Schematic diagram of herpes simplex virus.
Cold sores are small blisters that develop on the lips
or around the mouth. They are caused by the herpes simplex virus and
usually clear up without treatment within 7 to 10 days. You may not have any symptoms when you first become infected
with the herpes simplex virus. An outbreak of cold sores may happen some
time later.
Cold sores often start with a tingling, itching or burning sensation
around your mouth. Small fluid-filled sores then appear, usually on the edges
of your lower lip.
When to visit your doctor/ GP
If you have had outbreaks of cold sores before, it is likely that you'll
know what they are if they return. You only need to visit your doctor/ GP if you are unsure whether it is a cold sore
or if it is severe and spreading further than just the lip. You must see your
GP if a cold sore has not healed after 7 to 10 days.
What causes cold
sores?
The herpes simplex virus is responsible for cold sores. There are
two strains, known as HSV-1 and HSV-2.
Herpes simplex
virus
The herpes simplex virus – or "cold sore
virus" – is highly contagious and can be easily passed from
person to person by close direct contact. After someone has contracted the
virus, it remains inactive (dormant) most of the time.
However, every so often the virus can be activated by certain triggers,
resulting in an outbreak of cold sores. These triggers vary from person to
person, but can include sunlight, fatigue, an injury to the affected area,
and, in women, their period.
Some people have frequently recurring cold sores around two or three
times a year, while others have one cold sore and never have another. Some
people never get cold sores at all because the virus never becomes active.
Treating cold sores
Cold sores usually clear up by themselves without treatment within 7 to
10 days. However, antiviral creams are available over the counter from pharmacies
without a prescription. If used correctly, these can help ease your symptoms
and speed up the healing time.
To be effective, these treatments should be applied as soon as the
first signs of a cold sore appear – when you feel a tingling,
itching or burning sensation around your mouth. Using an antiviral cream after
this initial period is unlikely to have much of an effect.
Cold sore patches are also available that contain hydrocolloid gel,
which is an effective treatment for skin wounds. The patch is placed over the
cold sore while it heals. Antiviral tablets may be prescribed for severe cases.
Complications of
cold sores
Cold sores are usually mild, but may cause complications in rare cases.
People with weak immune systems caused by illness or treatments such as
chemotherapy are particularly at risk of complications.
Dehydration sometimes occurs if drinking
fluids becomes painful. Young children are particularly at risk of becoming
dehydrated.
The herpes simplex virus can also spread to other parts of your body.
Examples of when this can occur include:
- skin infections – these
often occur if the virus comes into contact with broken skin, such as
a cut or graze, or a skin condition
such as eczema
- herpetic whitlow (whitlow finger) –
this causes painful sores and blisters to appear on and around
your fingers
- herpetic keratoconjunctivitis – this
causes swelling and irritation (inflammation) of your eye area and sores
to develop on your eyelids.
Left untreated, herpetic keratoconjunctivitis can cause the cornea, the
transparent layer at the front of your eye, to become infected, which can
eventually lead to blindness.
It is therefore important not to touch your eyes if you have an unhealed
cold sore. If you must touch your eyes – for example, to remove contact
lenses – wash your hands thoroughly first.
In very rare cases, encephalitis, a condition where the brain
becomes inflamed and swollen, can be caused by the cold sore virus spreading to
the brain. It can be treated with intravenous injections of antiviral
medications, such as aciclovir.
Preventing
infection
It's not possible to prevent infection with the herpes simplex virus or
prevent outbreaks of cold sores, but you can take steps to minimise the spread
of infection.
Cold sores are at their most contagious when they burst (rupture), but
remain contagious until they're completely healed. Avoid close contact with
others until your cold sore has completely healed and disappeared.
