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Cold Sores

Information and treatment options for cold sores

Cold sores are caused by a strain of the herpes simplex virus (HSV-1). It is estimated that at least two-thirds of the UK population have this strain of herpes. An outbreak can be triggered, forming fluid-filled blisters usually around the mouth area. Whilst there is no cure for the herpes virus, cold sores are completely manageable with the right treatment.

What are cold sores?

Cold sores (labia herpes) are a common and contagious condition that causes small fluid-filled blisters, normally on the lips or around the mouth. They can also appear anywhere on the face, including the chin, cheeks and nose as well as the inside of the nostrils or inside the mouth. A small minority of individuals find that herpes simplex virus (HSV-1) can appear anywhere over the body, such as the fingers.

Outbreaks tend to clear up within 7-10 days and they may also be referred to as "fever blisters". Once the blisters burst, they form scabs until the infection has healed without scarring.

The strain of herpes simplex virus that causes cold sores is the type 1 strain (HSV-1). Type 2 (HSV-2) causes genital herpes. Both result in similar symptoms, and one can also cause the other (typically through oral sex).

When you initially become infected with herpes simplex virus, symptoms aren't always noticeable but most will find the first outbreak occurring within 20 days. Outbreaks generally last between a few days and 2 weeks. The rest of the time, there are no symptoms; this is known as being "dormant".

When cold sores begin to form you may feel "prodomes", meaning a number of smaller symptoms occurring before the main symptom. In this case, the prodome is the actual blisters/sores. This includes itching, tingling and/or burning sensation around the soon-to-be infected area. Fluid-filled sores will then appear, usually around the edges of the lips.

In order to successfully diagnose cold sores a qualified doctor will simply examine the cold sore. Occasionally, he or she may decide to take a swab from them but this isn't usually required.

Will I have cold sores for life?

Yes. The virus called herpes simplex causes cold sores, and all viruses stay within your body for the entirety of your life. This is the same for any viruses, including influenza (flu).

This doesn't mean you will have continual cold sores or blisters, but the virus will lay dormant for the majority of time. You may find certain triggers prompt an outbreak, and over time these tend to become easier to handle.

It is possible to be just a carrier of the herpes simplex virus. This means you will never experience an outbreak but you may pass it onto others. It is also possible to experience one outbreak and never have any others in the future because your body has efficiently created the antibodies to fight off the virus with the first try.

Cold sores and children

It is more common to be diagnosed with herpes simplex as a child than an adult.

One of the most common ways to be exposed to cold sores is, in fact, a family member. Cold sores can be transferred to children and babies through kissing relatives. If you have a cold sore present, or feel the initial tingling sensation, it's important to avoid kissing and close contact with children. This will not only pass the infection to the child who will then have the infection for life, but this can be dangerous in babies (neonatal herpes).

What are the causes of cold sores?

Cold sores are highly contiguous and can be passed through skin-to-skin contact – often kissing - as well as sharing appliances and items such as toothbrushes, razorblades and kitchen utensils. The risk of getting cold sores through shared items is quite low, however, you may wish to take additional precautions. It is also possible to contract cold sores from oral sex from an individual with genital herpes.

The most likely time to contract the virus is if you come into contact with a visible sore/blister. It is also possible, although less likely, to contract the herpes virus when the blisters have dried, or even through skin that looks unaffected as the virus lies within the surface of the skin and in saliva.

Known triggers of cold sores

Pinpointing a trigger can certainly help subdue cold sore bouts in the future. It's also worth noting that there may not be any triggers at all:

  • Tiredness or fatigue
  • Colds, flus and other illnesses
  • Lowered immune system
  • Injury to the affected area
  • High and low temperatures (fever)
  • Stress and other psychological factors
  • Strong sunlight/radiation
  • For women, hormonal changes in her cycle, i.e. menstruation
  • Having another infection, e.g. a respiratory tract infection
  • Skin trauma
  • Certain foods and drinks
  • Allergies

What causes the blisters to form?

The virus targets individual nerve cells and travels up to the 'ganglion' (a group of nerve cells) where it will remain dormant the vast majority of the time as our body effectively fights off any outbreaks. Blisters begin to form when this virus begins to multiply and reaches the surface of the skin. This is why tiredness and cold bugs tend to trigger cold sores; your immune system is not in top condition to combat the virus multiplying.

What are the symptoms of cold sores?

A primary infection in adults is rare as most people develop cold sores during childhood, however you may have the following symptoms for the first outbreak:

  • Burning, itching or tingling sensation
  • Ulcers and sores
  • Bleeding gums
  • A fever (high body temperature)
  • Blisters (sizes will vary and some small blisters may combine together)
  • Bad breath
  • Swollen lips, throat and/or glands
  • Difficulty swallowing
  • Nausea
  • Headaches

The initial outbreak tends to be the worst in symptoms as well as length. Recurrent cold sore infections usually last for a shorter time, between 6-10 days, and are more controllable with less troublesome effects. They tend to have limited symptoms such as the tingling sensation and the visible sores, but without the more serious symptoms listed under the first outbreak.

The process for recurrent outbreaks:

  • Before you witness the fluid-filled blisters, the tingling and/or burning sensation on and around the infected area that generally lasts for around 1-2 days. Beginning treatment at this stage is most advised.
  • The blisters will usually be visible for 2-5 days. This will be fluid-filled and will ooze to form a yellow crust.
  • Once the ulcer(s) burst revealing an open sore, this will only last for around 1 day before scabbing and ultimately healing approximately a week and a half later.
  • Sores tend to form in the same places as previous outbreaks, and they seldom leave scarring.

