Fifth disease is a viral illness causing a red rash on the arms, legs, and cheeks. It’s common and mild in most children. It can be severe in pregnant people or those with a compromised immune system.

Fifth disease is also known as the “slapped cheek disease.” Most doctors advise people with fifth disease to wait out the symptoms. This is because there’s currently no medication that’ll shorten the course of the disease.

However, if you have a weakened immune system, your doctor may need to closely monitor you until the symptoms disappear.

Read on to find out:

  • why fifth disease develops
  • who is most at risk
  • how to know when that red rash may be a sign of something more serious

What causes fifth disease?

Parvovirus B19 causes fifth disease. This airborne virus tends to spread through saliva and respiratory secretions among children who are in elementary school.

It’s most common in:

  • late winter
  • spring
  • early summer

However, it can spread at any time and among people of any age.

Many adults have antibodies that prevent them from developing fifth disease because of previous exposure during childhood. When contracting fifth disease as an adult, the symptoms can be severe.

If you get fifth disease while pregnant, there are serious risks for your unborn baby, including life-threatening anemia.

For children with healthy immune systems, fifth disease is a common, mild illness that rarely presents lasting consequences.

What does fifth disease look like?

What are the symptoms of fifth disease?

The initial symptoms of fifth disease are very general. They may resemble mild symptoms of the flu. Symptoms often include:

According to the Arthritis Foundation, symptoms tend to appear 4 to 14 days after exposure to the virus.

After a few days of having these symptoms, most young people develop a red rash that first appears on the cheeks. Sometimes the rash is the first sign of the illness that’s noticed.

The rash tends to clear up on one area of the body and then re-appear on another part of the body within a few days.

In addition to the cheeks, the rash will often appear on the:

  • arms
  • legs
  • trunk of the body

The rash may last for weeks. But, by the time you see it, you’re usually no longer contagious.

Children are more likely to get a rash than adults. In fact, the main symptom adults usually experience is joint pain. Joint pain can last for several weeks. It’s usually most noticeable in the:

How is fifth disease diagnosed?

Doctors can often make the diagnosis by simply looking at the rash. Your doctor may test you for specific antibodies if you’re likely to face serious consequences from fifth disease. This is especially true if you’re pregnant or have a compromised immune system.

How is fifth disease treated?

For most healthy people, no treatment is necessary.

If your joints hurt or you have a headache or fever, you may be advised to take over-the-counter (OTC) acetaminophen (Tylenol) as needed to relieve these symptoms. Otherwise, you’ll need to wait for your body to fight off the virus. This usually takes one to three weeks.

You can help the process along by drinking a lot of fluids and getting extra rest. Children can often return to school once the red rash appears since they’re no longer contagious.

In rare instances, intravenous immunoglobulin (IVIG) can be administered. This treatment is usually reserved for severe, life-threatening cases.

Fifth disease in adults

While fifth disease usually affects children, it can occur in adults. As with children, fifth disease in adults is almost always mild. Symptoms include joint pain and swelling.

A mild rash might occur, but a rash isn’t always present. Some adults with fifth disease experience no symptoms at all.

Treatment for these symptoms is typically OTC pain medication, such as Tylenol and ibuprofen. These medications can help reduce swelling and joint pain. Symptoms often improve on their own within one or two weeks, but they may last for several months.

Adults rarely experience problems with fifth. Women who are pregnant and adults with a weak immune system or chronic anemia may experience complications if they contract fifth disease.

Fifth disease during pregnancy

Most people who come into contact with the virus that causes fifth disease and those who later develop an infection will have no problem as a result. According to the Centers for Disease Control and Prevention (CDC), roughly 50 percent of pregnant women are immune to the virus, so they won’t develop fifth disease even if they’re exposed.

In those who aren’t immune, exposure could mean mild illness. Symptoms may include:

  • joint pain
  • swelling
  • a mild rash

A developing fetus is unlikely to be affected, but it’s possible for a mother to transmit the condition to her unborn child.

In rare cases, a fetus whose mother has contracted parvovirus B19 can develop severe anemia. This condition makes it difficult for the developing fetus to make red blood cells (RBCs), and it could lead to miscarriage.

Miscarriage caused by fifth disease is not common. Less than 5 percent of pregnant women who contract fifth disease will lose their fetus. Miscarriage usually occurs in the first trimester, or first three months, of pregnancy.

There’s no treatment for fifth disease during pregnancy. However, your doctor will likely request additional monitoring. This may include:

  • more prenatal visits
  • additional ultrasounds
  • regular bloodwork

Fifth disease in babies

Mothers who are diagnosed with fifth disease can transmit the virus to their developing fetus. If this happens, the baby could develop severe anemia. However, this is rare.

Babies with anemia caused by fifth disease may require a blood transfusion. In some cases, condition could cause stillbirth or miscarriage.

