Cold Sores

What are cold sores?

Cold sores are small blister-like sores which show up around the mouth or on the lips. Caused by the herpes simplex virus, they usually clear up by themselves after 7-10 days.

What causes cold sores?

Cold sores are caused by the herpes simplex virus, which is also known as the “cold sore virus.” They are very contagious and easily passed on by coming into close contact with someone who has one. The virus lives inside the skin and is inactive most of the time. For some people, they may only ever have one cold sore, while others have outbreaks several times a year. It's possible to never know you have the virus as a cold sore may never appear. 

How do you catch cold sores?

Cold sores are caught by coming into close contact with someone with an active outbreak. They are most contagious at the point of the blisters bursting but the virus can be contracted at any time when the cold sore is visible. 

What causes cold sore outbreaks?

Outbreaks of cold sores are commonly triggered by: 

• Fatigue
• The presence of infection 
• Your period
• Direct sunlight
• Injury to the area
• Fever
• Emotional stress 

How common are cold sores?

The cold sore virus affects 85% of adults so it is very common. Not everyone with the virus will get visible cold sores however so you may never know you have it.     

What are the different types of cold sore?

Cold sores can appear anywhere around the mouth or lips. The first stage is a blister, which then bursts before it crusts over. There are two types of herpes simplex virus. HSV-1 is what causes cold sores and HSV-2 is genital herpes.

Are cold sores contagious?

Cold sores are highly contagious during an outbreak. If you have a visible cold sore then avoid kissing, sharing cutlery or any other items which come into contact with your mouth. 

Are cold sores painful?

Cold sores are often painful and uncomfortable. They usually begin as a tingling, burning or itchy feeling around the mouth before the blister appears.    

Cold sores vs angular chelitis

Angular chelitis is slightly different to a cold sore. It only occurs in the corners of your mouth, causing dry, cracked skin which may resemble a sore. It is caused by a buildup of saliva which encourages fungal bacteria to grow. In contrast, a core sore is caused by the herpes simplex virus and can appear anywhere around the mouth or lips. 

How to treat cold sores

A cold sore will clear up on its own within 7-10 days but treatment can speed up the healing process and relieve discomfort. Antiviral creams like Aciclovir or Penciclovir can be used to promote healing and relieve the discomfort of a cold sore. They will only work if the cream is applied as soon as you get warning signs of a cold sore. These include a burning, itching or tingling sensation. Aciclovir tablets can be prescribed by a GP for severe outbreaks. Hydrocolloid gel patches hide the cold sore while soothing the area and painkillers or Anti-inflammatories like Paracetamol or Ibuprofen can be taken to ease the pain or discomfort. 

How to prevent passing cold sores on

If you have an outbreak or an active cold sore then there are several steps you can take to avoid passing them on. These include:  

• Avoiding touching the cold sore with your hands. You should only do this if you are applying treatment to it
• Wash your hands after applying cream to the cold sore, or after touching it
• Don't share cold sore treatments with anyone else
• Avoid kissing or any form of oral contact until the blisters have healed
• Don't share cutlery, cups or glasses, or anything which comes into contact with your mouth
• Take extra care around newborn babies, pregnant women and anyone with a lowered immune system 

Can you cure cold sores?

There is no cure for the cold sore virus. It remains dormant most of the time and may only cause an outbreak occasionally, if ever.

Can cold sore outbreaks be prevented?

The anti-viral drugs Valacyclovir and Acyclovir can be taken regularly to reduce the likelihood of cold sore outbreaks. Avoiding triggers can also help to prevent them. For example, wearing sun protection and managing stress.  

How to speed up cold sore treatment

Using antiviral cream can help to speed up the treatment of a cold sore. Holding a cold flannel or ice pack over the affected area helps to soothe it and ease inflammation, as can taking ibuprofen or paracetamol. Always wash your hands before and after touching the cold sore and stay hydrated.

Complications of cold sores

Cold sores are not serious and usually clear up by themselves in 7-10 days. In some cases cold sores can cause complications in people with a lowered immune system. This includes: 

• Skin infections 
• Sores on the fingers
• Irritation and swelling in the eyes
• Dehydration 

Cold sores are dangerous for babies as their immune systems have not yet developed. Always avoid kissing babies if you have an outbreak of cold sores. 

Are cold sores an STI?

