Cold Sores

Cold sores (also called fever blisters) are small fluid filled bumps that form on or around the mouth and are caused by the Herpes Simplex Virus (HSV). There are two types of herpes simplex virus HSV-Type 1 and HSV-Type 2. Most people get HSV-Type 1 infections, which causes cold sores, during infancy or childhood. The virus is spread through skin to skin contact and most people usually get it from close contact with family members or friends who carry the virus. It can be transmitted by kissing, sharing eating utensils, or by sharing towels. The most commonly affected areas include the lips, mouth, nose, chin, or cheeks and blisters occur shortly after exposure.

There are two kinds of infections – Primary infections and recurrent infections. Although most people get infected when exposed to the virus, only 10% will actually develop sores. The sores of a primary infection appear 2 – 20 days after contact with an infected person and can last from 7 to 10 days. The number of blisters varies from one to a group of blisters. Before the blisters appear, the skin may itch, sting, burn, or tingle. The blisters can break as a result of minor injury, allowing the fluid inside the blisters ooze and crust. Eventually the crust falls off leaving behind a slightly red healing skin. The sores from a primary infection heal completely and rarely leave a scar. However, the virus that caused the infection remains in the body. After the blister heals, the virus moves into the nearest nerve cells remains in a resting state. The virus will hide in this nerve until the immune system drops due to sickness or stress. When this happens people may have a recurrence either in the same location as the first infection or in a nearby site. Recurrent infections tend to be mild and can be triggered by a variety of factors including fever, sun exposure, menstrual period, trauma, or nothing at all.

Herpes lesions have a classic clinical appearance that is typically described as a cluster of tiny testicles on a pink/erythematous base. Herpes infections can be diagnosed based off of clinical appearance and history alone. If a diagnosis is uncertain, a swab from the infected skin for culture or smear may be taken and sent to the laboratory for analysis. Laboratory tests include special microscopic examinations and blood test for antibodies. Some tests are only valid for the early stages and more than one of these tests may be required to confirm the presence of herpes.

Oral antiviral medications such as acyclovir, or valacyclovir are very effective for treating herpes infections. These medications can be used to treat an outbreak or can be used consistently to suppress herpes occurrences, reduce outbreaks, and spreading by viral shedding.

Yes. Most people are aware that if they kiss someone while having a fever blister or have sex with a partner with an outbreak of genital herpes, they are likely to transmit the virus. However, most herpes is transmitted it in the absence of lesions! It is estimated that over 80% of all herpes is transmit it when there are no lesions and no symptoms. This is due to a phenomenon called asymptomatic viral shedding. Taking antiviral medications daily reduces both viral shedding and disease transmission.

It is estimated that between 200,000 and 500,000 people “catch” genital herpes each year and the number of HSV-Type 1 oral infections is even higher. Unfortunately, there’s no vaccine that prevents this very contagious disease but other methods of prevention before and during an outbreak are important. Tingling, burning, itching, or tenderness in an area of the body where there is a history of herpes infection are common symptoms of an impending outbreak. A person with oral herpes should avoid kissing, sharing cups, or lip balms. A person with genital herpes should avoid sexual relations, including oral/general contact during the period of symptoms or active lesions.

For most people with an intact immune system, herpes outbreaks are frustrating but not life threatening. HSV can be life-threatening to a person who has cancer, an individual with AIDS, a person who has had an organ transplant, or anyone who has some other major illness, because they’re immunity to infection has been reduced.

HSV infection of the eye can lead to herpes keratitis with pain, light sensitivity, a discharge, and gritty sensation in the eye. Without prompt treatment, scarring of the eye may result. Fortunately, antiviral medications are available to eliminate infection and prevent severe scarring in the cornea.