Fifth Disease: Symptoms and Treatment

By Howard Jeffries, MD
Medically reviewed checkmarkMedically reviewed
February 8, 2020

Fifth disease is a common viral infection among children, especially in late winter and early spring. Luckily, it’s usually mild and goes away on its own. If your child is experiencing cold-like symptoms that later turns into a rash, they may have fifth disease.

What Is Fifth Disease?

Fifth disease (also known as erythema infectiosum) is a viral infection caused by parvovirus B19. A common childhood illness, especially among children in elementary school, fifth disease is usually mild. Most children recover from the illness without needing any treatment or medication.

Fifth disease often starts with cold-like symptoms that are followed about a week later by a rash on the face, arms, legs, and body. A telltale sign of fifth disease is a bright red rash that looks like a slapped cheek on the face of the child with the infection. Before the rash appears, it is difficult to tell if your child has the infection because the symptoms are mild and not specific. Once the rash shows up, your child is probably no longer contagious and can return to school or to daycare. Unfortunately, without a blood test, it’s very difficult to diagnose a child with fifth disease prior to the appearance of the rash.

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Causes of Fifth Disease

Fifth disease is caused by human parvovirus B19. It spreads through direct contact with the saliva or mucus of an infected person, often through droplets carried through the air when that person coughs or sneezes.

The virus infects humans only. You cannot get this virus from your cats and dogs. It’s not to be confused with other parvoviruses that your pets can get that don’t infect humans.

Signs and Symptoms of Fifth Disease

Many people with fifth disease experience only mild symptoms, and in some cases, no symptoms at all. Most people feel better within a few weeks.

Initial symptoms will last 2-5 days and may include:

Subsequent symptoms can include:

  • Facial rash: A bright red rash that makes it look as though your cheeks have just been slapped. This rash is more common in children than in adults, and children often feel better by the time the rash appears. This easily recognizable rash distinguishes fifth disease from other childhood illnesses such as hand, foot, and mouth disease (HFMD).
  • Rash on the chest, back, arms, and legs: A blotchy rash, often forming a lacy pattern, may appear after the face rash. It can be itchy and cause discomfort, and in most cases goes away after 7-10 days. The rash may reappear if the skin is exposed to cold, heat, or sunlight.
  • Joint pain: This usually occurs in the hands, wrists, knees, and feet. This is more common among adults, especially women and typically lasts 1-3 weeks.

Diagnosing Fifth Disease

Fifth disease is usually diagnosed after the distinctive “slapped cheek” rash appears. It’s rare for the disease to be diagnosed beforehand because the initial symptoms are mild and non-specific. Children are at their most contagious before the rash appears and before anyone realizes they have the infection. This makes it difficult to prevent the infection from spreading.

In some cases, such as if you’re pregnant or if you or your child suffers from an immune deficiency or a blood disorder, your health care provider may order a blood test to see if you or your child has the infection.

Fifth Disease in Adults

Fifth disease is most common among school-aged children, but adults can catch it too. Adults are less likely than children to experience a rash, but more likely to experience joint pain in their hands, wrists, knees, and feet.

As with chicken pox, most people develop immunity once they’ve had fifth disease. Many adults have antibodies that protect them from parvovirus B19 due to earlier exposure when they were children.

Fifth disease and pregnancy

Parvovirus B19 can also be transmitted through blood, which means that a pregnant woman who is infected with parvovirus B19 can pass the virus to her baby. In most cases, their babies do not experience any problems. However, if you’re pregnant and suspect you have fifth disease, or if you’ve been exposed to someone with the infection, you should talk to your doctor. He or she will be able to order a blood test to determine whether or not you have the infection.

Treatment Options

Most children and adults who are otherwise healthy will recover from fifth disease without requiring any treatment.

However, if you or your child are experiencing itching, joint pain, or a fever, your health care provider may recommend that you do the following:

  • Give your child an antihistamine medicine to relieve itching.
  • Give your child over-the-counter medicine such as acetaminophen or ibuprofen to reduce fever and discomfort.

It’s important to note, antibiotics don’t work on fifth disease because the illness is caused by a virus and not by bacteria.

To help your child recover from fifth disease, make sure they get lots of rest and drink plenty of fluids. If your child’s rash is causing discomfort and itching, you can try oatmeal baths or other soothing bath treatments.

Prevention Tips

There is currently no approved vaccine against fifth disease.

You can reduce your chances of getting fifth disease by washing your hands often, for at least 20 seconds, with soap and water. It’s a good idea to teach your child how to wash their hands frequently and carefully so as to lower their chances of catching the disease.

I also recommend that you avoid sharing food and drinks with other people, and teach your child to do the same.

Some people with certain medical conditions can face serious complications from fifth disease, such as acute or severe anemia. These include:

  • Adults or children with weakened immune systems due to chemotherapy, HIV, or other conditions.
  • Adults or children with blood disorders, such as sickle cell anemia or hemolytic anemia.

When to See a Doctor

If your child develops a facial rash, you should contact your pediatrician to find out the best course of treatment (if any). However, if your child has an immune deficiency or a blood disorder you should make an appointment to see your child’s pediatrician. You should also visit the pediatrician if you or your child has a rash that doesn’t go away after more than a month.

If you’re pregnant and concerned that you might have fifth disease, contact your doctor to discuss next steps.

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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Howard Jeffries, MD

A pediatric cardiac intensivist at Seattle Children's Hospital, Dr. Jeffries is also Senior Medical Director, Regional Network. He completed a residency in pediatrics and a fellowship in pediatric intensive care. He has published chapters and peer-reviewed articles, with an emphasis on cardiac intensive care, informatics, outcomes assessment and quality improvement.