Cold sores are caused by a virus called Herpes Simplex Virus (HSV) 1A. The virus enters the body through a crack or damage in the skin thereafter it remains dormant inside the body in the collection of nerve cells (ganglia) near the spinal cord that supply the nerve fibres to the infected area1B,C. Although most people aren’t exactly sure when they first encountered the virus, it’s usually contracted in early childhood 3A,4A. Periodically the virus will reactivate when ‘triggered’ causing the virus to travel through the nerve fibres back to the skin to cause eruptions of blisters in the same site of infections 1D,3B.
Cold sores are highly contagious, affecting 64% of people worldwide (estimated 3.5 billion people) under 50 years old 1E,2A. Oral HSV-1 recurs up to 6 times a year 3C.
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.
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:
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 form1M. 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:
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