If a baby contracts fifth disease in utero, there’s no treatment. The doctor will monitor the mother and fetus throughout the pregnancy. The baby will likely receive additional medical care after delivery, including a blood transfusion if necessary.

When is fifth disease contagious?

Fifth disease is contagious in the earliest phase of the infection, before telltale symptoms like a rash appear.

It’s transmitted through respiratory secretions, such as saliva or sputum. These fluids are commonly produced with a runny nose and sneezing, which are early symptoms of fifth disease. This is why fifth disease can be transmitted so easily and so rapidly.

It’s only when a rash appears, if one does, that it could become clear that the symptoms are not the result of a common cold or flu. Rashes typically appear two to three weeks after exposure to the virus. By the time a rash appears, you’re no longer contagious.


Fifth disease has no long-term consequences for most people. However, if your immune system is weakened due to HIV, chemotherapy, or other conditions, you’ll likely need to be under a doctor’s care as your body works to fight off the disease.

If you have anemia before getting fifth disease, you’ll likely need medical attention.

This is because fifth disease can stop your body from producing RBCs, which can reduce the amount of oxygen that your tissue gets. This is especially likely in people with sickle cell anemia.

See a doctor right away if you have sickle cell anemia and think you may have been exposed to fifth disease.

It can be dangerous if you develop the condition during pregnancy. Fifth disease can harm your developing fetus if they develop a severe form of anemia called hemolytic anemia. It can lead to a condition called hydrops fetalis.

Your doctor may recommend an intrauterine transfusion via cordocentesis. This is a blood transfusion that’s done through the umbilical cord to help protect the unborn child from the disease.

According to the March of Dimes, other pregnancy-related complications may include:

How can fifth disease be prevented?

Since fifth disease is usually transmitted from one person to another through airborne secretions, try to minimize contact with people who are:

  • sneezing
  • coughing
  • blowing their noses

Washing your hands frequently can also help reduce the chances of contracting fifth disease.

Once a person with a healthy immune system has contracted this disease, they’re considered immune for life.

Fifth disease vs. sixth disease

Roseola, also known as sixth disease, is a viral illness most commonly caused by human herpesvirus 6 (HHV-6).

It’s most common in children ages 6 months to 2 years. About 90 percent of cases of sixth disease are in children younger than two years old.

The first symptom of roseola will likely be a high fever, about 102 to 104°F. It may last for three to five days. After the fever subsides, the telltale rash will develop across the trunk and often up to the face and out to the extremities.

The rash is pink or red in color, bumpy and blotchy-looking. Fifth disease and roseola have a rash in common, but other symptoms of roseola set these two infections apart.

Other symptoms can include:

  • runny nose
  • eyelid swelling
  • irritability
  • tiredness

Like fifth disease, roseola has no specific treatment. Your child’s doctor will likely recommend treating the fever with over-the-counter acetaminophen. You may also use liquids and other comforting techniques to keep the child comfortable until the fever and rash pass.

Children with sixth disease will rarely experience complications. The most common is a febrile seizure as a result of the high fever. Children who have a compromised immune system may have additional complication risks if they contract roseola.

Fifth disease vs scarlet fever

Scarlet fever, like fifth disease, is a common cause for red skin rashes in children. Unlike fifth disease, scarlet fever is caused by bacteria, not a virus.

It’s the same bacteria that causes strep throat. About 10 percent of children with strep throat will have a more severe reaction to the bacteria and develop scarlet fever.

Symptoms include:

  • sudden onset of fever
  • sore throat
  • possibly vomiting

Within a day or two, a red rash with small red or white bumps will appear, typically first on the face. Then it can spread to the trunk and limbs.

A white strawberry tongue is also common in children with scarlet fever. This looks like a thick white coating with raised red papillae, or red bumps, on the surface of the tongue.

Children between ages 5 and 15 are most likely to develop scarlet fever. However, you can develop scarlet fever at any age.

Scarlet fever can be treated with antibiotics, which can prevent severe complications like rheumatic fever.

Like fifth disease, scarlet fever is transmitted through respiratory droplets. Children who show signs of scarlet fever should stay home and avoid other kids until they have been fever-free and taking antibiotics for at least 24 hours.



My child was recently diagnosed with fifth disease. How long should I keep her out of school to prevent it from spreading to other children?

Anonymous patient


According to the Centers for
Disease Control and Prevention
, people with parvovirus B19, which causes fifth disease,
usually develop symptoms between 4 and 14 days after exposure. Initially, children
may have a fever, malaise, or cold symptoms before the rash breaks out. The
rash can last for 7 to 10 days. Children are most likely to spread the virus
early in the disease before the rash even develops. Then, unless your child has
immune problems, they’re probably no longer infectious and can go back to

Jeanne Morrison, PhD, MSN

Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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