In many cases of herpes simplex infections there are no symptoms of the primary infection. You may not even know you have contracted the virus, unless you get an outbreak of cold sores sometime later. However, if there are symptoms with a primary infection, they can be quite severe.
Symptoms of the primary infection
In most cases there will not be any noticeable signs or symptoms. However, if there are symptoms, they are most likely to occur in children under the age of five. If you or your child has a primary infection of the cold sore virus, you may experience:
- swollen and irritated gums, with small painful sores in and around your mouth (known as herpes simplex gingivostomatitis),
- sore throat and swollen glands,
- excess salivation (producing more saliva than normal),
- fever,
- dehydration (a lack of water in the body),
- nausea, and
- headaches.
If you or your child develops herpes simplex gingivostomatitis as part of a primary infection, it can last seven to 14 days, and it may take up to three weeks for the sores to heal. However, gingivostomatitis does not often recur after the primary infection. It is usually young children who get gingivostomatitis, although it is possible for adults to get it as part of a primary infection of the cold sore virus.
However, if an adult has a primary infection, it will usually present itself as pharyngotonsillitis (a sore throat and swollen tonsils), or a glandular-fever-like illness. The symptoms will usually be a sore throat, with or without swollen glands. You may also have halitosis (foul-smelling breath) and painful sores in and around your mouth, which can develop into ulcers with grey or yellow centres.
If someone has been infected with the herpes simplex virus at an early age, it may be triggered periodically in later life, which can cause recurring bouts of cold sores. After the primary infection, the symptoms are usually reduced to just the cold sores themselves.
Symptoms of the recurrent infection (outbreaks of cold sores)
Recurrent infections are usually shorter and less severe than the primary infection. The only symptom is usually the outbreak of cold sores, although in some cases you may also have swollen glands.
An outbreak of cold sores usually starts with a tingling, itching, or burning sensation around your mouth. Small fluid-filled sores then appear, most commonly on the edges of your lower lip.
If you have frequent recurrent infections, you may find that your cold sores occur in the same place every time. Your cold sores may grow in size and cause irritation and pain. They may weep, and eventually grow a crust or scab within 48 hours of the initial tingling sensation.
Most cold sores disappear within seven to 10 days without treatment, and they generally heal without scarring.
