Cold sores also called fever blisters, are a common viral infection. They cause severe discomfort and embarrassment for individuals when symptoms occur. Cold sores usually clear up on their own within 10 days, but there are things you can do to help ease the pain.
What are cold sores?
Cold sores are tiny, fluid-filled blisters on and around your lips. These blisters are often grouped together in patches. After the blisters break, a scab forms that can last several days. In most cases cold sores usually heal without leaving a scar.
Cold sores spread from person to person by close contact such as kissing. Cold sores are usually caused by herpes simplex virus type 1 (HSV-1), and less commonly herpes simplex virus type 2 (HSV-2). Both of these viruses can affect your mouth or genitals and can be spread by oral sex. Cold sores are contagious even if you do not see the sores. There is no cure for cold sores, but treatment can help manage outbreaks. Once you have had an episode of herpes infection, the virus lies dormant in nerve cells in your skin and may emerge as another cold sore at the same place as before.
Risk factors
Almost everyone is at risk of cold sores. Most adults carry the virus that causes cold sores, even if they have never had symptoms.
You are most at risk of complications from the virus if you have a weakened immune system from conditions and treatments such as:
• HIV/AIDS
• Atopic dermatitis (eczema)
• Cancer chemotherapy
• Anti-rejection drugs for organ transplants
What are some symptoms of cold sores?
Symptoms of cold sores might vary in severity and whether it is the first attack or a recurrence.
A cold sore usually passes through several stages:
• Tingling and itching. Many people feel itching, burning or tingling around the lips for a day or so before a small, hard, painful spot appears, and blisters erupt.
• Blisters. Small fluid-filled blisters typically erupt along the border of your lips. Sometimes they appear around the nose or cheeks or inside the mouth.
• Oozing and crusting. The small blisters may merge and then burst, leaving shallow open sores that ooze and crust over.
The first time you have a cold sore, symptoms may not start for up to 20 days after you were first exposed to the virus. The sores can last several days, and the blisters can take two to three weeks to heal completely. Recurrences typically appear at the same spot each time and tend to be less severe than the first outbreak.
In a first-time outbreak, you also might experience:
• Fever
• Painful gums
• Sore throat
• Headache
• Muscle aches
• Swollen lymph nodes
Children under 5 years old may have cold sores inside their mouths and the lesions are commonly mistaken for canker sores. Canker sores involve only the mucous membrane and are not caused by the herpes simplex virus.
When to see a doctor
Cold sores generally clear up without treatment. See your doctor if:
• You have a weakened immune system
• The cold sores do not heal within two weeks
• Symptoms are severe
• You have frequent recurrences of cold sores
• You experience irritation in your eyes
Diagnosis
Your doctor can usually diagnose cold sores just by looking at them. To confirm the diagnosis, your doctor might take a sample from the blister for testing in a laboratory.
Treatment
Cold sores generally clear up without treatment in two to four weeks. Several types of prescription antiviral medications may speed the healing process. These can be used as a cream, orally or by injection in severe infections.
If you regularly get cold sores, use antiviral creams as soon as you recognise the early tingling feeling. They do not always work after blisters appear.
How long cold sores are contagious?
Cold sores are contagious from the moment you first feel tingling or other signs of a cold sore coming on to when the cold sore has completely healed.
How to reduce the risk of spreading this condition?
To help avoid spreading cold sores to other people, or to other parts of your body, you might try some of the following precautions:
• Avoid kissing and skin contact with people while blisters are present. The virus spreads most easily when the blisters leak fluid.
• Avoid sharing items. Utensils, towels, lip balm and other personal items can spread the virus when blisters are present.
• Keep your hands clean. When you have a cold sore, wash your hands carefully before touching yourself and other people, especially babies.
Kissing a baby if you have a cold sore can lead to neonatal herpes which is very dangerous to newborn babies.
If you have cold sores the following are recommended:
• do not have oral sex until your cold sore completely heals as you could give your partner genital herpes
• do not touch your cold sore (apart from applying cream). If you do, wash your hands
• do not rub cream into the cold sore – dab it on instead
• do not eat acidic or salty food if it makes your cold sore feel worse
What triggers recurrences?
Recurrence may be triggered by the following:
• Viral infection or fever
• Hormonal changes such as those related to menstruation
• Stress
• Fatigue
• Exposure to sunlight and wind
• Changes in the immune system
• Injury to the skin
Conclusion
Cold sores are very common. They are caused by a virus called herpes simplex.
Once you have the virus, it stays in your skin for the rest of your life. Sometimes it causes a cold sore.
Most people are exposed to the virus when they are young after close skin to skin contact, such as kissing with someone who has a cold sore.
It does not usually cause any symptoms until you are older. You may not know if it is in your skin unless you get a cold sore. Cold sores usually heal in two to three weeks without leaving a scar. Several antiviral medications are available to help reduce symptoms but there is no cure for cold sores at this time.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
