Once herpes is acquired, the pattern of symptoms are classic.
Pain: The first clue that one has something wrong is pain around the lips and mouth. The pain may initially be vague and intermittent. However, it may become constant and the sensation may be like a burn. The pain is usually the first feature of the infection. In some individuals, the pain can be intense and over the counter pain medications usually do not help
Besides the pain, the other features of the infection may include and annoying and persistent itch.
Tingling around the lips is also a common feature of the infection
Blisters: The small blisters usually appear after 4-7 days after the infection. The number of blisters is variable. Some may have one, others may develop many. The blisters are tender to touch and are usually small in size (1-3 mm). Blisters may occur either on the outside or inside of the mouth. Blisters can also occur on the gums and tongue and make swallowing and chewing of food quite painful.
Rupture: During the ensuing days, the blisters may rupture and ooze some fluid. After 10-14 days, the blisters dry up and form a scab which falls off. All individuals are very infectious during this time period. The duration of the infection tends to last 2-3 weeks.
Cosmesis: The appearance of blisters makes herpes infection very unattractive. Many individuals try and camouflage the blisters with various creams and ointments. This infact makes the pain and redness worse. The blisters should be left alone. Any attempts to break or squeeze the blisters can result in scab and scar formation.
The diagnosis of herpetic sores requires a simple physical examination. No other blood work or x rays are required. In the very rare case, small amount of fluid may be obtained to confirm the diagnosis. Testing for herpes is redundant and an unnecessary waste of money. The diagnosis of a primary herpes infection is made from a clinical history and physical examination.
Confirmation of the herpes virus may be of an issue in hospitalized patients who are sick. For the average individual, a simple physical exam will suffice.