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Cold sores (fever blisters) are small, painful, fluid-filled blisters that occur on the lips, mouth, nose, chin, cheeks, and throat. They are most commonly caused by the herpes simplex type 1 virus (HSV-1). Less often, however, they can be caused by herpes simplex type 2 (HSV-2), the virus that most often causes genital herpes . Having a herpes simplex virus (HSV) infection around the mouth is very common. Nine out of ten older adults have been exposed to HSV, but not everyone who is exposed will develop cold sores.
Herpes Simplex on the Lips |
The virus can be spread by:
- Contact with the fluid from a cold sore of another person through kissing and other close contact
- Contact with the eating utensils, razors, towels, or other personal items of a person with active cold sores
- Sharing food or drink with a person with active cold sores
- Contact with saliva containing HSV
When HSV gets on the skin around the mouth, it invades nerves in the area. It then remains there, without causing symptoms, usually for 2-20 days, before the first (primary) outbreak occurs. This outbreak can cause blistering across the lips, tongue, and inside of the mouth. It may be accompanied by a body-wide, flu-like illness, consisting of fever, general aches and pains, and swollen lymph glands.
Once this outbreak is over, after about 7-10 days, the virus goes back into the nerves where it remains dormant until it is reactivated, causing another (secondary) outbreak. When this occurs, painful, blistering sores erupt, usually at the border of the colored part of the lip, and can last for up to 14 days. It is impossible to predict when these outbreaks may recur, but typically stress or illness may bring them on, as well as sunlight, immune suppressants, or a woman's menstrual period. Some people have outbreaks regularly, while some never have another.
What are the risk factors for cold sores?
[What are the symptoms of cold sores?
[How are cold sores diagnosed?
[What are the treatments for cold sores?][7]
Are there screening tests for cold sores?
[How can I reduce my risk of cold sores?
After being exposed to the herpes simplex 1 virus for the first time, you may develop a blistering rash in the mouth and/or lips that may be accompanied by a body-wide, flu-like illness. This first outbreak of cold sores is usually gone within 7-10 days, but it can last up to 20 days.
Blisters |
The symptoms of the first outbreak are:
- A blistering, painful rash of small ulcerations across the lips, gums, tongue, and the inside of the mouth (more common in children)
- Pain and blistering on the soft roof of the mouth, tonsils, and throat (more common in adults)
- Flu-like symptoms:
- Swollen, sore throat
- Mouth sores
- Fever
- Decreased energy
- Muscle aches and pains
- Difficulty breathing
- Swollen glands (lymph nodes) in the neck
After these initial symptoms, the virus may lie quietly in the nerves until it is reactivated, typically by stress or illness. Direct sunlight, a weakened immune system, and menstruation can also trigger reactivation. If reactivated, the virus will come out as a cold sore (fever blister). A few days before, you may notice some itching, burning, or pain in the area where the cold sore will appear. Some people have outbreaks regularly, and some never have another after the initial infection.
The symptoms of an active cold sore are:
- Small, painful, fluid-filled, red-rimmed blisters
- After a few days, the blisters dry and form a scab
- Scabs heal in about five days, usually without scarring or loss of sensation
American Academy of Dermatology
Address:
P.O. Box 4014
Schaumburg, IL 60618-4014
Phone:
1-866-503-SKIN (7546)
Internet Address:
http://www.aad.org/
Description of Services Provided:
This site provides education, support groups, and a physician locator. The information is comprehensive and contains color photos of cold sores at different stages of infection.
Australian Herpes Management Forum
Address:
c/o-STIRC, Marian Villa
Westmead Hospital, Westmead
NSW 2145
AUSTRALIA
Phone:
+61 (2) 8230 3843
Internet Address:
http://www.ahmf.com.au/default.htm/
Description of Services Provided:
This organization provides succinct, easy-to-understand information on oral and other forms of herpes. Its website contains large color photos of people with typical cold sores at different stages of the infection.
COLD SORES.CA
Internet Address:
http://www.coldsores.ca/
Description of Services Provided:
This Canadian website, written by dermatologists, provides over 10 articles about cold sores. You'll also find a dermatology glossary and images.
References:
Beers MH, Fletcher AJ, et al. Merck Manual of Medical Information. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003.
Cold sore. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/cold-sore/DS00358 . Updated July 2008. Accessed September 24, 2008.
Herpes simplex. American Academy of Dermatology website. Available at: http://www.aad.org/default.htm . Accessed September 24, 2008.
