Symptoms of Herpes

Both herpes simplex viruses (HSV) can cause sores. HSV type 1, which is normally transmitted through kissing or sharing objects like toothbrushes, normally causes sores on the mouth or tongue (cold sores). Sores from HSV type 2 are usually on the genital area, as this type of herpes is sexually transmitted. That said, it's possible no symptoms will occur with infection, or that sores may come and go.

Frequent Symptoms

There are some similarities among the symptoms of HSV 1 and HSV 2:

  • Severity: Cold sores and genital herpes tend to cause more noticeable and extensive symptoms during the first infection. Generally, recurrences are milder. 
  • Asymptomatic intervals: Cold sores and genital herpes are caused by viruses that enter through the skin and travel to the nerves, where they remain dormant (inactive) before recurring. These asymptomatic intervals can last for weeks, months, or even years.   
  • Warning signs of reactivation: Pain, tingling, or burning can occur prior to a recurrent episode of herpes. This is due to inflammation and irritation of the nerves in the infected area. These warning signs of another outbreak, often referred to as prodromal symptoms, mean that you are very contagious even if you do not have any visible sores. 

The vast majority of the time, HSV types 1 and 2 cause superficial symptoms of the skin in the specific areas mentioned. In exceptional circumstances, more severe symptoms can involve other parts of the body. 

The main difference between symptoms of the two types is where sores occur, though there are some other nuances worth noting.

Cold Sores (HSV 1)

Cold sores can appear on the outside of the mouth or lips, inside the mouth, or on the tongue. Symptoms of HSV 1 include:

  • Open, blistery or crusted sores
  • Pain with chewing, swallowing, or talking
  • Itchiness of the sores and the area around them

The symptoms may last for about three to 10 days, and recurrent sores generally affect the same area. 

Genital Herpes (HSV 2)

Typical symptoms of genital herpes include:

  • Internal and external blisters and sores that are small, fluid-filled, and often occur in clusters
  • Itching or burning feeling in the genital or anal area
  • Pain in the legs, buttocks, or genital area
  • Pain when urinating
  • Unexplained penile discharge
  • Unusual vaginal discharge

Symptoms disappear in 10 to 21 days. Recurrent attacks usually affect the same area but are less severe.

In men, the infection can involve the penis, anal opening, buttocks, and/or thighs. In women, the sores can occur in the vaginal area, cervix, urethra (the tube that carries urine), area around the buttocks, anal opening, and/or the thighs.

Women may be more susceptible to a genital herpes infection primarily because a woman's genital area is more likely to be moistened with body fluids, which allows the virus to more easily enter the skin. Women also tend to have higher rates of complications during the first genital herpes outbreak.

Less Common Symptoms

In general, herpes simplex infections cause sporadic recurrences of sores, often with a preceding trigger, such as a cold or a fever—and sometimes without any trigger at all.

An infection may cause other, though less common, symptoms as well. These include:

  • Severe pain in the area of the sores: The sores can cause extreme pain, usually as the result of repeated abrasion. For example, HSV type 1 can occur on the tongue near the teeth, which can cause extra irritation. HSV type 2 can occur near an area where there is repeated rubbing from the fabric of clothes, or an area that is aggravated by walking or sitting, which can exacerbate symptoms. 
  • Enlarged and painful lymph glands: Glands in the neck, under the arms, or in the groin can become enlarged or painful when you have an active herpes infection. 
  • Flu-like symptoms: The infection may cause a fever and generalized flu-like symptoms such as muscles aches and fatigue. This can happen due to the body's immune system response to HSV infection.

Symptoms in Other Areas of the Body

It is possible for HSV type 1 to occur in the genital area and HSV type 2 to occur on or in the mouth. Either case is usually a result of spread through oral sex. You cannot always know which type of virus you have by looking at it, as the sores caused by both viruses look the same.   

HSV 1 can also affect other areas of the body, such as the neck, arms, and torso. Symptoms include pain, itching, and blisters or sores. This is most often associated with wrestling and is described as herpes gladiatorum when it occurs in that setting. 

Complications

Most of the time, herpes only causes superficial sores. Herpes can result in serious complications that affect other parts of the body, but this is rare.

Generally, complications of herpes are most likely to occur in two situations: when a baby is born with herpes transmitted from the mother during delivery, and when a person's immune system is not functioning properly (as with HIV infection). 

Disseminated Herpes

Disseminated herpes occurs when a herpes virus infection spreads from the initial area of infection. For example, HSV type 2 herpes sores can recur, affecting multiple areas of the vagina; HSV type 1 sores can recur, affecting multiple areas of the tongue. Or, disseminated herpes can be more severe, such as when a herpes virus spreads to other areas of the body, such as the brain.

Ocular Herpes

Herpes infection can affect the eyes. This is a rare complication of HSV type 2, most often identified in newborns who may be exposed to the virus during vaginal delivery. Ocular herpes can produce painful sores on the eyelid or the eye itself. Symptoms of ocular herpes include the following:

  • Pain in and around the eye
  • Redness, rash, or sores on the eyelids, around the eyes, or on the forehead
  • Eye redness
  • Swelling and cloudiness of the cornea
  • Tearing
  • Blurred vision
  • Light sensitivity
  • Discharge

Hearing Loss

Herpes has been associated with the sudden hearing loss in children and adults, as well as with newborn hearing loss. This complication can occur if the herpes virus affects the nerves that control hearing. 

Encephalitis

Encephalitis is an infection of the brain. This is a serious infection that can cause developmental delays in children or cognitive (thinking) deficits in adults. 

When to See a Doctor

If you have a cold sore, you do not necessarily need to make an appointment with your doctor, because it will likely go away on its own within a few days. However, make an appointment for an evaluation if you have signs and symptoms of cold sores that are persistent and/or extremely painful, especially if they are associated with fevers, swelling, bleeding, or oozing. Though cold sores are generally not serious and rarely cause complications, you'll want to get outbreaks under control. 

If you have any signs of genital herpes, however, you should see a doctor within a few days, before the lesions go away. 

Sores on or near the genital area can herald a sexually transmitted disease, or they may be the result of some other type of irritation. Most sexually transmitted diseases are treatable, but it is difficult to know which one you may have—or if you have one at all—unless you are trained in diagnosing them. Many people do not communicate with sexual partners when it comes to STD status, so it's best to get a definitive answer on what's causing your symptoms.

If you have pain or bleeding with urination, pain with sexual activity, or if you notice that lesions in the genital area seem to be inflamed, you should call your doctor, even if you have already been diagnosed with and treated for herpes. 

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