Cold Sores

Cold sores spread from person to person through direct contact with an infected area i.e oral-to-oral contact like kissing or sharing utensils or towels ^1E,3D.  Cold sores last 10 to 14 days and are often very severe, making eating and drinking extremely uncomfortable ^1F.

There are 2 strains of this virus; HSV-1 and HSV-2. The main differentiator of the two herpes simplex viruses is their location or where they appear ^1A,G,2B.

• Herpes Simplex 1 (HSV-1) is usually associated with sores on the lips (Herpes labialis) ^1A,G,2B.
• Herpes Simplex 2 (HSV-2) is associated with sores on the genitals and is almost entirely sexually transmitted ^1A,G,2B.

Primary Infection:

The initial cold sore infection can appear 2 to 20 days after contact with the virus ^3E. The first infection may be very painful with symptoms of painful sores inside the mouth, tender enlarged lymph nodes, fatigue, fever and feeling generally ill ^1H,3F,4B,7A. This can lead to poor oral intake and dehydration ^3G. After the primary infection, the virus lies dormant in the body but can reactivate to cause symptoms ^3I.

Recurrent infections:

Oral HSV-1 recurs up to 6 times a year ^3C.  Cold sores can affect appearance and impact quality of life ^3H.  Recurrent infections are unlikely to be clusters ^1J. The duration of the symptoms tend to be shorter with symptoms being less severe ^3I.

The herpes simplex virus (HSV-1) is the cause of the infection however the infection can be reactivated by triggers such as psychological and environmental factors ^1A,L,3K. Triggers of cold sore outbreaks vary from person to person. It’s important to identify what your cold sore triggers are, so you can manage them to help avoid developing a cold sore. Here are some of the more common cold sore triggers ^{1L,3K,5A,6A,B,7B}.

People who have weakened immune systems are at higher risk of complications from the virus. Medical conditions and treatments that increase your risk of complications include ^7C:

• HIV/AIDS
• Severe burns
• Eczema
• Cancer chemotherapy
• Anti-rejection drugs for organ transplants

Tips to avoid the spread of cold sores to other people or to other parts of your body, you might try some of the following precautions ^7D:

There is no current cure for cold sores however antiviral medications are used to treat cold sores ^1M. Treatment is most effective if started early, when the lips start to tingle, burn or become itchy, before the blisters form^1M.  Commonly used antiviral medications are acyclovir or penciclovir ^1M.

Acyclovir is an antiviral medication that is active against Herpes Simplex Virus type 1 and type 2 and can be used for both primary and recurrent infections ^8A,B.

Antiviral creams like Acyclovir provide the below key benefits to cold sore patients:

• Prevents the virus from replicating ^8C
• Reduce the severity of symptoms ^9A
• Therapy should be initiated as soon as possible following the onset of signs and symptoms of herpes simplex infection ^8D
• Treatment should be continued for 5 days. If healing has not occurred, the treatment may be prolonged for up to 10 days ^8D