Miller C. Oral herpes/cold sores essential facts. Australian Herpes Management Forum website. Available at: http://www.ahmf.com.au/oralherpes/essentialfacts.htm . Updated June 2007. Accessed September 24, 2008.
Cold sores (fever blisters) are small, painful, fluid-filled blisters that occur on the lips, mouth, nose, chin, cheeks, and throat. They are most commonly caused by the herpes simplex type 1 virus (HSV-1). Less often, however, they can be caused by herpes simplex type 2 (HSV-2), the virus that most often causes genital herpes . Having a herpes simplex virus (HSV) infection around the mouth is very common. Nine out of ten older adults have been exposed to HSV, but not everyone who is exposed will develop cold sores.
Herpes Simplex on the Lips |
The virus can be spread by:
- Contact with the fluid from a cold sore of another person through kissing and other close contact
- Contact with the eating utensils, razors, towels, or other personal items of a person with active cold sores
- Sharing food or drink with a person with active cold sores
- Contact with saliva containing HSV
When HSV gets on the skin around the mouth, it invades nerves in the area. It then remains there, without causing symptoms, usually for 2-20 days, before the first (primary) outbreak occurs. This outbreak can cause blistering across the lips, tongue, and inside of the mouth. It may be accompanied by a body-wide, flu-like illness, consisting of fever, general aches and pains, and swollen lymph glands.
Once this outbreak is over, after about 7-10 days, the virus goes back into the nerves where it remains dormant until it is reactivated, causing another (secondary) outbreak. When this occurs, painful, blistering sores erupt, usually at the border of the colored part of the lip, and can last for up to 14 days. It is impossible to predict when these outbreaks may recur, but typically stress or illness may bring them on, as well as sunlight, immune suppressants, or a woman's menstrual period. Some people have outbreaks regularly, while some never have another.
What are the risk factors for cold sores?
What are the symptoms of cold sores?
What are the treatments for cold sores?
Are there screening tests for cold sores?
How can I reduce my risk of cold sores?
References:
Beers MH, Fletcher AJ, et al. Merck Manual of Medical Information. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003.
Cold sore. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/cold-sore/DS00358 . Updated July 2008. Accessed September 24, 2008.
Herpes simplex. American Academy of Dermatology website. Available at: http://www.aad.org/default.htm . Accessed September 24, 2008.
Miller C. Oral herpes/cold sores essential facts. Australian Herpes Management Forum website. Available at: http://www.ahmf.com.au/oralherpes/essentialfacts.htm . Updated June 2007. Accessed September 24, 2008.
A risk factor is something that increases your likelihood of getting a disease or condition.
It is possible to develop cold sores with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing cold sores. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.
The viruses that cause cold sores are easily spread. They come out of the skin and are “shed” from the site of the cold sore for 1-2 days before the sore appears. Then they are in the fluid of the cold sore blisters. Although cold sores typically form in response to stress or illness, they can sometimes form without an identifiable trigger.
Risk Factors for Becoming Infected With Herpes Simplex 1 Virus
Exposure to Someone With Cold Sores
Herpes simplex virus type 1 (HSV-1) can be spread by close contact with someone who has a cold sore or by using items contaminated with the virus. Kissing or sharing personal items, such as razors, towels, or eating utensils, with a person who has a cold sore will increase your risk of getting HSV-1. The virus you have can also be spread to the genital area of another person by having oral sex. People with cold sores should not perform oral sex on their partners.
Age
Infants and young children (up to three years old) have an increased risk of being exposed to HSV-1.
Risk Factors for Developing Cold Sores
Exposure to Sunlight
Exposure to sunlight or other ultraviolet light is a common trigger for the formation of cold sores.
Physical Stress and Illness
Stress on the body due to illness or excessive exercise can weaken the body’s immune system and lead to an outbreak of cold sores. Common examples of stress or illness include:
- Infection, fever, or cold
- Physical injury
- Dental surgery
- Menstruation
- Medication (such as steroids) or illness (such as HIV ) that suppresses the immune system
- Eczema
- Excessive exercise
Emotional Stress
Cold sore outbreaks commonly occur during times of emotional stress. The type of stress that activates cold sores is typically negative stress, instead of stress due to positive or normal life-changing events.
References:
Beers MH, Fletcher AJ, et al. Merck Manual of Medical Information. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003.
Cold sore. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/cold-sore/DS00358 . Updated July 2008. Accessed September 24, 2008.
Herpes simplex. American Academy of Dermatology website. Available at: http://www.aad.org/default.htm . Accessed September 24, 2008.
