Herpes symptoms: know what to look for

If you’re one of the whopping 3.7 billion people under the age of 50 who the World Health Organization (WHO) estimates are infected with herpes simplex virus-1, you may have experienced a cold sore at some point in your life (WHO, 2020). The WHO also estimates that 417 million people ages 15-49 are infected with herpes simplex virus-2, the virus that causes genital herpes. With numbers like these, it can seem hard to avoid herpes your entire life!

But did you know that HSV-1 and HSV-2, as they’re abbreviated, aren’t the only kinds of herpes you can be infected with? It turns out there are actually eight different types of herpes that commonly infect humans, each with its own set of symptoms. While these eight types are appropriately named human herpesvirus (HHV) 1 through 8, many of them have much more familiar names as well—things like chickenpox, mono, and roseola. So, even if you’ve been able to avoid infection with HSV-1 and HSV-2, chances are you’ve encountered at least one of these other types of herpes at some point in your life. Let’s dive into the symptoms so you can tell if you’ve ever had herpes:

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HHV-1 is better known as herpes simplex virus 1 (HSV-1). It is the virus that typically causes oral herpes (and can sometimes cause genital herpes as well).

In up to 80% of individuals, HSV-1 can be asymptomatic (Johnston, 2021). This means that people are infected with the virus, but they never experience the oral or genital symptoms that the virus sometimes causes. This may be one reason why so many people across the world have HSV-1—even when it is asymptomatic, it can still be spread from person to person.

The first time you are exposed to the virus is referred to as the “primary infection.” Symptoms begin appearing anytime between a couple of days to a couple of weeks after the exposure. The hallmark symptoms of primary HSV-1 infection are:

• Painful ulcers

• Swollen lymph nodes

• Fever

• A general feeling of discomfort

• Headache

In children, the painful ulcers typically occur on the inside of the mouth, including the roof of the mouth, the inside of the lips and cheeks, and the tongue. This is called herpetic gingivostomatitis. In adults, lesions in the mouth can be accompanied by a sore throat and inflamed tonsils.

When you have a “flare-up” of HSV-1, it is called “recurrent infection.” This is characterized by blisters and ulcers that appear where the lips meet the skin (called the vermilion border). Other names for recurrent infection are herpes labialis, cold sores, and fever blisters. The symptoms of recurrent infection include:

• Pain, burning, tingling, and itching at the site approximately one day before blisters appear (this is known as the prodrome or the prodromal symptoms)

• Painful blisters or vesicles on the lips or on the inside of the mouth

• Crusting over and healing of the blisters that take up to eight days (depending on whether there is treatment)

When HSV-1 causes genital herpes, the primary symptoms are similar to those of oral herpes except the ulcers are located on the genitals, and the swollen lymph nodes are in the groin.

Less often, HSV-1 causes symptoms in other areas of the body. Infection of the fingers, face, neck, or arms can occur if cuts or breaks in the skin are exposed to the virus. Blisters can also occur over areas of eczema in those who are using immune-suppressing medications to control their eczema. HSV-1 infection in the eye occurs in <5% of people but can cause severe problems, including blindness. HSV-1 can also be very dangerous if it infects the brain, sometimes leading to death or other neurological problems. And people who have weakened immune systems are at higher risk of developing HSV esophagitis, which is when HSV-1 infects the esophagus.

HHV-2 is better known as herpes simplex virus 2 (HSV-2). It is the virus that typically causes genital herpes (and can sometimes cause oral herpes as well). The symptoms of HSV-2 are similar to the symptoms of HSV-1, except the infection is primarily on the genitals (or around the rectum).

Infection can be asymptomatic, or it can cause blisters and ulcers on the genitals. These are associated with local symptoms, such as lymph node swelling and painful urination, and systemic symptoms, such as fever. HSV-2 can also recur, although recurrences are usually less severe than the primary infection. HSV-2 is also associated with rarer complications, such as HSV meningitis.

HHV-3 is better known as varicella-zoster virus (VZV). It is the virus that causes chickenpox (varicella) and shingles (herpes zoster).

When VZV first infects somebody, it causes chickenpox. The symptoms of chickenpox are:

• An itchy rash over the entire body. The rash is characterized by red marks that get raised, turn into vesicles or blisters, and then crust over before healing. New lesions appear at different times over approximately four days, so the rash may have different-appearing lesions at the same time

• Fever

• A general feeling of discomfort

• Sore throat

• Loss of appetite

• There can also be rarer complications, including bacterial skin infection and neurological infection.

