Cold Sores
What is a cold sore?
A cold sore (also known as herpes labialis, or fever blisters) is a common viral infection caused by the herpes simplex virus (HSV). Once someone is exposed to the herpes simplex virus, it lays dormant (inactive) in the nerve endings under the skin, and may later break out as a cold sore. Most people generally notice a tingling sensation around their mouth or lips, which develops into painful fluid-filled blisters (lesion) and later dries out to become a hard crust. Most cold sores last around 10-14 days. While the virus is active, it is very easy to pass on, especially in the first few days.
Cold sores are extremely common with an estimated 3 in 4 Australians infected by the herpes simplex 1 virus (HSV-1) - the most common type of cold sore virus. Many people are unaware they have the virus, as it remains latent in the body with no symptoms until activated. People are usually infected in childhood or early adulthood, and the herpes simplex virus will stay with the person for life. There is no cure for cold sores, however there are medications available to treat symptoms and prevent new outbreaks.
What causes cold sores?
Cold sores are caused when the herpes simplex virus enters the body through tiny scrapes in the skin or the soft mucous membrane lining of the mouth, genitals, anus or urethra. The virus is passed from person-to-person contact. Once infected, the virus lives dormant (inactive) in the nerve cells beneath the skin. Some people will never experience any signs or symptoms, and the virus will go unnoticed. But for around one third of those infected, generally a trigger (like stress, weather or being unwell) will activate an outbreak, which is when you may start to notice the tell-tale tingling feeling of a cold sore coming on. This is the earlier infection reactivating, not an indication of recent infection.
What is the difference between HSV-1 and HSV-2?
Cold sores are caused by the herpes simplex virus(HSV) – which sits in the ‘herpes family of viruses’ – this includes cold sores, genital herpes and shingles. There are two types of herpes simplex infection - herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Generally, cold sores around the mouth, nose or chin (also called ‘oral herpes’) are mostly caused by type 1 (HSV-1), while most cases of genital herpes are caused by type 2 (HSV-2). Less commonly, cold sores can be caused by HSV-2. This is because both viruses can affect the mouth or genitals, and be transferred through contact with those areas.
It’s estimated 75% of Australians are infected with the HSV-1 virus, and around 12% carry the HSV-2 virus. Although the statistics indicate the majority of Australians will be infected with herpes simplex virus during their lifetime, not all will experience lesions. This is because the HSV virus remains dormant in the body, with the potential to cause future outbreaks if triggered.
How do you catch cold sores?
Cold sores are highly contagious. Most are passed on by kissing someone who has a cold sore or is just about to get one, as their body ‘sheds’ the virus. You can also be exposed through contact with the fluid in an oozing blister. It can be passed on even when there’s no symptoms (known as ‘asymptomatic or viral shedding’), because the virus may be lying dormant in the skin cells of the lips.
Because cold sores can be caused by both the HSV-1 and the HSV-2 virus, it’s not just kissing on the lips to be aware of. The herpes virus can also be transmitted through:
sharing eating utensils, razors, towels, drinks or other items with an infected person
skin-to-skin contact during intercourse or oral sex
by sharing intimate toys
during foreplay or sex even if protection is worn - if the virus is active on the skin outside the area protected, it can be passed on. Its safest to avoid any intimate activity during a flare up.
being kissed anywhere on the face by someone with a cold sore (or about to get one)
touching someone with a cold sore
Once infected, you normally won’t experience symptoms from the first (or primary) infection, until the virus reactivates at a later stage. Cold sores usually appear in the same spot they appeared previously2. If you experience an outbreak, it’s very possible you were first exposed to the virus months or even years ago without realising.
Symptoms and stages of a cold sore
Cold sores are not pleasant, but they are quite predictable in their symptom patterns and usually heal in two to three weeks without leaving a scar#. Cold sores vary in severity of symptoms and frequency of outbreaks between each person. Most cold sores pass through several stages:
Stage 1
Tingling & itching
you may feel a tingling, burning or itching a day for a day or two – usually on the mouth, lips or nose.
a small, hard, painful spot may appear initially
note: as soon as you feel tingling or pain, treat a cold sore as soon as possible with antiviral medication (ointment or tablets). It won’t prevent it from appearing but may help to reduce the severity and duration of a cold sore.
