Cold sores are a condition in which small blisters develop around the mouth and on the lips. They’re commonly caused by a virus called Herpes Simplex. They are not usually serious or life threatening and almost always clear up within ten days of infection.

When you first get a herpes simplex infection you might not notice any symptoms at all, in fact, an outbreak of cold sores might not appear until some time after you’ve been infected. The first sign you will notice is a burning, itching or tingling sensation around your lips or mouth. Once this subsides you will notice small fluid filled spots or sores appearing, usually on the bottom of your lip.

If I get a cold sore, do I need to see a Doctor?

Once you have experienced a cold sore and know the signs, it’s highly likely you’ll be able to recognise them when they return. It’s not necessary to visit your doctor, unless you’re unsure as to whether it is a cold sore or not, of if you have any unusual or painful symptoms alongside it. If you experience a fever, high temperature or other pains, seek medical treatment.

Likewise, you should always see your medical practitioner if a cold sore hasn’t healed after ten days, with the right over the counter treatment.

How do cold sores develop?

There are two different strains of the herpes simplex virus. HSV-1 and HSV-2. The former of these is the one that causes cold sores. The latter is the strain that causes genital herpes. In some extremely rare cases, the HSV-2 virus can cause cold sores, usually they will occur as a result of engaging in oral sex with someone who has herpes.

The virus that causes cold sores is very contagious and can be passed from person to person if you have close and direct contact with them. Once you have the virus, it is with you for life, but will remain dormant for much of the time. At certain points in your life the virus will be triggered and will ‘come to the surface’ which will mean an outbreak of cold sores. Triggers vary person to person but outbreaks of cold sores can be triggered by stress, fatigue, illness or injury or fluctuations in the menstrual cycle in women.

There are sufferers who find they’ll have a few outbreaks at different times of the year whilst some people only experience one or two outbreaks in their life. There are some people who have the virus in their systems, but never experience a cold sore at all!

If I get a cold sore, how do I treat it?

Most people find that a cold sore will clear up without any form of treatment around ten days after infection. However, there are a good range of antiviral creams and lotions on the market, which are available from drugstores and a prescription is not needed for these. They work to heal the cold sore quickly and if used properly, prevent them from spreading elsewhere.

Timing is essential with these treatments. They need to be applied at the very first sign of a cold sore. As soon as you feel the tingle or burn, apply the treatment. Application of such a cream after the tingling has stopped and the cold sore appears, will be less useful.

Some people find that cold sore patches, usually containing hydrocolloid gel, are an effective treatment. They are placed over the wound whilst it heals. In some cases, which are more severe and long lasting, some people might need a course of antiviral tablets.

Are there any complications associated with cold sores?

For the most part, no. They’re usually a very mild and easily treatable condition. However, if you’re someone who has a weakened immune system, or suffer from other serious illnesses you may be more at risk of contracting them and suffering complications.

One of more serious complications is that the herpes simplex virus can spread to other parts of the body if it comes into contact with open wounds.

You may be more at risk of the following issues:

  • Skin infections: especially if you suffer from eczema or dermatitis
  • Herpetic whitlow: infection of the finger and surrounding area
  • Herpetic keratoconjunctivitis: infection of the eye

These conditions need immediate medical attention and treatment as they can be very painful and in the case of the latter, can cause blindness if left untreated for too long. If you have an unhealed cold sore, avoid touching your eyes or touching open wounds and cuts.

Is it possible to prevent cold sore infection?

It isn’t possible to prevent infection with the herpes simplex virus. However, you can take steps to worsen any outbreaks. Once a cold sore bursts, it’s at it’s most contagious point. However, they stay contagious until they’re completely healed. Avoid any close contact with other people until the sore has disappeared. This doesn’t mean you should stay away from work, school, or public places until it has vanished, but make sure you keep a good standard of personal hygiene, wash your hands and face regularly and keep the cold sore well treated with the right products.

You should:

  • Avoid touching cold sores, unless you’re putting a treatment on the area. Don’t rub creams/lotions in, pat them in as gently as possible and always wash hands afterwards.
  • Don’t share your medication or creams with anyone else
  • Don’t share anything that has come into contact with an affected area, such as make up, cutlery, crockery or glassware.
  • Don’t kiss anyone until the sore has healed
  • Don’t engage in oral sex until the sore has healed
  • Avoid touching or hugging new born babies and small children, pregnant women or the very elderly, and people with lowered immune systems as you may be more prone to infecting them.

What are the symptoms of cold sores?

When you are first infected with the herpes simplex virus, it’s likely there won’t be any symptoms at all. The first thing you will notice is a burning, tingling sensation in or around your mouth before the cold sore appears.

Cold sores may then reoccur at periodic intervals. Some people experience only one outbreak in their life, others many. In some cases, there can be initial symptoms and they can be quite pronounced. They also vary between children and adults. Children under five are most likely to develop symptoms prior to an outbreak of cold sores.

These can include:

  • Gums that become swollen or irritated. This is sometimes called herpes simplex gingivostomatitis
  • Swollen glands and a sore throat (though this can be concurrent with many other illnesses)
  • Excess production of saliva
  • Fever
  • Nausea
  • Dehydration
  • Headache

Although the condition herpes simplex gingivostomatitis predominantly affects children, it can occasionally develop in adults too. The condition will usually last for up to two weeks with any soreness taking three weeks to heal. Once the condition has abated, it doesn’t tend to recur.

