What is a Cold Sore?

A cold sore is a viral infection, usually caused by the herpes simplex virus 1 (HSV-1). A patient’s first outbreak after contracting the virus typically produces blisters, erosions or painful sores all around and inside the mouth.

Later outbreaks of the herpes simplex virus typically produce blisters or sores in one isolated area — either around the lips or inside the mouth. These sores seem to appear with increased stress or a lowered immune system.

What are the Symptoms of HSV-1?

When a person becomes infected with HSV-1 for the first time, there may be fever, fatigue, pain, local swelling of lymph nodes and sores that appear in the area of initial exposure, most commonly around the mouth. These may be widespread and when the rash appears around the mouth, it can affect the lips, gums, and even the tongue and tonsils. On the other hand, sometimes there may be no observed initial rash.

For recurrent outbreaks, you may notice a tingling or burning sensation in the place where the sore will appear. As the sore develops, there can be localized redness, blistering, loss of skin, and increasing pain.

Typically, these sores appear inside the mouth or around the lips, but occasionally the virus affects other parts of the body as well, depending on exposure.

What Causes a Cold Sore?

The root cause of any cold sore is an infection. This infection, the herpes simplex virus, is highly contagious and easily spread through person-to-person contact. Most of the time, this strand of herpes is an innocent infection — family members or friends share food, drink, or utensils and the virus spreads.

There is not a cure for cold sores. Once you’re infected with the virus, it remains in the nerve. A healthy immune system keeps the virus controlled. But if your immune system goes down, sores will likely reappear.

Sickness is one of the key triggers for the return of a cold sore. One reason it is called a cold sore is because they often develop when the immune system is weakened by a cold or the flu.

Stress also lowers the immune system and triggers the reappearance of these sores. Even high sun-exposure can weaken your immune system temporarily, resulting in a cold sore. Cold sores may also appear when trauma happens to an area previously affected by the infection. For example, if you eat something hot and burn your mouth, a cold sore may appear in that area.

Since the virus remains in the nerve after symptoms disappear, any weakening of the immune system or physical trauma to an area once affected directly by this virus can easily trigger its return.

How Are Cold Sores Diagnosed?

Typically your provider will be able to diagnose the cold sore by history and appearance. For lesions that may be more difficult to diagnose or for confirmation of diagnosis, there are several methods to detect the HSV virus. The provider may do a Tzanck smear, biopsy, or viral culture. Serologic tests are available to determine if an individual has been exposed to the HSV virus.

What Are the Treatment Options for Cold Sores?

Once you contract the herpes simplex virus, there is no way for us to remove it from the body, but we can manage its symptoms. Antiviral medications are an effective way to manage the pain, duration, and spread of cold sores.

Antiviral medications come in two different forms — topical and oral. Topical antiviral medications include ointments, creams, and dissolvable tablets to apply to the sore directly. Oral medications such as Acyclovir, Famciclovir, and Valacyclovir help shorten the duration of the pain and allow for quicker healing.

The majority of people use these medications episodically when cold sores appear. However, patients with frequently recurring cold sores may opt for an ongoing daily treatment in order to prevent future cold sores from appearing.

What Should You Expect During Cold Sore Treatment?

Cold sore medications require diligence. Most medications need to be applied or taken frequently. If you’re using a topical treatment, apply creams and ointments 3-5 times per day. Oral medications typically need to be taken 1-3 times per day. When taking these medications, it is also important to drink plenty of fluids.

Both topical and oral treatments for cold sores are very safe. Adverse reactions to topical treatments are especially rare unless a patient has an unexpected allergy to the medication.

When you notice a cold sore, begin treatment immediately. The sooner you begin your treatment regimen, the sooner the sore will heal and the less likely it is to spread to others. 


How quickly can you get rid of a cold sore? 

If you start a cold sore medication before an outbreak happens, you may be able to prevent the outbreak altogether. If you feel the tingling sensation, pain, or itchiness that often precedes the appearance of a sore, start treatment immediately. With early treatment, the sore itself may never appear.

If you begin treatment after the cold sore appears, it will heal within a few days. Medication will not make a cold sore disappear right away, but it will speed up the healing process. Instead of  weeks of symptoms, cold sore medication can shorten the duration of symptoms to several days of symptoms.

Besides decreasing the duration of the symptoms, these medications also work to alleviate the pain, burning, and itching that patients experience with cold sores. Plus, treatment decreases the shedding of the virus, making you less likely to infect other people while your symptoms are present.

Can I still kiss my children/grandchildren?

No, do not kiss babies while your symptoms are present. A cold sore indicates you are actively shedding the virus and your sore is contagious. It can easily spread to your loved ones. 

Herpes simplex is a highly contagious virus. When your symptoms appear, avoid contact with infants or other immunocompromised people. If you are unable to avoid contact, cover the lesion with a bandage. If they have not had oral herpes before, your symptoms can infect them.

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