Cold Sores

Not only do cold sores sneak up on you but in a considerable number of patients cold sores really are very persistent indeed. They just keep coming back, often for years and sometimes for life. The particular cold sores that we are looking into are those caused by the Herpes simplex 1 virus. See Fig. 1 below for an electron micrograph of the Herpes simplex 1 virus.

Figure 1: Electron Micrograph of the Herpes simplex virus; which causes cold sores and a number of other diseases which I shall discuss later. (Image Source: Wikipedia Herpes_simpex_virus.jpg‎)

Outbreaks

A typical cold sore outbreak is characterized by the development of a crop of small, red bumps that eventually turn into fluid-filled blisters generally located on or around the lips, or less often around the nostrils. These cold sores are usually caused by the Herpes simplex type 1 virus (HSV-1). For most of us initial exposure to the Herpes simplex 1 virus typically occurs during early childhood.

Infection

The Herpes simplex 1 virus (HSV-1) usually invades the body through small cracks in the skin. Once in; HSV-1 will travel along sensory nerves to the cell body of the neuron (soma). It is here in the sensory ganglia that HSV-1 will reside as a life-long, latent virus.

Infection for Life – It is important to note that in all cases HSV is never removed from the body by the immune system. Once you have been infected with HSV-1, the virus stays in your body for life, and can reactivate at any time.

HSV-1 Relapse – In some people the latent HSV becomes “reactivated” and will then travel down the sensory nerves to the skin, where it multiplies, causing the tell-tale blisters. It is for these reasons that cold sores tend to be a recurrent type of infection.

Asymptomatic – You can however remain asymptomatic for considerable periods of time as the Herpes simplex 1 and 2 viruses tend to undergo erratic and unpredictable periods of dormancy during which the patient experiences no symptoms. Recent studies have shown that more than 70% of Australian adults carry the HSV-1 virus. However, only approximately 30% of adults in Australia and New Zealand report experiencing cold sores.

HSV-1 and HSV-2 – While both HSV-1 and HSV-2 can cause cold sores and other forms of herpes infections such as genital herpes we generally find that the type of Herpes simplex virus causing the various forms of disease generally obey the following rules:

• Herpes simplex 1 -Above the waist
• Herpes simplex 2 – Below the waist

Cold Sore Outbreak Phases

1. Tingling – It is best to start treatment for cold sores immediately you get the tingling sensations. You may also find that you will experience additional precursory sensations such as itchiness, burning sensations, a redness around the lips and mouth or in some cases diffuse pain around the lips and mouth. This first phase can take place very rapidly and you may well find that you rapidly enter phase 2 very soon after becoming aware of phase 1.
2. Red and Swollen – The site of the cold sore will rapidly become red and swollen very soon after the tingling.
3. Blistering – This is the most infectious stage of a cold sore breakout. Small red, fluid-filled blisters will develop and quickly coalesce into a cluster of blisters.
4. Weeping – Cold sores (the coalesced blisters) will generally weep or burst leaving behind a shallow ulcer (crater). It is this stage of an outbreak that is usually the most painful.
5. Scabbing – Eventually the cold sore will “dry up” and form an unsightly yellow crusty scab which can often lead to embarrassment to the sufferer.
6. Healing – As the cold sore outbreak abates and heals the scabs left behind will eventually flake off revealing a region of pink-coloured skin that usually heals without a scar.

Cold Sore Outbreak Time Frame – This whole process if untreated, usually takes 5-6 days with a range of 2-20 days.

Warning Signs Cold Sore Outbreak Imminent – Most sufferers who experience sporadic episodes of cold sore breakout will invariably find that they do experience specific sensations and other telltale warning signs that herald an imminent cold sore outbreak. Some of which are: tingling sensations, burning sensations, itching, pain or redness around the lips or mouth.

Predicting Cold Sore Breakout Site – Most times the preliminary warning signs will be experienced at and around the site of the pending future breakout. This is really handy since it does allow the sufferer to apply treatment to the correct location thereby concentrating ones countermeasures where they will have the greatest benefit.

Early Treatment – It is most advisable to begin treatment immediately upon becoming aware of the first indications that an outbreak is imminent. Prompt response and implementation of a treatment regime as early in an outbreak as possible is the key to delivery of the maximal benefits of said treatment regime.

Cold Sore Outbreak Triggers – As with most diseases there are a number of factors that can act as the stimulus (trigger) for a cold sore outbreak. These include: dry chapped lips, excessive exposure to direct sun light, fatigue, fever, illness, menstruation, skin trauma, stress, the common cold

Epidemiology

Make no mistake about it cold sores are contagious. The virus (HSV-1) can be passed on from person to person through close physical (skin-to-skin) contact or saliva even when blisters are not present.

Initial Exposure and Infection – Initial HSV-1 infection generally occurs very early in life; as a baby or child, from contact with HSV carriers. This includes parents, relatives and other acquaintances and associates (domestic help for example) and more often than not involves kissing. It can also be acquired in later life from activities such as oral sex.

Times of Highest Risk – Although it is possible to transfer the virus even when there is no apparent cold sore, the risk is much higher when the cold sore is visible, as the virus can be shed making it easy to infect other people.

Recurrent Cold Sore Outbreaks – Many people have recurrent cold sore outbreaks, but the good news is these tend to become milder and less frequent with age, and may even stop occurring.

Treatment

While we can’t currently totally eradicate HSV from our bodies the actual cold sores themselves can be treated in a variety of ways to help reduce the painful effects of a breakout as well as to expedite the healing process.

Maximizing Treatment Effectiveness and Benefits – Note that in order to gain the best results of a treatment regime sufferers should commence treatment as soon as possible.

Over-the-Counter Antiviral Treatments – There are a number of antiviral treatments for cold sores some of which are available as over-the-counter creams that are applied multiple times a day for 4-5 days.

Medical Science – Doctors also have the option of recommending both non-prescription and prescription-only tablet treatment regimes. If you get cold sores frequently or if they are severe, seek advice from your doctor about which type of treatment is better for you. The options available include the following:

• One dose tablet treatment
• Twice-daily tablet treatment
• Creams that are applied multiple times daily for 4-5 days. Always have treatment on hand so you can treat the outbreak early for optimal benefit.

Medical Assistance – If your current outbreak of cold sores is not such that immediate medical assistance is required you should make a point of discussing the subject with your doctor at your next doctor’s visit.

Be Prepared – Always bear in mind that cold sores are especially unpredictable. For this reason it is important that you always have treatment on hand. In this way you will be ready for any future cold sore breakout episode as and when it occurs.

Additional Resources and Links

Remember that doctors are the best people to consult for advice on cold sores. Always verify any information that you find online with your doctor. There are a number of cold sore and general herpes simplex virus-related websites on the Internet that provide accurate and up-to-date information. Here are a few to get you started:

Australian Herpes Management Forum – www.ahmf.com.au

Australian Herpes Website – www.herpes.com.au

International Herpes Management Forum – www.ihmf.org

International Herpes Alliance – www.herpesalliance.org

New Zealand Herpes Foundation – www.herpes.org.nz

Conclusion

All cold sore treatments are at their most effective when begun as early in an outbreak as possible. Attacking both Herpes simplex 1 and 2 viruses when they first start to multiply is critical to the successful reduction of the effects and consequences of an outbreak. Early treatment will help speed healing and reduce pain and tenderness.