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EspañolFifth disease symptoms: What are the early signs of fifth disease?
Overview: What does fifth disease look like?
Fifth disease is a common childhood viral illness caused by human parvovirus B19. It’s less common in adults because people are immune after they’ve had it. Parvovirus B19 infects red blood cells but spreads through respiratory droplets like a cold or flu. The initial symptoms are usually those of a cold: low fever, runny nose, stuffy nose, sore throat, muscle aches, headache, and just generally feeling under the weather. Eventually, the virus enters the bloodstream. At that point, children will show the classic symptom of fifth disease called “slapped cheeks,” a bright red rash on the face. At a later stage, a splotchy lacework rash spreads to the chest, arms, and legs. Adults and some children may also have arthritis symptoms like joint pain or stiffness. Fifth disease is usually a temporary and harmless infection. People have symptoms for a few days or weeks—or no symptoms at all—and the body clears the virus without lingering problems. However, that’s not true for pregnant women or people with weak immune systems or blood disorders like sickle cell anemia. In those people, fifth disease can be a more serious illness with severe complications.
RELATED: Common childhood illnesses
Key takeaways:
Fifth disease is a common health condition among children and adolescents but can affect anyone regardless of age, sex, race, or ethnicity.
Early signs of fifth disease include fever, cold symptoms, malaise, headache, muscle aches, nausea, and vomiting.
Serious symptoms of fifth disease caused by severe anemia may require immediate medical attention.
Human parvovirus B19 causes fifth disease. You may be at risk for developing fifth disease symptoms if you are a child or adolescent or have a weakened immune system.
Fifth disease is usually self-diagnosable.
Fifth disease generally does not require treatment. Fifth disease symptoms typically resolve without treatment in three weeks to two months.
Treatment of fifth disease may include symptom-relief medications.
Fifth disease may occasionally result in complications like arthritis, severe anemia, pregnancy problems, and fetal death.
Use coupons for fifth disease treatments like Tylenol Children’s (acetaminophen) and Children’s Motrin (ibuprofen) to save up to 80%.
What are the early signs of fifth disease?
In the initial stage, early signs of fifth disease include:
Low-grade fever
Feeling sick
Muscle aches
Joint aches
Joint stiffness
Nausea
Vomiting
Stuffy nose
Runny nose
Sore throat
About 1 in 5 children will not show any of these early signs of fifth disease.
RELATED: How to identify—and treat—fifth disease (parvo) in kids
Later fifth disease symptoms
In the later stages, symptoms of fifth disease may include:
A blotchy red cheek rash (“slapped cheeks” rash)
Spotty, lacelike, but non-itchy rash on the chest and limbs
In some young adults, a purple and swollen rash covers the feet, hands, wrists, and ankles called papular purpuric gloves and socks syndrome (PPGSS)
Joint aches
Joint stiffness
Some people have no symptoms. Others may only have arthritis symptoms without any rash.
Fifth disease vs. measles symptoms
Both fifth disease and measles are two of the so-called “six diseases” that were historically known to cause skin rashes in childhood. The other four are scarlet fever, rubella, Duke’s disease, and roseola. Roseola is a common virus that causes fever and a rash in children. But in communities where there is widespread vaccination, cases of measles, scarlet fever, and rubella are rare. Only 121 cases of measles were reported in the U.S. in 2022 according to the Centers for Disease Control and Prevention (CDC). People who are vaccinated are very unlikely to contract measles, but it is possible. In communities with high vaccination rates, exposure to measles is rare. The most relevant risk factor is travel to or living in communities with low measles vaccination rates. The difference between fifth disease and measles is severity. Fifth disease is generally a mild viral illness. Measles can cause serious illness with concerning symptoms such as high fever
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RELATED: Rubella vs. rubeola: compare causes, symptoms, treatments, & more
Stages of fifth disease: How can I tell which one I have?
Fifth disease is a highly contagious viral infection that is spread in the same way as colds and flu: through water droplets in the air. That means the first symptoms often suggest a respiratory illness: runny nose, stuffy nose, sore throat, muscle aches, and headache. This early stage typically lasts about seven to 14 days, and during this entire time, the disease is highly contagious.
Eventually, the virus populates the bloodstream, a condition known as viremia. The early symptoms go away and are replaced by a facial skin rash on the child’s cheeks. This second stage usually lasts about five to 10 days. People are no longer contagious at this point.
In the last stage of the disease, a lacelike skin rash appears on the chest and limbs. The rash may get worse when exposed to sunlight or heat. In rare cases, a severe and swollen rash may appear on the hands and feet. This is also the stage where people often first develop joint pain or stiffness. Some adults only experience joint problems without a rash. This final stage typically lasts one to three weeks, but the rash may reappear intermittently for a few weeks.
