Cold sores, technically knows as herpes labialis, are caused by herpes simplex virus type 1. (Note: it is herpes simplex virus type 2 that is responsible for genital herpes infections).
Across Canada, 90 per cent of us are exposed to herpes infection by the time we reach adulthood, although only 20 to 40 per cent experience recurrent cold sore outbreaks.
The initial infection results from contact with saliva that contains the virus. It is usually indistinguishable from an upper respiratory tract infection. However, there can be fever, chills, muscle aches, plus an outbreak of tiny blisters in and around the mouth.
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On average this initial infection lasts about three weeks, but the virus is able to remain dormant in the neural ganglion cells (that is, the nerve cells that branch from the brain or central nervous system to the facial epithelia or skin).
Thus, once infected, we may be always infected and the virus itself may persist and be reactivated to cause cold sore symptoms.
Reactivation of the herpes virus is usually the result of a stress. Infections, fever and other viral infections such as the common cold place a strain on the body’s systems which can trigger cold sore outbreaks.
In fact, it was this close relationship between the common cold and herpes that gave the latter its common name of “cold sores.” Other stressors can include sun exposure, impaired immune system such as with HIV infections, women’s monthly periods and eczema.
As well, emotional stress on its own can promote an outbreak.
Cold sores are comprised of fluid-filled blisters usually around the mouth, lips and nose. The blisters break open and ooze so that crusts eventually form over the lesions. The cold sores last for two to three weeks and clear without leaving scars. They can be painful, itchy and cause a burning sensation.
Often, because of the irritation, people scratch them, which may lead to secondary bacterial infections.
Antiviral drugs are the mainstay of therapy. However, they must be started as soon as possible because as time elapses the viral numbers can increase dramatically to the point where they overwhelm the drug.
Acyclovir cream and ointment can be applied directly to the cold sore, but the treatment needs to be applied at least five times daily and care needs to be taken to not touch the application tube to the lesion.
Oral antivirals include acyclovir, famciclovir and valacyclovir. Again, they must be started as soon as possible. Some people experience a prodrome or a “tingling” sensation just prior to a cold sore outbreak. This is the ideal time to start antiviral drugs.
Cool or warm compresses applied to the lesions, oral pain relievers like acetaminophen, and even topical anaesthetic/anti-inflammatory products may help alleviate symptoms.
Cold sores are certainly unpleasant, but they are not deadly. Be aware, though, that people with immune system problems whose cold sores are severe or recur often, or whose eyes may become infected need to consult their health care provider as soon as possible.