However, there's no need to stay away from work or miss school if
you or your child have a cold sore. You can help minimise the risk of the cold sore virus spreading and cold
sores recurring by following the advice below:
- avoid touching cold sores unless you're
applying cold sore cream – creams should be dabbed on gently rather
than rubbed in, as this can damage your skin further
- always wash your hands before and after
applying cold sore cream and after touching the affected area
- don't share cold sore creams or medication
with other people as this can cause the infection to spread
- don't share items that come into contact with
the affected area, such as lipsticks or cutlery
- avoid kissing and oral sex until your cold
sores have completely healed
- be particularly careful
around newborn babies, pregnant women and people with a low immune system,
such as those with HIV or those having chemotherapy
- if you know what usually triggers your cold sores, try to avoid the triggers – for example, a sun block lip balm (SPF 15 or higher) may help prevent cold sores triggered by bright sunlight.
Symptoms of cold
sores
You won't usually have any symptoms when you first become infected with
the herpes simplex virus (the primary infection). An outbreak of cold sores may occur some time later and keep coming back
(recurrent infection). However, if the primary infection does cause symptoms, they can be quite
severe.
Herpes simplex
virus primary infection
In children
Symptoms of the primary infection are most likely to develop in children
younger than five years old. Symptoms include:
- swollen and irritated gums with small, painful
sores in and around the mouth – this is known as herpes simplex
gingivostomatitis
- sore throat and swollen glands
- producing more saliva than normal
- high temperature (fever) of 38C (100.4F) or
above
- dehydration
- feeling sick (nausea)
- headaches.
Herpes simplex gingivostomatitis usually affects young children, but
adults can also develop it. It can last 7 to 14 days, with the sores
taking up to three weeks to heal. However, gingivostomatitis doesn't usually
recur after the primary infection.
In adults
Primary herpes simplex viruses are rare in adults, but the symptoms are
similar to those experienced by children. You'll usually have a sore throat with or without swollen glands. You
may also have bad breath (halitosis) and painful sores
in and around your mouth. These can develop into ulcers with grey or yellow centres.
If you develop the herpes simplex virus at an early age, it may be
triggered periodically in later life and can cause recurring bouts of cold
sores. After the primary infection, the symptoms are usually reduced to just
the cold sores themselves.
Recurrent
infections (cold sores)
Recurrent infections usually last for less time and are less severe
than the primary infection. The only symptom is an outbreak of cold sores, although
you may also have swollen glands. An outbreak of cold sores usually starts with a tingling, itching or
burning sensation around your mouth. Small fluid-filled sores then develop,
usually on the edges of your lower lip.
If you have frequent recurrent infections, you may develop cold sores in
the same place every time. They may grow in size and cause irritation and pain.
Initially, they may ooze before crusting or scabbing over within 48 hours of
the initial tingling sensation.
If the cold sores are very troublesome, it's possible to suppress them
by taking an antiviral tablet called acyclovir regularly, every day for a few
months. This is usually only recommended if cold sores are causing a lot of
problems, and they may come back when treatment is stopped. Most cold sores disappear within 7 to 10 days without treatment and
usually heal without scarring.
Causes of cold
sores
Cold sores are usually caused by the herpes simplex virus. In most cases the virus is passed on in early childhood – for
example, when a child is kissed by a family member or friend with a cold sore.
The virus passes through the skin and travels up the nerves, where it
lies inactive (dormant) until it's triggered at a later date.
Cold sore triggers
Factors thought to trigger outbreaks of cold sores include:
- having another infection,
such as a respiratory tract infection
- having a high temperature (fever)
- emotional upset or
psychological stress
- tiredness and fatigue
- an injury to the affected area
- menstruation (periods)
- strong sunlight.
However, in many cases there is no obvious trigger for an outbreak.
Genital herpes
Cold sores can happen after having oral sex with a man or woman who
has genital herpes.
Treating cold
sores
Cold sores usually clear up without treatment within 7 to 10 days.
Antiviral tablets or cream can be used to ease your symptoms and speed up
the healing time. If you develop a cold sore, some general advice to follow includes:
- drink plenty of fluids to avoid dehydration
- avoid acidic or salty foods and eat cool, soft
foods
- if brushing your teeth is painful, use an
antiseptic mouthwash
- dab creams on to sores rather than
rubbing them in
- wash your hands using soap and water before
and after applying cold sore creams
- avoid touching your cold sores, other than to
apply cream, and don't share your cold sore cream with others.