Miller C. Oral herpes/cold sores essential facts. Australian Herpes Management Forum website. Available at: http://www.ahmf.com.au/oralherpes/essentialfacts.htm . Updated June 2007. Accessed September 24, 2008.
After being exposed to the herpes simplex 1 virus for the first time, you may develop a blistering rash in the mouth and/or lips that may be accompanied by a body-wide, flu-like illness. This first outbreak of cold sores is usually gone within 7-10 days, but it can last up to 20 days.
Blisters |
The symptoms of the first outbreak are:
- A blistering, painful rash of small ulcerations across the lips, gums, tongue, and the inside of the mouth (more common in children)
- Pain and blistering on the soft roof of the mouth, tonsils, and throat (more common in adults)
- Flu-like symptoms:
- Swollen, sore throat
- Mouth sores
- Fever
- Decreased energy
- Muscle aches and pains
- Difficulty breathing
- Swollen glands (lymph nodes) in the neck
After these initial symptoms, the virus may lie quietly in the nerves until it is reactivated, typically by stress or illness. Direct sunlight, a weakened immune system, and menstruation can also trigger reactivation. If reactivated, the virus will come out as a cold sore (fever blister). A few days before, you may notice some itching, burning, or pain in the area where the cold sore will appear. Some people have outbreaks regularly, and some never have another after the initial infection.
The symptoms of an active cold sore are:
- Small, painful, fluid-filled, red-rimmed blisters
- After a few days, the blisters dry and form a scab
- Scabs heal in about five days, usually without scarring or loss of sensation
References:
Beers MH, Fletcher AJ, et al. Merck Manual of Medical Information. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003.
Cold sore. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/cold-sore/DS00358 . Updated July 2008. Accessed September 24, 2008.
Herpes simplex. American Academy of Dermatology website. Available at: http://www.aad.org/default.htm . Accessed September 24, 2008.
Miller C. Oral herpes/cold sores essential facts. Australian Herpes Management Forum website. Available at: http://www.ahmf.com.au/oralherpes/essentialfacts.htm . Updated June 2007. Accessed September 24, 2008.
Because they have very recognizable features, cold sores are most often diagnosed by physical exam and by your medical history. If your doctor is not sure, she may take a sample of the fluid or tissue from the blister or a blood sample for testing.
Testing may include any of the following:
- Viral culture—With a cotton swab, a sample of the fluid from the cold sore blisters is taken as soon as possible after an outbreak begins. The virus is then grown in the laboratory and identified. This test is very accurate if the sample is taken while there are still clear blisters.
- Tzanck test—The cold sore is lightly scraped to collect cells onto a glass slide. These cells are then examined under a microscope to identify them. This test is quick, but is accurate in only 50%-70% of cases.
- Antibody titer (ELISA)—The body creates antibodies to fight an infection. This blood test measures the level of antibodies made by the body to fight herpes simplex virus (HSV). It is about 85% accurate in detecting if you have been infected by HSV. However, it is not used routinely as the only diagnostic test.
- Polymerase chain reaction (PCR)—This test multiplies the number of pieces of the HSV in the test fluid, making it easier to detect. This test is as accurate as a culture, but with quicker results. It is expensive, however, and not commonly used.
References:
Beers MH, Fletcher AJ, et al. Merck Manual of Medical Information. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003.
Cold sore. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/cold-sore/DS00358 . Updated July 2008. Accessed September 24, 2008.
Herpes simplex. American Academy of Dermatology website. Available at: http://www.aad.org/default.htm . Accessed September 24, 2008.
Miller C. Oral herpes/cold sores essential facts. Australian Herpes Management Forum website. Available at: http://www.ahmf.com.au/oralherpes/essentialfacts.htm . Updated June 2007. Accessed September 24, 2008.
Most people are exposed to herpes simplex virus (HSV) when they are children. However, some contract the virus when they are adults. Once you have HSV, it cannot be cured, but changing some lifestyle activities can lower the risk of contracting it or having recurrent outbreaks.
Here are some of the tips for reducing your risk of contracting HSV or having recurrent outbreaks of cold sores:
- Avoid exposure to the virus that causes cold sores.
- Avoid excessive exposure to the sun.
- Reduce physical and emotional stress.
- Practice good hygiene habits.
- Avoid certain foods.
- Get adequate sleep and eat a healthful diet.
Avoid Exposure to the Virus that Causes Cold Sores
HSV can be spread by close contact with someone who has a cold sore or by using items contaminated with the virus. Do not kiss, have close contact with, or share personal items (such as towels, razors, and eating utensils) with someone who has an active cold sore, or thinks he is about to have one. It can also spread to the genital area by having oral sex. Do not let a partner with an active cold sore perform oral sex on you.
