What Is a Cold Sore?

“What is that THING on your lips?”

“Is that some type of  STI (Sexually Transmitted Infection)?”

“Is it contagious?”

These questions are every cold-sore sufferer’s nightmare. It can be embarrassing to display a large red ugly blister anywhere on the face, let alone the lips, which is a conspicuous location. But let me be the first to tell you: cold sores are super common and span all age groups.

What are cold sores anyway? How can we make them disappear as quickly as possible, and prevent future outbreaks? Let’s dispel some myths and reveal the truth about cold sores in today’s episode.

What Are Cold Sores?

Cold sores are caused by a form of the Herpes Simplex virus, a cousin to the chicken pox and shingles viruses.

There are two types of Herpes Simplex Viruses (HSV):

HSV Type I: Affects the lips, mouth, and throat. It is often first transmitted in childhood, believe it or not. This happens if there’s contact with the saliva of someone else that is affected, via shared cups, utensils, toothbrushes, or kissing. It is not an STI typically, and is very common ... even in children.                                                                                                                      

HSV Type II: Is often sexually transmitted and therefore considered an STI. It happens via skin-to-skin contact, and can still be transmitted even without a visible blister. A condom is the only way to prevent its transmission but it can still be transmitted via nearby exposed skin areas; this is a term called “shedding.” If you are diagnosed with genital herpes, it's important to also ask your doctor to test you for other sexually transmitted infections.

It’s important to note, however, that there is some cross-reactivity between the two types, which means that people can also get Type I in the genitals and Type II in the mouth. The most common way cross reactivity happens is while engaging in oral sex.

The First Outbreak:

Breakouts are usually recurrent. But the very first breakout is often the most severe. The virus enters the surface of the skin, lips, mouth, or genitals. Then penetrates deeper through the skin layers and finally to the nerves.  Typically multiple painful blisters can form on the lips, mouth, or throat during the first outbreak. And fever, body aches, and enlarged lymph nodes in the neck are also common with the first outbreak. Symptoms can last up to two weeks.

Further Breakouts: 

After the initial infection, the virus remains dormant in your body and resurfaces in times of stress or when your immune system is down (like when you are sick). Future outbreaks are not as severe, thankfully, and often last only up to one week. Fever and other symptoms are also rare with subsequent breakouts. Nevertheless, recurrent herpes can be quite a nuisance.

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Diagnosis of Herpes Simplex

The very best way to diagnose HSV is by exam. Tests are not often necessary, nor are they very accurate.

Your doctor can diagnose after a simple visual inspection of the sore, which has a very characteristic appearance. The sores are either blisters or vesicles with some fluid within, along with a reddish base surrounding the sore itself. It often scabs and heals over.

There is a swab and blood test for HSV, but it is not very reliable. Here’s why:

1.       People can carry the viruses without ever having symptoms.  In fact, most people have been exposed to it, carry the virus, and never display any symptoms.

2.       Like previously mentioned, there’s cross reactivity of the two types. Therefore, testing a specific spot will not accurately reveal whether it was sexually transmitted or not, which is often the main question at hand.

Treatment of Herpes Simplex

Unfortunately, like many other viruses (think cold and flu) there is no cure for herpes simplex. But treatment options can make the symptoms bearable until the breakout clears up and/or shortens the severity and duration of the outbreak.

Here are some ways to deal with HSV:

1.       No treatment:  If the symptoms are not bothersome, you don’t need to do a thing. The breakouts do self-resolve.

2.       Topicals:  Over-the-counter (OTC) gels that can provide some temporary pain relief, although often brief.

3.       Pain Relievers:  OTC acetaminophen or ibuprofen as needed may help take the edge off. Ibuprofen has an extra benefit because it also helps fight the inflammation, which often causes the discomfort.

4.       Anti-Virals:  Prescription acyclovir or valcyclovir can help shorten the duration of your symptoms and diminish the severity. However, in order to be effective it must be taken within 3 days of onset, and the earlier the better.

5.       Prophylaxis: If your symptoms occur too frequently, one option is to take a daily prescription antiviral to keep the virus suppressed. This requires a conversation with your doctor, in order to determine when the pros outweigh any cons of a daily antiviral.

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Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.

Image courtesy of shutterstock.