Answers to Questions about Cold Sores

Are cold sores really “herpes”?

Yes. cold sores are caused by a type of the herpes virus, but, it is rarely the same virus strand that causes genital herpes.

Cold sores are typically caused by Herpes simplex virus type 1 (HSV1). Genital herpes on the other hand is usually caused by a different strand of the virus called Herpes simplex virus type 2 (HSV2).

It is possible to transfer the different viruses to other areas of the body. HSV1 (or cold sores) can be transferred to the genitals through oral sex. In the same way, HSV2 (or genital herpes) can be transferred to the mouth.

How common are cold sores? Cold sores are very common. It is estimated that 80% percent of the American population have been exposed to the Herpes simplex virus (which is the virus that causes cold sores).

An interesting fact is that although a person has been infected with the herpes and cold sore virus, they may not necessarily experience an outbreak. This is because some people’s immune systems have the ability to completely suppress the virus.

Where do cold sores usually appear?

Cold sores are usually confined to the mouth area (particularly on and around the lip). Less commonly, cold sores can occur on other facial areas such as above the mouth, the nose, nostrils, cheek or chin.

Cold sores can also appear on the fingers, this is referred to as Herpes Whitlow.

Cold sores do not usually occur inside the mouth, however if they do, it is most likely on the gums or hard palette (roof of the mouth). If the lesion appears inside the mouth, especially on the soft tissue, it is most likely to be a canker sore, not a cold sore.

When cold sores reoccur they will typically appear in the same location that they did during previous outbreaks.

The difference between Canker sores & Cold sores

Cold sores or fever blisters are caused by the herpes simplex virus and are usually relatively easy to identify. To view pictures of the herpes virus (including cold sores and mouth herpes) visit our Herpes Pictures page.

There is another condition which can cause ulcers inside the mouth known as Canker sores. Canker sores are not a form of herpes, however, they are often confused and mistaken for cold sores.

Canker sores are ulcerations, especially of the lip or oral mucosa and can be caused by acute stress, trauma to the area in your mouth, allergies, or by a reaction to a particular bacteria.

Canker sores are not considered to be contagious. Cold sores and mouth herpes on the other hand are caused by the herpes simplex virus and can be very contagious.

If you are experiencing ulcerations on or inside of your mouth please visit your health care provider for a professional diagnosis. These two conditions can appear very similar and should not be self-diagnosed.

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How do you get cold sores?

Cold sores are generally contracted from skin to skin contact with an infected area. For example, if someone has a cold sore on their lip they can pass on the virus to another person’s mouth through kissing.

The usual incubation period of the virus (time before any symptoms show) is approximately two to twelve days after the first exposure to the virus. As most people contract cold sores before the age of seven, it is common for a person not to remember their first or ‘primary’ cold sore outbreak.

Once infected with cold sores, the virus remains inside the body in a latent (sleeping) state. Throughout a person’s life the virus can then become “activated” causing a cold sore recurrence.

What causes or “activates” a cold sore recurrence?

There are many factors that can influence or “trigger” a cold sore outbreak, however, it seems to be related to times when the immune system is lowered or run down.

Cold sore outbreaks can sometimes be triggered by the following:

Being run-down

Menstruation Cycle

Pregnancy

Drinking a lot of alcohol

Exposure of the area to strong sunlight

Conditions that compromise a person’s immune system

Where the body’s immune system is not functioning normally

Prolonged periods of stress

Fatigue

Ultraviolet light

Skin irritation (such as sunburn)

Diet and certain foods

Another illness (especially with fever)

Temperature extremes

Steroid medication (e.g., asthma medication)

Anything that lowers your immune system or causes local injury can trigger recurrences.

What are some of the symptoms of a cold sore?

Before a cold sore appears the area will sometimes tingle, feel slightly raised and may appear red and inflamed.

This pain or tingling sensation is called the prodrome (or warning symptom) and typically occurs 1 to 2 days before the cold sore appears.

A cold sore generally appears as a small, fluid-filled blister which goes through a cycle of phases. The blister will usually weep (ulcerate) and form a scab or ‘crusting’ before healing and disappearing completely.

What are the symptoms?. The duration of a cold sore outbreak may last from 8 to 12 days.

Are cold sores contagious?

Yes. Cold sores are caused by the Herpes simplex virus and, if the virus particles are transferred to another person they too can become infected.

