Many people who develop cold sores never experience it for the second time. It is because the body produces antibodies in response to the virus. However, the number of times cold sores occur varies from person to person. The virus may remain inactive after the first infection for the rest of the person’s life or cause more infections, leading to blisters and other symptoms. Continue reading to learn if you are at risk of developing recurring cold herpes and how to get rid of this condition.
Causes
Cold sores are usually caused by a virus called HSV-1, but in rare cases, they may result from HSV-2 infection (herpes simplex virus type 2). Both viruses are highly contagious and spread through close contact with other people. The most common way to infect someone with HSV-1 or HSV-2 is by kissing and sexual contact, but the infection may also happen if you share personal hygiene items such as razors, towels, and lip balm.
According to the World Health Organization, 3.7 billion people younger than 50 carry herpes simplex type 1, which means they developed cold sores infection at some point, and their bodies contain antibodies for HSV-1.
The infection caused by herpes simplex virus type 2 is way less common. It is estimated that 491 million people under 50 have it, with sexual contact being the most common cause.
What Triggers Cold Sores?
Carrying either HSV-1 or HSV-2 puts you at risk of developing blisters on your lips, mouth, or chin. Whether the virus activates or not depends on numerous factors, including:
- High levels of stress
- Menstruation
- Eczema
- High temperature (fever)
- Certain foods
- Allergies
- Fatigue
- Cosmetic surgery
- Dental work
- Weakened immune system
- Exposure to the sun
- Chemotherapy
- Severe burns
The above factors may cause the virus to activate and cause the infection. They vary from person to person, meaning specific triggers won’t result in cold sores in some people.
As for getting the HSV-1 or HSV-2 virus for the first time, the risk is associated with intimate contact with other people and sharing items, especially personal hygiene items such as toothbrushes, razors, and lip balms. Contacting the infected person’s saliva puts you at the highest risk of getting the virus, which most often occurs while kissing and sharing drinks.
First Signs and Symptoms
The first cold sores infection is different from the following outbreaks. In addition to blisters, the following symptoms may develop after 2 to 20 days after exposure to the virus:
- High body temperature
- Swollen lymph nodes
- Muscle pain
- Upset stomach
- Dehydration
- Nausea
- Difficulty swallowing
- Sore throat
- Tongue or mouth pain
- Burning sensation in the mouth
A burning sensation on the face or lips often develops several days before sores appear. The sores themselves are usually tiny red blisters filled with fluid. They may appear on the chin, mouth, lips, and rarely inside the nostrils. It is possible to develop more than one cold sore.
Blisters are tender to the touch and may cause pain. They crust over time, which usually takes up to two weeks. Until that happens, sores are highly contagious.
Don’t hesitate to contact your healthcare provider if you develop additional symptoms besides the sores. Although rare, severe cold sores may lead to serious health complications.
Stages of Cold Sores
So, what does the outbreak of cold sores look like? A typical case of cold sores goes through five major stages – tingling, blistering, bursting, crusting, and healing.
Stage 1: Tingling
Before other symptoms appear, cold sores cause a tingling or itching sensation around the mouth, especially on the lips. An uncomfortable prickling feeling usually persists for one to two days.
Stage 2: Blistering
After about 48 hours after exposure to the virus, blisters start to form on the mouth, accompanying a tingling sensation. Blisters contain highly contagious fluid. There may be only one sore to appear, but more may follow. Areas most often affected are around the mouth, but sores may also develop in cavities such as nostrils and eyes.
Stage 3: Bursting
At this stage, sores start to erupt, resulting in open, oozing, and painful blisters. It usually occurs four or five days after the exposure. Since the sores ooze, stage 3 is the most contagious period of the infection. During that time, you should avoid intimate contact with people and not share personal hygiene items.
Stage 4: Crusting
At stage 4, ruptured sores that left open wounds are being repaired by the body, forming a crust on the surface of the sores. Crusting is one of the body’s defense mechanisms when faced with damaged skin. The crust helps keep foreign bodies out of the vulnerable area, making it heal faster.
The crust shrinks over time, which often causes itchiness and uncomfortable sensation. It may bleed if you scratch it too hard.
Stage 5: Healing
Cold sores infection usually reaches the last phase after 8 to 10 days. The scabs fall away when the healing process is close to its end, revealing a fresh layer of skin.
Recurring Cold Sores
Recurrent cold sores usually don’t involve additional symptoms that may develop after the first exposure to the virus. In most people, recurrent blisters heal within 7 to 10 days.
Following tips on preventing cold sores and avoiding triggers that make sores appear on your face can lower the frequency of the infection and even stop it from occurring entirely. See ‘How to Prevent Cold Sores?’ to learn what you can do.
Complications
Complications are more likely to occur during the first infection of cold sores when your body hasn’t produced any HSV-1 or HSV-2 antibodies. They are very rare and are more often diagnosed in children. The possible outcomes include:
- Persistent fever
- Skin infections
- Difficulty breathing or swallowing
- Herpetic keratoconjunctivitis
- Herpetic whitlow (whitlow finger)
- Red, irritated eyes
Untreated severe cold sores can harm the eye’s health, leading to vision loss if herpetic keratoconjunctivitis develops. If you have cold sores and experience any changes in vision or inflammation in the eye area, seek medical care as soon as possible.
Diagnosis and Tests
Most healthcare providers can diagnose cold sores by looking at the affected area. If the origin of the blisters is not fully clear to the healthcare professional, they may order tests, including the swab test and blood test.
