Cold Sores, ugh!

Cold Sores, ugh!

Here it comes again … that annoying tingle, pressure and pain on your lip.  Ugh, you know the drill.  It is those dreaded cold sores making an unwelcome appearance, again.  However, you are not alone, more than 80% of the adult population in the United States has the virus that causes cold sores, this is due to the highly contagious nature of the virus. Many people have the virus, but few people know what it is or what causes them, and most importantly how to get rid of them! 

Cold Sore

Cold Sores, sometimes called fever blisters, are caused by the herpes simplex virus (HSV).  There are two types of herpes simplex virus:  HSV-1 (oral) and HSV-2 (genitalia).  HSV-1 is mainly responsible for the unsightly sores around the mouth, simply known as outbreaks.  Herpes (HSV-1) outbreaks can occur anywhere, but most of the time they land in and around the mouth, and most commonly occur at the border of the lip with the face (herpes labialis). 


HSV-1 outbreaks can also occur on "tight/tough" tissue ... ie, the hard palate, the gum tissue right next to the teeth, or anywhere on the face.  Furthermore, they can involve, most ominously, the eyes. HSV-1 outbreaks are sometimes confused with "canker sores" which only occur on the soft, moveable gum tissue inside the mouth.  They're both ulcers - they both hurt - the main difference is that "canker sores" are not definitively caused by a virus (thus treatment is different). 

The herpes simplex virus that causes cold sores is usually contracted through a break in the skin in or around the mouth.  It is spread when a non-infected person comes in contact with an infected person that either has an active outbreak or is in the shedding phase.  This contact can be in the form of touching or kissing, sharing eating utensils, drinking after each other, sharing razors, or any type of contact including sexual contact. 

Sometimes people contract the virus early in life from parents or caregivers who are infected with the virus.  Infection by the type 1 strain of herpes simplex virus (HSV-1) is most common; however, cases of oral infection by the type 2 strain are increasing. Type 1 has historically, been considered to cause oral outbreaks while type 2 was considered to cause genital outbreaks.  However, the distinction between the two types of HSV and origin of outbreaks is not as distinct as it once was.  Recently, it seems the more common difference between the two is social stigma. 

Many people who carry the virus never develop signs or symptoms of the virus, but can still be contagious and can pass the virus to others.  There are two phases when the virus is active and contagious: the shedding phase and the active (outbreak) phase. A person who never experiences an outbreak can experience a shedding phase when they are contagious, but have no symptoms of the virus.

The shedding phase can be called "viral shedding," or just "shedding." During shedding, the virus can be passed on to others by all forms of direct skin-to-skin contact, or by sharing eating or drinking utensils or razors .  Sometimes shedding is accompanied by symptoms, such as blisters, but many times there are no noticeable symptoms at all, this is "asymptomatic shedding." Thus it is virtually impossible to tell when a person is contagious with the naked eye.  It is estimated that over 70% of new HSV-1 and HSV-2 cases are transmitted during asymptomatic shedding when there are no obvious symptoms of the virus. 

For people who do develop symptoms, a cold sore usually passes through several  phases:           

• Tingling or itching – in or around the mouth 1 to 2 days before blisters erupt.  This is also known as the prodromal phase.  A person is considered contagious during this phase.
• Blisters – often times form in clusters.  Typically, these blisters form around the borders of the lips. However, they can occur in the mouth or the skin surrounding the lips. A person is also contagious during this phase as well.
• Oozing and crusting – The blisters eventually pop and leave a lesion that will crust over and then eventually heal. This is also a contagious phase.  

Initial outbreaks, or first time outbreaks, can be more severe and have the above symptoms with a few more that include:

• Sore throat
• Swollen glands around the neck or other parts of the body
•  Small children sometimes drool before an outbreak
• Headaches
• Muscle aches

All the phases typically last for a total of two weeks. HSV outbreaks are usually non-threatening to a person’s health, but a large majority of people find outbreaks, painful and embarrassing.

There is no cure for HSV infection.  However, there is good news! Thanks to modern medicine there are things that can be done to minimize outbreaks and discomfort. The rate of outbreaks for individuals varies from never to more than 12 times annually.  The average person experiences three outbreaks a year.  When a person is not having an outbreak the virus lies dormant in nerve cells.

 There are some things that a person can do to minimize outbreaks:

• Stay healthy – a compromised immune system allows the virus to become active.  This explains why people get cold sores when they are sick, thus the name “cold sore” and “fever blisters.”
• Avoid excessive sun exposure.
• Get lots of rest – fatigue is a no- no when trying to avoid outbreaks
• Minimize stress
• Consult your physician or dentist about possible medications.  Depending on your needs there are oral or topical medications that you can be used during the in-active phase, prodromal phase and active phase (outbreak).  Some of these medications can minimize or prevent an outbreak, and prevent spreading the virus to others. 
• Laser treatment, although early

While an outbreak for most people is unnerving and a nuisance, sometimes it can pose serious health risks. Consult a doctor for sure if:

• Cold sores do not heal in two weeks
• You have a compromised immune system
• Symptoms are severe
• You experience very frequent outbreaks
• You experience eye irritation