Patients may have prodromal symptoms of nausea, fever, burning pain, or itching around the lips. Subsequently, a vesicular lesion on top of an erythematous base develops. Primary infection is often associated with systemic symptoms like fever, chills, and malaise. Rarely primary infection can present as severe pharyngitis with tonsillar exudate, pharyngeal edema, and oral lesions.8 Symptom number and severity are often less with reactivation of the disease. In reactivation, patients typically do not demonstrate systemic symptoms, though malaise and regional lymphadenopathy occur in some cases. The prodromal symptoms can precede the development of lesions by 6-53 hours.9 Recurrence patterns vary from patient to patient, but specific triggers can predictably provoke an individual’s infection. In recurrent infections, the time from prodromal infection to resolution is usually five days.

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