A swab test involves taking a sample from the sore’s fluid to determine if it contains HSV viruses. Although a blood test is not recommended for people without symptoms, it is a preferred way of diagnosing cold sores in some cases.
Treatment
Strong immune systems can neutralize cold sores within 7 to 10 days after exposure to HSV. Recurrent infections also often subside on their own. However, not everyone can treat cold sores without medication and adequate self-care management. The following treatment options are the most often recommended ways by doctors to deal with herpes simplex virus:
- Over-the-counter medicines: Non-prescription antiviral creams and ointments relieve itchiness and tingling sensation and promote healing in stages 4 and 5 of cold sores.
- Lemon balm: According to scientific evidence, lemon balm supports healing cold sore lesions. In addition to cold sores and herpes, lemon balm is used to treat eczema and wounds.
- Antiviral prescription medicines: Some healthcare professionals may decide to prescribe you an antiviral medication to boost your immune system and stop the virus from multiplying.
- Pain-relievers: If your blisters cause a lot of discomfort and pain, you may benefit from applying pain-relieving medicines to your sores.
- Sunscreen: Sunscreen does not have healing properties but is essential to cold sores treatment. Sun rays can worsen blisters and even trigger an infection outbreak in some people. Protecting your skin from sun rays is crucial when you are affected by this condition.
How to Prevent Cold Sores?
Preventing cold sores involves a combination of lifestyle changes and awareness of potential triggers. While it may not be possible to reduce the risk to zero, these strategies can help reduce the frequency of outbreaks:
Maintain good hygiene:
- Avoid close contact with someone who has an active outbreak of cold sores.
- Refrain from sharing personal hygiene items like toothbrushes, razors, towels, and lip balm.
- Wash your hands regularly, especially after touching your face or an active cold sore.
Sun protection:
- Use lip balm with sunscreen to protect your lips from sun exposure.
- Wear a wide-brimmed hat and sunglasses outdoors, especially in strong sunlight.
Manage stress:
- Practice stress-reduction techniques such as meditation, yoga, or deep breathing exercises.
- Get adequate sleep to help reduce stress levels.
Look into your diet:
- Avoid foods that may trigger outbreaks, such as nuts, chocolate, and citrus fruits.
- Maintain a balanced diet rich in vitamins and minerals to support your immune system.
Medications:
- Consult your healthcare provider about antiviral medications that may help reduce the frequency and severity of outbreaks.
- Over-the-counter creams and ointments may provide relief during an outbreak.
Avoid known triggers:
- Identify specific triggers that lead to your cold sore outbreaks and take steps to avoid them.
- If hormonal changes or certain foods trigger outbreaks, adjust your lifestyle accordingly.
Improve your immune system:
- Maintain a healthy lifestyle with regular exercise and a well-balanced diet to boost your immune system.
- Consider taking supplements like lysine, which may help prevent cold sore outbreaks.
Early treatment:
- If you feel a tingling or itching sensation around your mouth, take action immediately. Apply a cold sore treatment or consult your healthcare provider for prescription medication.
Safe sexual practices:
- If you or your partner have genital herpes (HSV-2), use safe sexual practices to prevent the spread of the virus to the oral area.
Remember that while these strategies can help reduce the risk of cold sores, the herpes simplex virus (HSV) may still be present in your body, and outbreaks can occur regardless of your efforts. By incorporating these countermeasures into your routine, you can better manage and minimize the impact of cold sores on your life.
Key Facts
Cold sores are mainly caused by HSV-1, transmitted through close contact, especially kissing, and sharing personal hygiene items that may contain saliva with the virus. HSV-2 can also lead to cold sores but is less common, primarily transmitted through sexual contact.
Various factors can trigger cold sore outbreaks, including stress, fever, certain foods, allergies, and fatigue. People with strong immune systems are more resistant to cold sores and less prone to triggering the outbreak.
First infection may result in such symptoms as high fever, swollen lymph nodes, muscle pain, and nausea. Cold sores appear as characteristic tiny red blisters filled with fluid, typically around the mouth, lips, or chin. They are usually diagnosed during a visual examination.
Treatment options include over-the-counter antiviral creams, lemon balm, prescription antiviral medications, pain relievers, and sunscreen for protection. Antiviral medications may be prescribed in more serious cases.
Preventive measures include good hygiene, sun protection, stress management, dietary adjustments, immune system support, early treatment of symptoms, and safe sexual practices if genital herpes is present.
While cold sores are not curable, understanding their causes, symptoms, stages, and treatment options can help individuals manage and reduce the frequency of outbreaks.
Sources
- World Health Organization. (2023). Herpes simplex virus.
https://www.who.int/en/news-room/fact-sheets/detail/herpes-simplex-virus - NIH. (2021). Cold sores: Overview.
https://www.ncbi.nlm.nih.gov/books/NBK525782/ - Amercian Academy of Dermatology Associacion. COLD SORES: SIGNS AND SYMPTOMS.
https://www.aad.org/public/diseases/a-z/cold-sores-symptoms - Amercian Academy of Dermatology Associacion. COLD SORES: DIAGNOSIS AND TREATMENT.
https://www.aad.org/public/diseases/a-z/cold-sores-treatment - Amercian Academy of Dermatology Associacion. COLD SORES: TIPS FOR MANAGING.
https://www.aad.org/public/diseases/a-z/cold-sores-self-care - Amercian Academy of Dermatology Associacion. COLD SORES: WHO GETS AND CAUSES.
https://www.aad.org/public/diseases/a-z/cold-sores-causes
