Erythema infectiosum - Symptoms of slapped cheek syndrome

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 initial symptoms are flu-like, and usually last a few days. They include:

• 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
• joint pain

In around 20-30% of cases these symptoms do not occur, or are so mild as to be barely noticeable.

Your child will be most contagious during these initial symptoms.

After this stage, there is usually a period of around seven to 10 days without any further symptoms. This tends to be followed by a rash which occurs in three distinct stages.

First stage

Around 75% of children will develop a bright red rash on both cheeks (the so-called "slapped cheeks"). 

The rash may be particularly noticeable in bright sunlight and usually fades over two to four days.

Second stage

One to four days after the appearance of the "slapped cheek" rash, a light pink rash usually appears on your child’s chest, stomach, arms and thighs. This rash often has a raised, lace-like appearance and may cause discomfort and itching.

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.

Third stage

In some cases, the rash can continue to fade, then re-appear, for weeks after the infection has passed.

The re-appearance of the rash is usually triggered by exercise, or if your child is hot, anxious or stressed.

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 flu-like symptoms, such as developing a fever and sore throat, are also more common in adults than in children. 

Less than 50% of adults will develop a rash. This means a diagnosis of slapped cheek syndrome may be missed at first as the symptoms are often mistaken for arthritis or joint damage.

If there is doubt over a diagnosis, you may have a blood test to check the antibodies that your body produces as a response to infection. The results of this test will confirm a diagnosis.

In most people, the symptoms of a parvovirus B19 infection will pass within one to three weeks, although some adults will experience recurring episodes of joint pain and stiffness for days or months afterwards.

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 111.

• pregnant women
• people with a condition 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.