It is common not to notice any symptoms when you first become infected with herpes simplex virus, however when the first outbreak comes, it is often the most intense. Recurrent infections will be far more manageable. Symptoms can vary between adults and children, as well as in recurrent infections.

In children, the primary infection can include a sore throat and swollen glands, high temperature, nausea, headaches, irritated gums and possibly dehydration.

Frequency of the outbreaks

The number of times you experience cold sores will vary between each individual. If you've found that certain triggers prompt outbreaks, avoiding these may mean the virus is continually dormant. Others may experience cold sores on a monthly basis (continual preventative treatment is an option here) or just once or twice in a year.

How to prevent an outbreak of cold sores

The best way to prevent the herpes simplex virus is to avoid contact with the infection, however if you have already contracted HSV-1 there are simple ways to manage it. Whilst the frequency and severity ranges from person to person, you can follow these methods to help to prevent an outbreak of cold sores:

  • Avoid spreading the virus further through limiting the contact when the infection is active
  • Monitor your triggers to cut down on the amount of outbreaks
  • Washing your hands after touching a cold sore
  • Use sun cream on your face and lips when exposed to the sun
  • Avoiding kissing an individual with a cold sore
  • Avoid picking at any cold sores you have to stop the virus spreading to other areas of the body
  • Keep to a healthy diet and exercise plan to improve your lifestyle
  • Get enough sleep to avoid tiredness

How to treat cold sores

As all strains of herpes are a virus, there isn't a cure, but there are treatments are available that can stop the spread of the virus and speed-up recovery. Over-the-counter treatments are available and these offer relief from a range of symptoms. If you wish to also speed up recovery, antiviral prescription options offer a stronger solution and these should be taken a number of times a day as per doctor instruction and the patient leaflet.

  • Antiviral creams, such as Aciclovir 5% Cream, Zovirax and Fenistil Cold Sore Cream can be applied to the cold sores 5 times a day on a daily basis to ease the symptoms of this condition.
  • Antiviral medications like Valtrex, Famvir and Aciclovir can be taken in the form of tablets to relieve and treat cold sores symptoms as soon as they appear.
  • Over-the-counter (topical) medications usually contain benzocaine, lidocaine, tetracaine or dibucaine to name four active ingredients. They offer fast temporary symptomatic relief (10-30 minutes).
  • Sunscreen and lip balms containing sunscreen can be used if sunlight and radiation is a trigger.
  • Pain relief in the form of paracetamol and ibuprofen can be taken if symptoms are particularly painful.

These oral prescription treatments treat the virus directly in order to improve recovery time and should be taken within 48 hours of an outbreak for maximum effectiveness when treating cold sores.

How to use cold sore creams?

When using creams, it's important to gently dab the area, and not to vigorously rub the cream in. Then wash your hands with soap and warm water after application to avoid spreading the virus further. If you wish to be extra cautious, you can wear rubber gloves, which are easy to purchase online.

If you're prone to experiencing frequent bouts of cold sores or genital herpes, it is possible to be prescribed a continual preventative treatment. It is also advised to keep your preferred cream available in your medicine cabinet (be sure to check the expiry date before each use).

Self care; ease the symptoms of cold sores yourself

There are certain techniques you can use to help alleviate any discomforting cold sore symptoms, and speed up recovery.

  • Wash your hands frequently, especially after touching your face
  • Avoiding hot, acidic, salty and spicy foods
  • Eat soft foods that will not scratch or irritate the area
  • Use an antiseptic mouthwash rather than a toothbrush
  • Do not kiss anyone whilst a cold sore is present
  • Do not give oral sex whilst a cold sore is present
  • Limit shared items use such as cutlery, towels and cups
  • A cool compress can relieve itching and pain

The likelihood of you contracting the herpes virus (cold sores) through shared items such as towels and cutlery is very small, however you may want to remain on the safe side.

What if the treatment isn't working?

Cold sores take time to heal and once you begin using a cream and managing triggers, you should begin to see an improvement within 10 days. If there are no improvements within that time, you can arrange to see your GP.

If you believe the cold sore to be out of the usual, large, particularly painful or think it may be something else, you can also arrange a visit to your doctors.

If you have a weakened immune system for whatever reason (for example, if you have diabetes) or are pregnant, you should contact your doctor. There is an increased risk of babies contracting neonatal herpes, which will need to be monitored.

If you have children with cold sores, and their symptoms are particularly bad (swelling, trouble breathing, etc), you must visit a medical service as soon as possible.

How to buy cold sore treatment online

You can buy treatments for cold sores after completing a quick and confidential online consultation form. This consultation will include questions regarding your medical history, in particular which, if any, medications you are currently taking. This online consultation is reviewed by one of our partner doctors who will then approve your order if they deem your selected medication as suitable for your particular set of requirements when treating your case of cold sores. Once approved, you will be provided with a prescription. This prescription is then sent to our UK pharmacy who will then package and dispatch your chosen antiviral medication for delivery to the address you've allocated.

Your chosen medication will be delivered via our next day delivery service. All of the treatments we provide are delivered in plain and discreet packaging in order to uphold your privacy.

With our next day delivery service for all of the medications we offer, you will have your medication before the worst of the symptoms appear.