

Viral Type

A possible fourth factor affecting recurrence rate is viral type. According to another study, genital HSV2 infections were the most frequently recurring herpes infections, followed by oral HSV1, genital HSV1, and last of all, oral HSV2.

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