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Erythema infectiosum - Symptoms of slapped cheek syndrome

NHS Choices Medical Reference

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The symptoms of slapped cheek syndrome usually begin in the first couple of weeks after your child is exposed to the parvovirus B19 virus. The symptoms tend to follow three distinct stages.

First stage

The first stage is usually characterised by mild flu-like symptoms, such as:

  • a high temperature (fever) of 38C (100.4F), although your child's temperature will not usually rise above 38.5C (101F)
  • sore throat
  • headache
  • upset stomach
  • feeling tired
  • itchy skin

In many cases these symptoms do not occur, or are so mild as to be barely noticeable.

During the first stage of symptoms, your child will be most contagious.

Second stage

Between three to seven days after the symptoms start, your child will develop a bright red rash on both cheeks (the so-called "slapped cheeks"). The rash may be particularly noticeable in bright sunlight.

Third stage

The third stage of symptoms usually begins one to four days after the appearance of the "slapped cheek" rash.

During this stage, the rash will usually spread to your child's chest, stomach, arms and thighs. The rash usually has a raised, lace-like appearance and may cause discomfort and itching.

The rash is usually more noticeable after exercise, or if your child is hot, anxious or stressed.

By this time, your child should no longer be contagious and they will be able to return to nursery or school without the risk of passing the infection onto others.

The rash should then pass after a few days. In rare cases it can last up to four or five weeks.

Parvovirus B19 infection in adults

The most common symptom of a parvovirus B19 infection in adults is joint pain and stiffness in your:

  • hands
  • knees
  • wrists
  • ankles

Other symptoms, such as developing a fever and sore throat, are rare in adults.

In most people, the symptoms of a parvovirus B19 infection will pass within one to three weeks, although one-in-five adults will experience recurring episodes of joint pain and stiffness for several months, sometimes years.

When to seek medical advice

Slapped cheek syndrome in children and parvovirus B19 infection in adults is usually mild and the infection should clear up without treatment.

When to seek urgent medical advice

People who are in the risk groups listed below are advised to contact their GP as soon as possible if they think they have developed a parvovirus B19 infection. If this is not possible, contact your local out-of-hours service or call NHS Direct on 0845 46 47.

  • pregnant women
  • people with a condition that is known to cause chronic anaemia, such as sickle cell anaemia, thalassaemia and hereditary spherocytosis (an uncommon genetic condition that causes red blood cells to have a much shorter life span than normal)
  • people with a weakened immune system as a result of a condition such as HIV or acute leukaemia
  • people having treatments known to weaken the immune system, such as chemotherapy or steroid medication

You may also have a weakened immune system if you're taking medication to suppress your immune system because you've recently received a bone marrow transplant or organ donation.

Chronic usually means a condition that continues for a long time or keeps coming back.
Contagious is when a disease or infection can be easily passed from one person to another through infection.
A high temperature, also known as a fever, is when someone's body temperature is 38C (100.4F) or above.
Immune system
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.
Joints are the connection point between two bones that allow movement.
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Medical Review: November 09, 2011
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