Stage 2
Blisters
a few days after the tingling starts, small fluid-filled blisters will appear on the surface of your skin
skin around the blisters is often red, swollen, and sore
blisters are often accompanied by pain, tenderness and a sensation of heat or burning (not cold, as the name indicates)
note: avoid touching the area and contact with anyone else, as you are highly infectious during this stage
Stage 3
Oozing & crusting
Over a few days, small blisters may merge together and then burst open
Open sores may be red and shallow, and ooze
After oozing, the sore will take a few days to dry out and form a yellowy-brown crust
Eventually the crusted blister will scab over and slowly disappear by flaking away
note: you are most infectious during the oozing stage. Avoid contact with others and don’t touch or pick the area, as it can worsen symptoms or cause a bacterial infection.
As well as blisters, the following symptoms can also be common:
Fever
Tiredness
nausea
swollen glands
headaches
pain and swelling in the mouth
sore throat
dehydration
Cold sore triggers
The herpes simplex virus lives dormant in your nerve cells. In some people, certain trigger events such as a cold, can cause cold sores to break out. This is where the term ‘cold sore’ comes from. Some people experience only one or two cold sores their whole life, while others will have frequent breakouts, so understanding your triggers and what can be done to avoid these is important. Common triggers that can activate cold sores include:
Emotional upset or stress
viral infection or fever (e.g. influenza or chest infections)
exhaustion
sunlight
exposure to windy or cold conditions
changes in the immune system
injury to skin
alcohol
menstrual period
Cold sore treatment
There is no cure for cold sores, however anti-viral medication can reduce the severity and duration of symptoms if taken immediately as you start feeling symptoms coming on. This medication may also prevent complications and lower the risk of a recurrence. You can help manage and relieve symptoms of cold sores with:
Antiviral medication – either oral tablets (e.g. Famciclovir) or cream/ointments (e.g. Aciclovir) are available over-the-counter (OTC) at pharmacies, and should be taken as soon as you notice a cold sore coming on. Taking this immediately can shorten a cold sore duration by reducing the virus’ ability virus to reproduce.
Prescription antiviral tablets may assist
Daily preventive antiviral treatment may be recommended by your GP or pharmacist if you get cold sores frequently
Povodine-iodine ointments (ie. Betadine) may provide antiviral action
Ice or cold compress on the area for pain relief
Painkillers (e.g. paracetamol) may provide some relief
Lip balms (petroleum jelly) may help relieve dry and cracked lips, and may help with healing during the crusting phase
Cold sore blister patches (e.g. Compeed) can help the healing process and help reduce the risk of spreading the cold sore by covering it
Keep the cold sore dry and clean
Avoid touching, licking or picking the area
Eat soft foods if cold sores are around your mouth
Complementary medicines such as Lysine may help as a preventative measure against cold sores
How to prevent cold sore outbreaks
While there’s no cure for cold sores, the following measures may help prevent future outbreaks:
Avoid triggers where possible
Wear sunscreen on face and lips when outside, and keep protected from heavy winds
Keep stress levels down
Avoid getting ill or run down
Eat a healthy, balanced diet
Drink alcohol in moderation
How to avoid transmitting HSV
As cold sores are easily transmitted, the following measures may help to prevent spreading the infection:
Always wash hands if you touch affected area
Don’t touch eyes or anywhere on face after touching cold sore
Avoid sharing personal items such as towels, toothbrushes, makeup, cutlery, and drinks
Avoid touching or kissing infants and babies
Don’t kiss others
Avoid direct physical contact with others, especially kissing, intimate activities or intercourse while virus is active until at least 10 days after symptoms have disappeared.
Avoid contact with children who have burns or eczema, or anyone with a compromised immune system. As the virus is easily spread, it can become a severe infection in immunocompromised individuals.
When to see a Doctor?
Speak to your GP about cold sores if you have a weakened immune system, your symptoms are very severe, if the cold sore has spread (especially to the eyes), if symptoms are not healing, or if you experience frequent cold sores. If you aren’t sure what you’re experiencing is a cold sore, your GP can run a simple test, and rule out any other health conditions at play. Antibiotics may be required for an infected cold sore.
There is no cure for cold sores, but there are ways to treat the symptoms and prevent new outbreaks. At MediADVICE, our pharmacists can provide expert advice on helping to treat your cold sore, and recommend products that may provide relief of your symptoms. Speak to your local MediADVICE pharmacist today.