Cold sores are caused by the herpes simplex virus, known as HSV type 1. This is not the same as the genital herpes virus which is caused by HSV-2. The two viruses are related but cold sores are not a sexually transmitted infection. They can be passed on by kissing, sharing drinks or cutlery or towels. Genital herpes is passed on during sexual contact.

Will cold sores make me ill?

The first time you have a cold sore it may cause ulcers instead of the usual sores. You may also experience flu or fever-like symptoms. If this happens you can take over the counter medication such as ibuprofen to ease any symptoms. 

Can you get cold sores anywhere else?

Cold sores usually appear on the mouth but you can also get them on other areas of your body such as the fingers, nose and cheeks.

What triggers cold sore outbreaks?

There are several factors which can trigger an outbreak of cold sores. These include: 

• Stress and emotional upsets 
• Fatigue 
• Other infections 
• Menstruation 
• A fever 
• An injury to the affected area 
• Strong sunlight 

Why do cold sores come back?

Once you have the cold sore virus, herpes simplex, it continues to live inside your skin. For the most part, the virus stays dormant but certain triggers can cause cold sores to appear now and again.  

What are the different cold sore stages?

Cold sores begin as a tingly, burning sensation before a sore appears. The second stage is where the sore bursts. It then crusts over before disappearing.

Should I be worried if my child has cold sores?

The cold sore virus is common in children but it is not harmful. In children under 5 herpes simplex gingivostomatitis is more likely to occur. This may lead to the following symptoms: 

• Swollen, irritated gums 
• Sore throat 
• Swollen glands 
• Dehydration 
• Fever 
• Producing more saliva 
• Headaches
• Nausea 

If they have a cold sore ensure they wash their hands regularly and avoid picking or scratching at the sores. 

Are cold sores related to stress?

Stress can trigger an outbreak of cold sores. This can only happen if you already have the cold sore virus. Increased levels of stress hormones can cause your immune system to lower, leaving you feeling run down. This makes your body vulnerable to infection, including the appearance of cold sores.

Are certain foods bad for cold sores?

Acidic foods and those rich in an amino acid called Arginine can aggravate cold sores. These include:  

• Nuts
• Sesame seeds
• Sunflower seeds
• Chocolate 
• Wholegrains
• Flaxseeds 
• Green leafy veg 
• Citrus fruits
• Tomatoes 
• Vinegar 
• Fruit juice
• Wine 
• Salty foods

Can cold sores be passed on via kissing?

The herpes simplex virus can be passed on during kissing. You should avoid this if you have a visible cold sore or if you can feel one coming on (tingling, itching or burning sensation).

Can you catch cold sores from sharing a drink?

Cold sores can be passed on by sharing drinks, cutlery, lipsticks or towels. If you have a cold sore then avoid sharing anything you have had oral contact with. 

Cold sores and breastfeeding

Cold sores in babies are known as neonatal cold sores. These can cause serious harm to a baby as their immune system has not yet developed. If you have a cold sore, do not kiss a baby as this is the most common way they are passed on to them. Cold sores can be passed on during breastfeeding if you have sores around your nipples.

Are cold sores genetic?

Cold sores are not genetic, they are caused by the herpes simplex virus which is passed on by coming into close contact with someone with a cold sore.

When are you no longer contagious?

When your cold sores have completely disappeared you are no longer contagious. Once they have scabbed over the cold sore may still be contagious as it can still burst or leak.

Can you have oral sex if you have cold sores?

Oral sex should be avoided if you have cold sores as you can pass the virus on to the genitals which can cause genital herpes. 

Are cold sores dangerous?

While cold sores can be uncomfortable and unsightly, they are not dangerous. However, they can cause complications in people with lowered immune systems. Such individuals may experience: 

• Dehydration- which is particularly common in children 
• Skin infections- usually brought on by cuts, sores or skin reactions coming into contact with the virus
• Herpetic whitlow- this is where the sores spread to your fingers 
• Herpetic keratoconjunctivitis- this affects the eyes, causing swelling and irritation. If this is left untreated it can lead to a serious eye infection 

Sources

• NHS > Cold Sores
• NHS Inform > Cold Sores
• NHS > Neonatal Herpes
• Web MD > What are cold sores?
• Web MD > Angular Chelitis
• Herpes > Cold Sores
• BlisterBalm > What foods can trigger cold sores?