A person may show symptoms within days after contracting genital herpes, or it may take weeks, months, or years. Some people may have a severe outbreak within days after contracting the virus while others may have a first outbreak so mild that they do not notice it. Because of these possibilities, it can be difficult for people to know when and from whom they may have contracted the virus.
Herpes viruses typically infect the oral or genital mucosa. When herpes affects the mouth, it causes the typical "cold sores," which are painful sores or blisters that form on the lips, mouth, or gums. Prior to the development of the blisters, there may be a prodrome (early symptoms indicating onset of a particular disease) consisting of an itching, burning, or tingling sensation in the affected area. The virus remains dormant in the nervous system throughout life, and this is the reason that cold sores often recur in the same location.
A doctor will base a presumptive diagnosis on information provided by the patient and on the physical examination. The characteristic appearance of the herpes sores leaves little doubt about the diagnosis, so the typical appearance of the sores is key to the diagnosis. This appearance helps distinguish oral herpes from oral thrush, shingles, gonorrhea, and syphilis. In addition, chapped or sunburned lips can resemble oral herpes, but the tissue stain (Tzanck smear, see below) shows no virus-induced cell changes. Further testing is usually not necessary but is sometimes done.
"When you are having an outbreak of oral herpes, symptoms usually start with a burning, itching or tingling sensation on your lips," Michael says. "This will intensify until a small rash, and then blisters, appear. These sores are commonly called 'cold sores'. The blisters are usually filled with a clear or slightly yellow liquid. Over a short time, these blisters will burst leaving a painful, raw area. These will then dry and scab over. The scabs will generally fall off after a week or two, leaving fresh clear skin beneath."