Most primary infections with HSV-1 are asymptomatic (no apparent symptoms). However, primary infection can cause a variety of clinical symptoms such as infection of the mouth and gums (gingivostomatitis) and a sore throat (pharyngitis) in children. Lesions may occur anywhere in the oral region and may involve the roof and floor of the mouth, as well as the inside of the cheek. Disease may develop over a few days and can be painful.
Lesions may occur anywhere in the oral region and may involve the roof and floor of the mouth, as well as the inside of the cheek. Disease may develop over a few days and can be painful.
The swelling and tenderness of the tonsils may result in swallowing difficulties. Sometimes blisters may also be present in the mouth. In people with normal immunity (immunocompetent) the fever will cease and lesions will heal and crust over in a week. Even when no clinical symptoms of primary HSV-1 infection are apparent, some people will shed virus making them infectious.
HSV-1 can also infect skin, but only if the skin is damaged, such as in patients with eczema (atopic). Children who suck their thumbs may develop herpes on their finger.
Healthcare workers, such as anesthesiologists and dentists, may also develop herpes infected fingers (digits) from patients with cold sores or oral viral shedding.
Primary HSV-1 infection has also been associated with a variety of other skin disorders. These conditions are not thought to be directly caused by the virus, but result from an immunological reaction in the skin at the time of infection.
A less common but clinically important primary HSV-1 infection site is the eye. Such infection may occur in one or both eyes as conjunctivitis, or as infection of the eyelid with blisters on the lid margin, swelling of the eyelids, and tearing.
The eye itself may also be more extensively involved. Occasionally, children with labial herpes or herpetic whitlow may rub their eyes and spread the virus to their eyes in this fashion. In immunocompromised patients, HSV-1 eye infection may also involve the retina.