What To Look For

Symptoms

Symptoms vary depending on the stage of the virus, the initial or primary outbreak, and recurrence. Both herpes simplex viruses 1 and 2 produce similar symptoms, but they can differ in severity depending on the site of infection. More than 60% of new HSV-2 infections and about a third of new HSV-1 infections do not produce symptoms.

General Symptoms of a First (Primary) Herpes Simplex Infection

Skin Eruptions and Pain. The first time a person experiences a herpes simplex outbreak, skin eruptions appear 2 - 12 days after the initial exposure to the virus.

• The first sign of infection is fluid accumulation (edema) at the infection site, which is quickly followed by small, grouped blisters -- the characteristic HSV lesions.
• These form on an inflamed skin base, which is more visible in dry skin areas.
• The blisters then dry out and heal rapidly without scarring within 7 - 10 days. Blisters in moist areas heal more slowly than others. The lesions may sometimes itch, but itching decreases as lesions heal.
• When the crust falls off, the lesions are no longer contagious. (The virus may still be active in nearby tissue, but such persistence is rare.)
• Once HSV gains entry to a site in the body, the virus can also spread to nearby mucosal areas through nerve cells. This characteristic spreading can cause fairly large infected areas to erupt at some distance from the initial crop of sores.

The primary skin infection with either HSV-1 or HSV-2 lasts up to 2 - 3 weeks, but skin pain can last 1 - 6 weeks in a primary (the initial) HSV attack.

Other Symptoms. Some patients experience other symptoms as well, which may occur before the actual outbreak (called a prodrome).

• Fever rising to about 102°F, muscle aches, headache, and flu-like malaise. These general symptoms usually resolve within a week.
• Lymph glands near the site may be swollen as well.

It may be especially important to identify a primary infection (if possible) and to treat it as soon as possible, since some preliminary research suggests that early treatment may limit the number of viruses that remain latent in the body and reduce the frequency of recurrent outbreaks.