According to the Centers for Disease Control and Prevention, 45 million Americans are infected with herpes. As many as 90 percent have no idea they are infected. Herpes lesions progress through four characteristic stages that can be used to identify them. Although medical attention is not necessarily required, people with active herpes lesions should not engage in sexual activity due to the chance of transmission.
Stage 1: Prodrome
About one to two days before the onset of an outbreak, many people experience premonitory symptoms in the form of a prodrome. Herpes prodrome is characterized by an itching, tingling, burning or painful feeling in the area where the lesions subsequently appear. In some cases, the area can be distinguished by mild swelling or redness.
Stage 2: Bumps and Blisters
Herpes skin lesions usually begin as painful small red bumps or tiny, fluid-filled blisters on a red base. According to the American Social Health Association, they are frequently mistaken for pimples, ingrown hairs, jock itch, insect bites or yeast infections, which explains why as many as 90 percent of people with herpes are unaware that they are infected. During the first outbreak, bumps and blisters may appear in clusters and are usually on both sides of the body. In subsequent episodes, there are usually fewer lesions, often on just one side of the body, notes Dr. Lawrence Corey, Chair of Virology at the University of Washington College of Medicine.
Stage 3: Crusts and Ulcers
About two to three days after bumps and blisters appear, they give way to crusts and ulcers, according to a 2005 article in the journal "American Family Physician." Crusts, as the name implies, are crusty, yellowish, granular scabs. They are more commonly seen on skin lesions, such as the border of the lip and groin. Lesions on the mucous membranes do not crust effectively, resulting in ulcers--shallow, pink, well-demarcated "craters” where the surface layer of tissue is clearly absent. Crusts and ulcers are often itchy and painful. Viruses may be shed in high concentrations at this time.
Stage 4: Healing
Healing occurs as crusts and ulcers are gradually replaced by new tissue. As with other kinds of skin problems, healing occurs from the outside to the inside, with measurable decreases in diameter and depth. In a primary outbreak, the process may take as long as six weeks. In recurrent outbreaks, lesions usually resolve within a week. It is believed that antibodies present in recurrent outbreaks play some role in speeding the healing process, explains Dr. Corey. Herpes lesions usually heal without scarring, however, mechanical trauma from friction or “picking” and secondary bacterial infections make scars more likely.
References
- American Social Health Association: Herpes Resource Center
- Herpes Simplex Viruses (Chapter); L. Corey; In: Harrison’s Principles of Internal Medicine, 17th edition; A.S. Fauci, E. Braunwald, D.L. Kasper, S.L. Hauser, D.L. Longer, J.L. Jameson, and J. Loscalzo (Eds.); 2008
- American Family Physician; Genital Herpes: A Review; J.G. Beauman; Oct 15 2005
