Herpes Simplex Virus

Symptoms vary depending on whether the outbreak is initial or recurrent.

The first (primary) outbreak is usually worse than recurrent outbreaks.

Genital Herpes

Primary Genital Herpes Outbreak. For patients who do experience symptoms, the first outbreak usually occurs in or around the genital area within 1 – 2 weeks after sexual exposure to the virus. The first signs are a tingling sensation in the affected areas, (genitalia, buttocks, thighs), and groups of small red bumps that develop into blisters. Over the next 2 – 3 weeks, more blisters can appear and rupture into painful open sores. The lesions eventually dry out and develop a crust, and then heal rapidly without leaving a scar. Blisters in moist areas heal more slowly than others. The lesions may sometimes itch, but itching decreases as they heal.

About 40% of men and 70% of women develop other symptoms during initial outbreaks of genital herpes, such as flu-like discomfort, headache, muscle aches, fever, and swollen glands. (Glands can become swollen in the groin area as well as the neck.) Some patients may have difficulty urinating, and women may experience vaginal discharge.

Recurrent Genital Herpes Outbreak. In general, recurrences are much milder than the initial outbreak. The virus sheds for a much shorter period of time (about 3 days) compared to in an initial outbreak of 3 weeks. Women may have only minor itching, and the symptoms may be even milder in men.

On average, people have about four recurrences during the first year, although this varies widely. Over time, recurrences decrease in frequency. There are some differences in frequency of recurrence depending on whether HSV-2 or HSV-1 causes genital herpes. HSV-2 genital infection is more likely to cause recurrences than HSV-1.

Oral Herpes

Oral herpes (herpes labialis) is most often caused by herpes simplex virus 1 (HSV-1) but can also be caused by herpes simplex virus 2 (HSV-2). It usually affects the lips and, in some primary attacks, the mucous membranes in the mouth. A herpes infection may occur on the cheeks or in the nose, but facial herpes is very uncommon.

Primary Oral Herpes Infection. If the primary (initial) oral infection causes symptoms, they can be very painful, particularly in small children.

  • Blisters form on the lips but may also erupt on the tongue.
  • The blisters eventually rupture as painful open sores, develop a yellowish membrane before healing, and disappear within 3 – 14 days.
  • Increased salivation and foul breath may be present.
  • Rarely, the infection may be accompanied by difficulty in swallowing, chills, muscle pain, or hearing loss.

In children, the infection usually occurs in the mouth. In adolescents, the primary infection is more apt to appear in the upper part of the throat and cause soreness.

Recurrent Oral Herpes Infection. Most patients have only a couple of outbreaks a year, although a small percentage of patients experience more frequent recurrences. HSV-2 oral infections tend to recur less frequently than HSV-1. Recurrences are usually much milder than primary infections and are known commonly as cold sores or fever blisters (because they may arise during a bout of cold or flu). They usually show up on the outer edge of the lips and rarely affect the gums or throat. (Cold sores are commonly mistaken for the crater-like mouth lesions known as canker sores, which are not associated with herpes simplex virus.)

University of Maryland Medical Center. 2011.  Herpes Simplex Symptoms. Retrived February 3, 2011 from http://www.umm.edu/patiented/articles/what_symptoms_of_herpes_simplex_virus_000052_2.htm

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