Cold sores are typically spread by direct skin-to-skin contact with the virus. Kissing or rubbing against the infected area are common examples of how the virus particles can be transferred. See below for more information.

How is the cold sore virus spread?

If a person has an active cold sore on their lip the herpes virus particles can be transferred to any part of the body that is kissed, including the mouth, face or the genitals. Keeping this in mind, it is very important to avoid kissing and oral sex during an active bout of cold sores.

It should also be made aware that the virus is considered to be contagious from the very first sign of an outbreak (including the tingling, itching stage) until the area is completely healed again. The cold sore virus can also spread at times when there are no visible symptoms due to what is known as Herpes Viral Shedding.

It is important to take precautions during an active cold sore outbreak to prevent the virus from spreading.

Herpes and cold sores are most easily spread when a sore is present, but, the virus can also be spread at other times too. Some people notice itching, tingling or other sensations before they see anything on their skin.

These are called “Prodromal Symptoms” and they warn that the virus may be present on the skin. Herpes is most likely to be spread from the time these first symptoms are noticed until the area is completely healed and the skin looks normal again. Contact with the infected area (including oral sex, kissing and touch) is very risky during this time.

It is also possible to transmit virus particles to another person through intermediate objects such as a drinking glass, eating utensil, lip stick, lip gloss, toothbrush, or even a face cloth.

Can cold sores be spread to other body areas?

One kind of complication involves spreading the virus particles from the location of an outbreak to other places on the body by touching the infection. The fingers, eyes, and other body areas can accidentally become infected in this way.

Preventing self-infection is simple. Do not touch the area during an outbreak. If you do, wash your hands as soon as possible with soap and warm water. This will help prevent the virus from spreading further.

When are cold sores most contagious?

Cold sores are considered to be most contagious when the blisters have burst open and have begun to weep fluid. This is because the liquid held in these blisters contains literally millions of herpes simplex virus particles.

During an outbreak, the population of virus particles becomes less and less as the cold sore runs its course. There is a much smaller amount of virus particles present when the sore is healing and when the scab has formed.

However, as there are still virus particles present throughout every phase of the cold sore outbreak the infected area is still considered to be contagious until the skin has completely healed.

If you know that you have come into contact with the virus in the past few minutes or so (e.g. If you or your partner have just touched an infected area) the simple action of washing your hands and the infected area with soap and warm water can help to sweep away the virus from your hands and other areas. By doing this you can help avoid the virus from spreading further.

What is the best cold sore treatment?

This will depend on the individual. There are many different treatments and remedies for cold sores to assist with healing and help to prevent recurrences.

Cold Sore ointments such as Abreva and Zovirax can help to shorten the duration of the outbreak. Home remedies such as ice, alcohol, manuka honey, black tea (which is high in tannins) or diluted tea tree oil may also be helpful to speed recovery.





Ice can be applied to the sores to both numb and soothe the area, as well as lower the temperature of the infection, helping to inhibit the virus

Warm tea bags applied to the infected area every hour may be beneficial. This is because black tea bags (such as Early Grey) contain tannic acid which has antiviral properties, best used at the first sign of an outbreak

Petroleum jelly and other lip moisturizers can soothe and moisten the lips, helping to prevent the cold sore scabs from cracking and bleeding. Lucas Papaw ointment works really well.

There are also medicinal herbs and nutrients, such as Lysine, which can make a difference to the frequency of cold sores.

What can I do to prevent cold sores?

Healthy Living

By taking good care of yourself you can help your body defend against the cold sore virus, reducing the possibility of an occurrence. Good rest, low amounts of stress, moderate exercise and fresh fruit and vegetable juices will assist in boosting the immune system (your body’s natural defense system against the herpes virus).

Be Sun Smart

Exposure to sunlight and ultraviolet rays can trigger a breakout of cold sores. To help protect yourself wear a hat when you are outside in the sun and use a lip balm that contains sunscreen (preferably one with an SPF rating of 15+ or higher).

Moisturize

Damage to your lips can bring on an episode of cold sores, so it is important to keep your lips protected from chapping and wind burn. A moisturizing lip balm can help here.

If the cold sores are frequent, use a treatment to help reduce viral activity

The right management of your cold sores can make a difference, especially those which help to prevent the cold sore virus from becoming active in the first place.

Once a cold sore appears there are different treatments that you can use to shorten the duration of the outbreak and heal the symptoms more quickly. Visit the Cold Sore Treatments page to read through different products that may be able to help.

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