Avoid Excessive Exposure to the Sun
Exposure to sunlight is known to cause outbreaks of cold sores. Although it is impossible to avoid all sun exposure, use sunscreen on your lips and skin to help reduce the sun’s effect. Also, whenever you go outside in sunny weather, wear a large-brimmed hat to protect your face from the ultraviolet rays.
Reduce Physical and Emotional Stress
Physical and emotional stress may reduce the body’s ability to fight HSV, and stress may trigger an outbreak of cold sores. Although exercise may actually help to reduce emotional stress, an excessive amount can weaken the body. Relaxation techniques , such as meditation and deep breathing, can help reduce emotional stress.
Practice Good Hygiene Habits
Good hygiene can prevent the spread of cold sores and help reduce the length and severity of the outbreaks. During an outbreak:
- Avoid touching the sores, especially avoid contact with any open cuts on your skin.
- Wash your hands frequently during the day.
- Keep your fingernails clean by scrubbing daily.
- Take care not to spread the virus to other parts of your body such as the eyes and genital area.
Avoid Certain Foods
Foods that irritate the tissue of the lips and mouth, such as certain fruits or spices, may trigger a cold sore outbreak. These food-related “triggers” are different for every person. Be aware of your trigger foods and avoid them.
Get Adequate Sleep and Eat a Healthful Diet
The body heals fastest when it receives rest and good nutrition. Strive for a good night’s sleep, along with a balanced, healthful diet .
References:
Beers MH, Fletcher AJ, et al. Merck Manual of Medical Information. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003.
Cold sore. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/cold-sore/DS00358 . Updated July 2008. Accessed September 24, 2008.
Herpes simplex. American Academy of Dermatology website. Available at: http://www.aad.org/default.htm . Accessed September 24, 2008.
Miller C. Oral herpes/cold sores essential facts. Australian Herpes Management Forum website. Available at: http://www.ahmf.com.au/oralherpes/essentialfacts.htm . Updated June 2007. Accessed September 24, 2008.
The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.
Screening Guidelines
There are no screening guidelines for cold sores.
A simple antibody blood test can show if you have been exposed to the herpes virus in the past. If you test positive, it means you could get a cold sore in the future. However, since almost everyone tests positive for herpes simplex type 1, this test is not very useful for screening purposes.
References:
Beers MH, Fletcher AJ, et al. Merck Manual of Medical Information. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003.
Cold sore. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/cold-sore/DS00358 . Updated July 2008. Accessed September 24, 2008.
Herpes simplex. American Academy of Dermatology website. Available at: http://www.aad.org/default.htm . Accessed September 24, 2008.
Miller C. Oral herpes/cold sores essential facts. Australian Herpes Management Forum website. Available at: http://www.ahmf.com.au/oralherpes/essentialfacts.htm . Updated June 2007. Accessed September 24, 2008.
You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with cold sores. By talking openly and regularly with your doctor, you can take an active role in your care.
General Tips for Gathering Information
Here are some tips that will make it easier for you to talk to your doctor:
- Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
- Write out your questions ahead of time, so you don't forget them.
- Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
- Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.
Specific Questions to Ask Your doctor
About Cold Sores
- What causes cold sores?
- What are the symptoms of cold sores?
- How long do they last?
- How are cold sores diagnosed?
- Are there any serious complications of herpes simplex that I should be aware of?
About Your Risk for Developing Cold Sores
- Based on my medical history, lifestyle, and family background, am I at risk for cold sores?
- How do I know if someone in my family had or has cold sores? What physical signs or symptoms should I be looking for?
- When are people with cold sores most contagious? Who is most vulnerable to catching herpes simplex from me?
- How do I best prevent cold sores?
About Treatment Options
- What is the best treatment option for cold sores?
- Can they be cured?
- What medications are available to help me?
- What are the benefits/side effects of these medications?
- Will these medications interact with other medications, over-the-counter products, or dietary or herbal supplements I am already taking for other conditions?
- Are there any alternative or complementary therapies that will help me?
About Lifestyle Changes
- Can I make any changes in my activities that will help prevent cold sore outbreaks?
- Are there dietary changes I should make?
- Can I exercise?
- How often should I exercise?
- What can I do to help reduce stress in my life?
- Can I spread HSV-1 from my mouth to parts of my partner’s body during sex?
About Your Outlook
- How often will I have an outbreak?
- Are there other treatments for me if I have frequent recurrences?
