Cold Sores

Cold sores are caused by the Herpes Simplex Virus (HSV) and are transmitted by skin-to-skin contact with an infected person. HSV enters the body through small breaks in the skin, most commonly on or around the lips.

There are two types of HSV. HSV-1 most often causes cold sores of the mouth and lips, and HSV-2 typically causes genital herpes. However, HSV-1 can be spread to the genitals through oral sex, and rarely HSV-2 can cause sores on the mouth and lips.

• Burning, tingling, or itching around the lips or nose starting two to 21 days after exposure.
• Within 12 hours, small, red areas with fluid-filled blisters develop
• As blisters increase in size, they rupture and leak fluid. This stage is the most painful.
  • After blisters rupture, they form a hard crust and the sore heals, leaving a red, tender site.

The virus remains in the body but lies dormant in a bundle of nerves called the trigeminal ganglion and stops causing infection. The virus may become active again and cause recurrent cold sores. Cold sores typically recur three to four times a year, although some people may develop more than one cold sore per month. The frequency and severity of outbreaks generally decreases over time. People often experience tingling, burning, or itching at the site prior to an outbreak. Outbreaks are often spontaneous, without a specific reason or cause, but some common triggers include:

• Overexposure to sunlight
• Stress
• Fatigue
• Illness
• Hormonal changes (premenstrual, pregnancy)
• Surgical procedures or trauma to the site

To prevent recurrences, avoid trigger factors as much as possible, and:

• Eat a balanced diet with at least five servings of fruits and vegetables daily to support a healthy immune system.
• Get proper rest and exercise.
• Manage or prevent stress.
• Avoid trauma to the lips, such as chapped lips, or biting or peeling of lips.
• Apply sunscreen to areas of the face or lips (using lip balm, SPF > 15) where cold sores appear.
• Be careful shaving near sores. Shaving can spread the virus to other areas of the face.

The ability to infect others typically occurs when symptoms are present, including milder symptoms of tingling, burning, and itching. The virus can also reactivate without any symptoms, so a person can be contagious without having symptoms. Most of the time, the virus is inactive and cannot be transmitted. HSV prefers warm, moist environments with soft tissue (mucous membrane) such as the mouth or genital area, but can also spread to tougher skin if a cut or break in the skin is present.

Autoinoculation, which occurs by touching the site of the infection and then touching a cut or mucus membrane, is possible but unlikely after the first episode. The following measures can reduce the likelihood of infecting others:

• Wash hands thoroughly with soap and water after touching the sore. Do not touch the sore and then touch other body parts.
• Do not share items that come in contact with the mouth of others such as lip balm, cups, straws, eating utensils, washcloths, razors, vape pens, or cigarettes.
• Do not put fingers in the mouth or bite fingernails.
• Do not kiss people, especially children, when a sore is present.
• Do not rub the eyes. Wash hands before applying makeup or putting in contact lenses. Never put contacts in the mouth. Although rare, herpes infections can be spread to the eye during the first outbreak and can cause sores on the cornea, which may result in cloudy vision, scarring, or blindness.
• Avoid contact sports during an outbreak.
• Do not engage in oral sex if an outbreak is present, including cold sores, genital sores, or feel an outbreak coming on, or if a partner is experiencing an outbreak. Using a barrier for oral sex (condoms, sex dams, household plastic wrap) may decrease the chance of transmission