When to see a doctor for fifth disease symptoms
Most cases of fifth disease cause only mild illness and resolve without treatment or complications. However, if the fever is very high or lasts more than three days, see a doctor.
Some people are at an increased risk for serious complications and should see a doctor if fifth disease symptoms are experienced. These include pregnant women and anyone with a weak immune system or a blood disorder like sickle cell disease.
Healthcare providers typically diagnose fifth disease from the symptoms. Blood tests to identify parvovirus antibodies are unnecessary unless there are complications or risk of complications.
Emergency room treatment is unnecessary unless there are serious complications. The most serious complication of fifth disease is transient aplastic anemia, a sudden and dangerous drop in blood cells. This is a risk for people with a weakened immune system or a blood disorder like sickle cell disease. The most common symptoms of aplastic anemia include fatigue, easy bleeding, and infections that won’t go away.
RELATED: What temperature is considered a fever?
Complications of fifth disease
Fifth disease is a generally harmless viral infection that does not cause problems except in people with compromised immune systems, blood disorders, or pregnant women. In those cases, complications of fifth disease include:
Transient aplastic anemia is a condition in which the body stops making blood cells
Pregnancy problems (fetal anemia, fetal heart problems, fetal heart failure, hydrops fetalis)
Fetal death (2% to 6%) and stillbirth
Chronic infection (in immunocompromised people)
Chronic anemia (in immunocompromised people)
In some adults, joint pain, joint stiffness, and arthritis caused by fifth disease can sometimes last for months or years.
How to treat fifth disease symptoms
Fifth disease typically resolves on its own without treatment. Treatment for fifth disease is uncommon and usually consists of support and symptom-relief medications. Acetaminophen or ibuprofen can help with fever, muscle aches, headaches, or joint problems. However, aspirin should never be given to children or teens with a viral infection because of the risk of Reye syndrome. Cold symptoms can be helped with cold or flu medications. If the rash is itchy or uncomfortable, antihistamines may provide some relief.
Talk to a healthcare provider before giving medication for fever or cold symptoms to very young children.
There is currently no vaccine to prevent fifth disease. A parvovirus B19 vaccine was developed and tested but has not been FDA-approved.
Signs fifth disease is getting better
Fifth disease usually resolves in a few weeks without treatment. Not everyone will have all the symptoms, but they do go away for good. Except for people with a weak immune system or who have certain blood disorders, there are usually no lingering complications or problems following an infection. Once symptoms pass, the body has a lifelong immunity against future infections.
Most importantly, know the risk factors
Fifth disease is usually a harmless viral infection that goes away without medical care. However, a few people may be at risk for complications. Pregnant women top the list because of the risks to the fetus. Approximately 30% of pregnant women with an active parvovirus B19 infection will pass the virus on to the fetus. Pregnant women who have fifth disease or have been exposed to parvovirus will need to have extra care to check for complications.
People with blood disorders or weakened immune systems are also at risk for complications, particularly transient aplastic anemia, a steep drop in the body’s blood cells that usually requires emergency treatment. People with these risk factors should get medical help. Although healthcare providers can’t treat parvovirus infection, they can monitor for complications in at-risk individuals and provide valuable medical advice for managing the infection.
FAQs about fifth disease symptoms
How long is fifth disease contagious?
People with fifth disease can spread the disease in the early symptomatic stages. The viral illness is primarily spread through respiratory droplets, so close contact, coughing, and sneezing are common ways to spread the infection. Once the rash appears, infected people can no longer spread the disease.
Can adults get fifth disease from a child?
Fifth disease is uncommon in adults but does happen. Most people contract fifth disease as school-age children and gain lifelong immunity against future infection. Adults who have never had a parvovirus infection have a 50% chance of getting the virus if they live with an infected child. At-risk teachers or child care workers have a 20% to 30% chance of catching parvovirus B19 from infected children they work with.
What time of year is fifths disease most common?
Fifth disease outbreaks usually occur in the late winter, spring, and early summer.
What’s next? Additional resources for people with fifth disease symptoms
Test and diagnostics
Clinical presentations of parvovirus B19 infection, American Family Physician
Erythema infectiosum, StatPearls
Fifth disease, Centers for Disease Control and Prevention (CDC)
Parvoviruses, StatPearls
Treatments
Parvovirus B19 infections, American Family Physician
Parvoviruses, StatPearls
Scientific studies and clinical trials
More information on related health conditions
Heat rash treatments and medications, SingleCare
Rubella vs. rubeola: compare causes, symptoms, treatments, & more, SingleCare
What is roseola? How do you treat it?, SingleCare