Mouth pain may be severe, breath is fetid, and cervical adenopathy is present. In adolescents and young adults, posterior pharyngitis and tonsillitis may be the primary problem. The differential diagnosis includes streptococcal pharyngitis, aphthous stomatitis, Stevens-Johnson syndrome, herpangina, and infectious mononucleosis. Symptoms and signs may persist for 10 to 21 days, and autoinoculation to other sites, such as fingers and eyes, is common. Recurrent herpes labialis is a shorter and milder affliction, often heralded by local pain or tingling for a few hours.
Vesicles appear most often on the vermilion border and are painful.
Healing is complete within eight to 10 days. Systemic complaints are uncommon in recurrent herpes labialis. Primary infections may present as unilateral follicular conjunctivitis, blepharitis, or corneal epithelial opacities. Healing is usually complete within two to three weeks. Branching dendritic ulcers, usually detected by fluorescein staining, are virtually diagnostic and are often associated with diminished visual acuity.