When VZV recurs, it causes shingles. The symptoms of shingles are:

• A very painful rash that affects an area of the body known as a dermatome. A dermatome is a section of skin that is supplied by nerves from a specific part of the spinal cord. When a rash forms in a dermatome, it is usually linear and only affects one side of the body. Typically this occurs on the torso, but this is not always the case. In rare instances, the rash can spread over the entire body. Like with chickenpox, the rash is red and made up of vesicles and blisters that eventually crust over.

• Headache

• Fever

• A general feeling of discomfort

• Fatigue

• Pain that persists for months after the rash heals. This is called postherpetic neuralgia and occurs in 10-15% of people with shingles (Albrecht, 2021).

Like other forms of HHV, VZV can cause more serious symptoms and complications if the eyes or brain are involved.

HHV-4 is better known as Epstein-Barr virus (EBV). It is the virus that causes infectious mononucleosis, which is sometimes just called “mono.” Sometimes it is referred to as the “kissing disease.” Symptoms include:

• Fever

• Sore throat

• Swollen lymph nodes

• Fatigue

• Muscle aches or weakness

• Skin rash

• Headache

• Loss of appetite

• Enlargement of the spleen, which is located on the left side of the abdomen. It is recommended that people with EBV infection avoid contact sports for 3 to 4 weeks to avoid rupturing the spleen.

EBV is also linked to an increased risk of certain types of cancer, such as Burkitt lymphoma. It can also cause ear infections, diarrhea, and a condition called Guillain-Barre syndrome.

HHV-5 is better known as cytomegalovirus (CMV). It typically doesn’t cause noticeable disease except for when it infects people who have a weakened immune system, such as individuals with human immunodeficiency virus (HIV). When it does cause symptoms, they are similar to the symptoms of mono.

CMV can also be transmitted from mother-to-child during pregnancy. This can cause complications in the newborn, including:

• Hearing loss

• Vision loss

• Intellectual disability

• Microcephaly (small head)

• Calcifications in the brain

• Seizures

• Rash

• Yellowing of the skin

HHV-6 typically only causes disease in children ages 6 to 24 months (Healthychildren.org, 2015). The disease is characterized by a high fever. When the fever resolves, a flat, red rash develops over the torso, neck, and arms. The condition is known as roseola.

HHV-6 can also recur in people who have weakened immune systems. In these people, it is linked to a variety of conditions including autoimmune disease, brain inflammation, chronic fatigue syndrome, heart disease, and complications with organ transplants (Strausbaugh, 2001).

HHV-7 rarely causes disease, but when it does, it resembles roseola caused by HHV-6.

HHV-8 is also typically asymptomatic in people with intact immune systems. When it does cause symptoms, they can mimic the symptoms of mono, and a rash may be involved.

More significantly, HHV-8 is associated with Kaposi’s sarcoma, a type of cancer of the blood vessels. Kaposi’s sarcoma is rare but can be seen in people with HIV once they have progressed to acquired immunodeficiency syndrome (AIDS). In fact, Kaposi’s sarcoma is considered an AIDS-defining illness; if somebody with HIV has Kaposi’s sarcoma, they have AIDS. It can also occur in people who have had an organ transplant, such as a kidney transplant. Kaposi’s sarcoma is characterized by purple, red, or brown lesions on the skin that can also appear inside the mouth or on the insides of the eyelids.

HHV-8 is also associated with lymphoma and with a condition called Castleman’s disease.

B virus is an extremely rare form of herpes that comes from macaque monkeys. In fact, only 50 cases of B virus have ever been documented, and only one case occurred from human-to-human contact (Cohen, 2021; CDC, 2019). Symptoms include fever, chills, muscle aches, fatigue, and headache. When B virus progresses, it can lead to severe brain damage and death.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

October 10, 2019

Written by

Mike Bohl, MD, MPH, ALM

Fact checked by

Tzvi Doron, DO

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About the medical reviewers

Mike Bohl, MD, MPH, ALM

Dr. Mike is a licensed physician and a former Director, Medical Content & Education at Ro.

Tzvi Doron, DO

Dr. Tzvi Doron is Board Certified in Family Medicine by the American Board of Family Medicine.