Herpes is an infection caused by the herpes simplex virus (HSV) type 1 or 2. The part of the body affected by the virus denotes the type of infection. Herpes has cyclical episodes, with dormancy following a period of active symptoms. The first episode is usually the most severe, and symptoms may take two to four weeks to heal. Signs of herpes may not develop immediately after an individual contracts the virus, but noting symptoms and seeking treatment is essential to ensure one does not spread the infection.
Fluid-filled blisters are the most common symptom of herpes. They appear on the skin in a localized area. Oral herpes blisters develop on the face, usually around the lips. Blisters may also appear on or around the genitals. Though less common, some people may also develop blisters on the buttocks, anus, and inner thighs. Herpes whitlow causes blisters on the fingers, cuticles, toes, and feet. Regardless of the site of these sores, herpes blisters tend to break open and seep, then crust over before healing. This process usually takes take seven to 21 days, though the initial breakout may take longer.
A herpes episode usually starts with a tingling sensation in the area where the sores will form. This tingling may begin up to two days before the appearance of the blisters. In some individuals, especially those who are unaware they have the virus, the sensation may be so mild as to go unnoticed. However, individuals who have had a few episodes will likely be alerted of an impending flare-up and can take measures to lessen discomfort.
The tingling sensation often accompanies burning and itching in the affected area. These symptoms may persist even after the appearance of the sores because the virus is active in the epidermal layer. It is imperative that people resist the urge to scratch and irritate the skin, regardless of how severe the discomfort may be. Further aggravating the skin will only cause more damage, lengthening the recovery period and possibly spreading the infection. Scratching also increases the risk of the blisters becoming secondarily infected with bacteria.
Once the blisters form, the affected skin will be red and painful. Inflammation and redness increase the prominence of the blisters. The pain can range from a dull ache to more severe discomfort. The affected area may also become tender, such that any contact causes increased pain. These symptoms usually subside as the sores heal, but tenderness may remain afterward.
Pain and burning during urination are typical signs of genital herpes. The pain may be mild or severe but will make urination uncomfortable regardless. This symptom is more commonly experienced by women because the sores on the external genitalia become irritated when they come into contact with urine. The pain usually lessens in intensity once the crusting stage is complete. Once the sores heal, urination pain should cease.
Other systemic symptoms that may accompany a herpes outbreak are headaches and muscle pain. Headaches tend to be severe while the muscle pain can be of low intensity, though draining nonetheless. As with a low-grade fever, over-the-counter medications can provide relief. A severe complication, herpes meningoencephalitis, can also cause these symptoms.
Many herpes flare-ups cause the lymph nodes near the affected area to enlarge. With genital herpes, the lymph nodes on both sides of the groin are affected. With oral herpes, those of the neck or ear become inflamed. As the herpes flare-up subsides, the enlargement should also decrease. Tenderness accompanying the swelling can add to discomfort or pain, especially in people with genital herpes.
In many individuals, herpes episodes come with flu-like symptoms, especially fever, due to the virus' interference with the immune system. The fever is usually low-grade, though it may cause fatigue and a general feeling of ill health. Fever is most common during the first outbreak of herpes and is less likely to occur with subsequent flare-ups. In a few cases, body temperature may rise even before the appearance of sores, though most experience this sign after the outbreak begins. Physicians usually recommend over-the-counter medication for relief from the fever. In rare cases, mostly involving young children and those with impaired immunity, a high-grade fever may develop and persist longer.
In some cases, the herpes virus may spread and infect one or both eyes, causing herpes keratitis. This infection can result in pain, blurred vision, and light sensitivity, as well as discharge and a feeling of grittiness in the eyes. Severe infections that do not receive proper treatment may also cause scarring that could lead to clouded or impaired vision. The virus can be transferred to the eye by touching or scratching a herpes blister and then touching or rubbing the eye.
Some oral herpes infections can spread to the esophagus, a tube that leads from the mouth to the stomach, causing herpes esophagitis. When that happens, pain and difficulty swallowing can develop. Some people also experience nausea, chest pain, heartburn, and low-grade fever. Typically, people with particularly low immunity experience this complication.
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