Antiviral creams
and tablets
Antiviral creams such as aciclovir or penciclovir (also known
as Fenistil) may speed up the healing time of a recurrent cold sore
infection if used correctly. Cold sore creams are widely available over the counter from
pharmacies without a prescription.
They're only effective if you apply them as soon as the first signs of a
cold sore appear, when the herpes simplex virus is spreading and replicating.
Using an antiviral cream after this initial period is unlikely to have
much effect.
If you have frequently recurring bouts of cold sores, use antiviral
medication as soon as you feel the tingling sensation that indicates
a cold sore is about to develop. You'll need to apply the cream up to five
times a day for four to five days.
Antiviral creams can only help to heal a current outbreak of cold
sores. They do not get rid of the herpes simplex virus or prevent future
outbreaks of cold sores occurring.
Antiviral tablets are generally more effective than creams at treating
cold sores, but are usually only prescribed for more severe cases.
Cold sore patches
Cold sore patches that contain a special gel called hydrocolloid are
also available. They are an effective treatment for skin wounds and are placed
over the cold sore to hide the sore area while it heals.
Non-antiviral
treatments
Several non-antiviral creams are also available over the
counter from pharmacies without the need for a prescription.
These creams are not specifically designed to treat cold sores and won't
help them heal faster, but they may help ease any pain or irritation.
Ask your pharmacist to recommend a suitable treatment for you.
Pain can also be treated with painkillers such as ibuprofen or paracetamol – both are available in
liquid form for young children. However, do not take ibuprofen if you have asthma or stomach ulcers, or you've had them in the
past.
Children under the age of 16 should not be given aspirin. You must speak to your doctor/ GP if you have cold sores and you're pregnant.
Treating
complications
If your cold sores are particularly severe or your immune system is
damaged – for example, if you have HIV or you are having chemotherapy treatment – you may be
at risk of developing serious complications.
For example, your risk of developing encephalitis or the infection spreading
to other parts of your body, such as your eyes, is increased. You should visit your GP if you are at risk. They may prescribe antiviral
tablets and refer you for specialist treatment.
The type of treatment recommended will depend on the severity of your
cold sore symptoms and the complication that's causing problems. For example, if you develop herpetic keratoconjunctivitis – a
secondary eye infection – you may need to see an ophthalmologist, a
specialist eye doctor.
Gingivostomatitis
Visit your GP if you or your child develops swollen, painful gums
(gingivostomatitis) as a result of the primary herpes simplex infection.
They'll be able to suggest treatments to help ease your symptoms.
If the infection is painful, your GP may suggest using a preparation
that contains benzydamine, which is available as an oral rinse or oral
spray, to help relieve any pain in your mouth or throat.
Brushing your teeth may also be painful because of the swelling of your
gums. Your GP may suggest using an antiseptic mouthwash. This helps prevent
secondary infections and will also control a build-up of plaque if you can't
brush your teeth effectively.
As with the treatment of cold sores, any pain or fever can be treated
using ibuprofen or paracetamol. In rare cases of gingivostomatitis, it is possible for your lips to
become stuck together in places. Using a lip barrier cream available from your
local pharmacist will help prevent this.
Dehydration
If you or your child has gingivostomatitis, it's important to drink
plenty of fluids to avoid becoming dehydrated. Young children are particularly
at risk as they may refuse to eat or drink because of the pain in
their mouth. It's important to watch out for signs of dehydration, such as:
- headaches
- tiredness
- irritability
- lightheadedness
- low urine output.
Most cases of gingivostomatitis get better in 7 to 14 days, although it
may take up to three weeks for the sores to heal completely.
Specialist
treatment
If you or your child still has symptoms of gingivostomatitis after two
weeks or the infection is severe, go back to your GP, who may refer you for
specialist treatment. Specialist referral may also be needed for gingivostomatitis if you're
pregnant or have a weakened immune system.
You should visit your GP if you have a newborn baby who develops gingivostomatitis,
as they may also need to be referred for specialist treatment.
Source: NHS Choices