Symptoms

During the primary infection of oral herpes, these symptoms may occur:

• Small fluid blisters appearing on or inside the mouth or on the back of the throat
• Swelling of the lymph nodes in the neck

Symptoms may be mild or go unnoticed. Subtle symptoms may be mistaken for small cuts, bites or pimples.

In recurrent infections:

• When symptoms occur, they may appear as blisters or sores that generally heal more quickly than primary infection lesions.
• Many patients experience warning symptoms such as itching, tingling or pain 1-2 days before recurrences.

During the primary infection of genital herpes, these symptoms may occur:

• Some people develop one or two crops of sores or blisters within days, but sometimes within weeks or months of infection.
• Sores/blisters may appear on the penis or vulva, near the anus, or on the thigh and buttocks.
• Sores and blisters may break, ooze fluid, crust over, and heal in 2-4 weeks.
• Fever and swelling of the lymph nodes near the groin may occur.
• Headache and painful urination may be experienced.
• Some people develop minor or no symptoms.

These effects may appear in recurrent infections:

• Symptoms may appear as blisters or sores.
• Many patients experience warning symptoms such as itching, tingling or pain 1-2 days before recurrences.

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In both HSV Type 1 and Type 2 cases, the infection follows the same course of action. During the primary infection, the virus makes multiple copies of itself, which mobilizes the body’s defences to fight the virus, thus limiting its spread. The defensive action may result in the characteristic sores and blisters or it may result in no visible symptoms. If present, the itchy, painful blisters break and form sores that eventually heal. The virus then retreats from the skin along nerve pathways to nerve cells where it establishes a small, permanent colony. During this resting phase (latency), the virus does not trigger the body’s defences. During the recurrent infection, the virus is reactivated, causing it to travel back down nerve pathways to the skin, where it triggers a recurrent infection. The virus again begins to multiply. This recurrent infection may result in sores and blisters similar to the ones exhibited during the primary infection; alternatively, there may be no symptoms.

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For both oral and genital herpes, transmission is by skin-to-skin contact when the virus is active. The virus is transmitted when a contagious area (lesion) comes into contact with breaks in the skin or mucous membrane tissue, usually in the mouth and genitals. The virus cannot breach intact skin.

• Most cases of oral herpes are transmitted during childhood by infected persons kissing or sharing eating utensils or towels with family and close friends.
• Most cases of genital herpes are transmitted during sexual contact with an infected person. It is possible for a person to contract genital herpes from oral sex with a partner with oral herpes.
• Both oral and genital herpes can be transmitted whether symptoms are present or not.
• Mothers can transmit genital herpes to their children during childbirth.

Herpes zoster is caused by reactivation of the varicella-zoster virus after a chickenpox infection. It is not clear what reactivates the virus, but a weakened immune system (which helps fight infection) may cause the virus to move along nerve fibres toward the skin where it multiplies and causes the symptoms to appear. Illness, trauma and stress may also be triggers that reactivate the virus.

If blisters break, the virus can be transmitted by direct skin contact to somebody who has never had chickenpox. That person will develop chickenpox, not shingles (although shingles can then occur later in life).

The herpes zoster virus typically results in the following symptoms:

• Reddish rash that turns into groups of blisters within a few days. Blisters crust and heal in 2-3 weeks. Most commonly, shingles occurs in a single area on one side of the body, in a strip or band of skin supplied by fibres from one nerve. This may show up as a banded rash wrapping one side of the trunk from spine to sternum.
• Burning, tingling pain, or skin sensitivity in one area on one side of the body. Pain may begin a few days before the rash and can range from mild to intense.
• Possible headache, fever, chills, nausea, diarrhea.

Complications following a diagnosis of herpes zoster include:

• Post-herpetic neuralgia (chronic pain). In about 1 in 5 cases, severe pain persists for months to years after the rash disappears. Elderly patients have a higher risk of developing post-herpetic neuralgia. Most people with post-herpetic neuralgia get better with time, usually within a year. A few people develop chronic, persistent pain.
• Herpes zoster ophthalmicus. Shingles of the eye causes swollen eyelids, eye redness and pain. Without prompt treatment, this can scar the eye, cause vision damage or lead to glaucoma, which can cause blindness.
• Ramsay Hunt Syndrome occurs when facial nerves are involved and includes facial paralysis, hearing loss, loss of taste in half the tongue, ear pain, and skin lesions near the ear and ear canal.