According to MedlinePlus, a patient information service of the U.S. National Library of Medicine and the National Institutes of Health, herpes is an infection caused by the herpes simplex virus. Oral herpes causes cold sores, also called fever blisters, around the mouth or on the face. Genital herpes affects the genitals, buttocks or anal area. Herpes also causes other kinds of symptoms you may be less familiar with.
Prodrome
The onset of a herpes outbreak usually starts with a prodrome, or precursor stage, characterized by pain, tingling and burning in the area where lesions later appear. Sometimes the affected area will also appear slightly red or raised (swollen). The prodrome, says the CDC, may begin anywhere between two hours and two days before other symptoms. During the first outbreak, patients usually don't know that they have been infected with herpes, and prodromal symptoms may not be recognized as such.
Constitutional Symptoms
According to "Harrison's Principles of Internal Medicine," most people with herpes also experience constitutional symptoms such as fever, headache, muscle or joint pain, lack of appetite and malaise in association with an outbreak. Fever may last for two to seven days. Other symptoms last longer--two to 14 days. Constitutional symptoms are most severe during the first outbreak. For oral herpes, they may not recur at all during subsequent outbreaks. For genital herpes, they usually do recur, but become progressively milder over time.
Skin Lesions
According to a 2007 article in Archives of Internal Medicine, the characteristic lesion of herpes is a painful, 1-2 mm blister filled with clear or cloudy yellow fluid and featuring a central depression or "umbilication." In first-time outbreaks, these lesions may appear in clumps widely distributed over a large surface area. In recurrent outbreaks, they usually appear in comparatively few places. Over 72 to 96 hours, the blisters rupture and crust over. Healing usually takes about one week during a recurrent outbreak and up to four weeks during a first-time outbreak. During this time, the lesions may be painful, itchy or both.
Internal Lesions
In addition to the lesions you can see, herpes also produces lesions that are less easily identified, especially during the first outbreak. According to Dr. Lawrence Corey in "Harrison's Principles of Internal Medicine," first-time oral herpes may involve lesions on the back of the throat, tonsils, hard and soft palates, gums, tongue and lining of the cheeks. Lesions on the back of the throat and tonsils often appear first. In one-third of people, the easier-to-spot lesions on the gums, tongue and lining of the cheeks follow later. These lesions often make it difficult to eat and cause swelling of the lymph nodes in the neck.
Genital herpes also produces internal lesions. In women particularly, the first outbreak is often associated with ulceration of the uterine cervix, according to a 2005 article in the American Family Physician. In women, herpes can also affect the lining of the uterus (endometritis), the Fallopian tubes (salpingitis) and the inside of the vagina. In men, herpes can cause inflammation of the prostate. Both men and women can develop herpes urethritis and proctitis (inflammation of the urethra and rectum, respectively). Internal lesions can cause problems with urination, defecation and intercourse--although people with active herpes lesions are advised not to engage in intercourse.
References
- Archives of Internal Medicine; The Treatment of Herpes Simplex: An Evidence-Based Review; C. Cernik, K. Gallina, and R.T. Brodell; June 2008
- 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
