Bruce P.Robinson, MD

Cold Sores | Herpes Simplex Virus

The herpes simplex virus (HSV) causes blisters and sores often around the mouth, nose, genitals, and buttocks, but they can occur almost anywhere on the skin. HSV infections can be very annoying because they may reappear periodically. The sores may be painful and unsightly. For chronically ill people and newborn babies, the viral infection can be serious, but rarely fatal. There are two types of HSV - Type 1 and Type 2.

Herpes Simplex Virus

Often referred to as fever blisters or cold sores, infections are tiny, itchy, clear, fluid-filled blisters, often grouped together. They most often occur on the face.

Cold sores are caused by certain strains of the herpes simplex virus (HSV). HSV-1 usually causes cold sores. HSV-2 is usually responsible for genital herpes. But either type can spread to the face or genitals through close contact, such as kissing or oral sex. Shared eating utensils, razors and towels might also spread HSV-1.

Cold sores are contagious even if you don't see the sores. Cold sores spread from person to person by close contact, such as kissing. 

There are two kinds of infections - primary and recurrent. Although most people get infected when exposed to the virus, only 10 percent will actually develop sores. The sores of a primary infection appear two to twenty days after contact with an infected person and can last from seven to ten days.

The number of blisters varies from a single 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 to ooze, crust & scab. Eventually, crusts fall off, leaving slightly red, healing skin.

The sores from the primary infection heal completely and rarely leave a scar. However, the virus that caused the infection remains in the body. It moves to nerve cells where it remains in a resting state.

People may then have a recurrence either in the same location as the first infection or in a nearby site. The infection may recur every few weeks or not at all.

Children under 5 years old may have cold sores inside their mouths and the lesions are commonly mistaken for canker sores. Canker sores involve only the mucous membrane and aren't caused by the herpes simplex virus.

Recurrent infections tend to be mild. They can be set off by a variety of factors including fever, sun exposure, a menstrual period, trauma (including surgery), or nothing at all.

When to see a doctor

Cold sores generally clear up without treatment. See your doctor if:

  • You have a weakened immune system
  • The cold sores don't heal within two weeks
  • Symptoms are severe
  • You have frequent recurrences of cold sores
  • You experience irritation in your eyes

There's no cure for cold sores, but treatment can help manage outbreaks. Prescription antiviral pills or creams can help sores heal more quickly. And they may reduce the frequency, length and severity of future outbreaks.

Link to Domeboro instruction sheet

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