It’s rarer for adults to experience any symptoms prior to an outbreak of cold sores, if they do, they are likely to be similar to the ones that children suffer from. Adults have sometimes reported swollen glands, or a sore throat and bad breath. Sometimes painful sores will develop in the mouth which then become ulcerated.

If the herpes simplex virus begins at a young age, it can then lead to further bouts in adult life, resulting in more outbreaks of cold sores. Once a primary infection has occurred, it is likely that only cold sores will be experienced.

Woman Covering Face with Sheet

What happens when cold sores recur?

Some people find they only ever have one outbreak of cold sores and that they never come back. This does not mean that the virus has disappeared. Once you have it, it will remain in your system for good. In some people it simply stays dormant, whilst in other regular recurrences of cold sores happen.

Further infections will usually last for less time and will be less severe than the initial infection. The only symptoms you will be likely to experience are the burning and tingling followed by the appearance of the sore itself.

People who experience cold sores might find that when they recur they develop in the same places over again. They can sometimes grow in size and cause some skin irritation and pain. In some patients they will crust and scab over after a couple of days after the initial burning and tingling has passed.

If cold sores prove to be particularly troublesome it is sometimes possible to take an antiviral medication on a regular basis to help suppress symptoms. Doctors will only recommend this if cold sores are causing real issues. Once treatment stops there is no guarantee that they won’t come back again and further courses of tablets may be necessary. However, for most people, cold sores disappear within ten days of occurring, without any need for treatment.

What causes the cold sore virus?

The cold sore virus is usually caused by herpes simplex type 1. In most cases, the virus is caught during childhood and will likely occur as a result of direct contact with someone who has a cold sore – so for example if a friend or family member kisses a youngster whilst in the middle of an outbreak.

The virus gets into the skin and passes up into the nerves. It becomes dormant and needs a trigger to activate. Some people carry the virus and never have an outbreak, whilst others have frequent bouts of cold sores.

Common triggers for outbreaks are:

  • Other infections and illnesses, such as chest infections or colds.
  • Fevers
  • Stress, whether emotional or psychological
  • Suffering from tiredness or fatigue
  • Menstrual cycle
  • Being exposed to strong sunlight

On rare occasions, the cold sore virus can be caused by the herpes simplex virus type 2, which is more commonly associated with genital herpes. The two viruses can interchange when a couple engage in oral sex where one of them has genital herpes. In cases of genital herpes, the same sores develop, but just on the male and female genital areas.

How to treat cold sores properly

As a rule of thumb, most cases of cold sores clear up after around ten days, without the need for any treatment other than over the counter preparations.

There are some other steps you can take to help speed up healing and recovery:

Make sure you drink enough fluidsDon’t eat foods that are highly salty, spicy or acidicDo eat foods that are cool and soft
Some people find that brushing their teeth can become painful. If you can’t brush your teeth, or find it difficult, make sure to use an antiseptic mouthwash two to three times a day.If applying over the counter creams, do not rub them in, simply dab them on the affected area.Always make sure to wash your hands before and after applying creams and always after inadvertently touching the cold sore or affected area.
Never share any creams or medications with other cold sore sufferers, to avoid cross contamination

Cold sore creams and preparations are readily available over the counter at drug stores and don’t need a prescription. In cases where antiviral tablets are required, a doctor’s appointment will be needed for examination and prescription of drugs.

Creams will only be effective if you apply them at the first signs of a cold sore. Once the sore has erupted, applying a cream will have little to no effect. In cases of frequently recurring cold sores that have been diagnosed and for which medication has been prescribed, then you should use the antiviral tablets as soon as you feel any tingling or burning sensation develop. Application of these creams should be done four to five times a day for four to five days.

It’s worth pointing out that creams will only help to heal a current outbreak of cold sores. They won’t get rid of the cold sore virus from your system, and they won’t stop future outbreaks of cold sores from occurring. Tablets are a lot more effective at treating cold sores, but they are almost always prescribed for those people who have more severe cases.

Are there other treatments available for cold sores?

In some cases, a patch containing hydrocolloid gel are available to treat cold sores. They provide a protective barrier to place over the cold sore to allow it to heal free from other contaminants.

There are also a few other types of non-antiviral cream available to buy over the counter from pharmacies without any need for a doctor’s visit or prescription. These won’t treat cold sores but will help to ease any pain and discomfort caused by the cold sore virus. Drugstore pharmacists will usually be able to help you decide which treatment is the right one for you.

In some cases, it is possible to take simple painkillers such as ibuprofen or paracetamol to help with pain and discomfort. Ibuprofen should always be taken with caution and only ever with food and a drink, as taken long term, it can cause stomach problems and irritation. If you are suffering from cold sores and are pregnant then you should speak to your Doctor for advice on how to treat them.

Complications from cold sores

Cold sores rarely cause complications in otherwise healthy people. However, if you suffer from serious illness or have an immune system which is impaired, for instance, if you have cancer or HIV, then you may be at risk of developing more serious complications and side effects.

You are at an increased risk of developing encephalitis, or having the cold sore infection spreading to other parts of your body is higher.

If you have cold sores and suffer from any more serious health conditions, visit your Doctor for advice and help on how to go about treating them as you may require more specialist treatment and help to make sure you get over the problem without sustaining any more long term complications.

Cold sores are a relatively uncomplicated condition to treat, and should not cause any long term problems, unless you have any previously diagnosed illnesses which could result in a compromised immune system. If you are concerned, speak to a healthcare professional who can help and advise you. For the most part they can be treated at home with simple creams, ointments and lotions to help with any pain or discomfort.