Thursday, April 18, 2013

Cold Sores--Ouch!

You know the feeling…tightness near your lip, tingling, stinging and swelling.  You sigh and think to yourself, “I hate this. How long is it going to last this time?” It is a cold sore. Nobody likes cold sores, and let’s face it not only do they hurt, but they are embarrassing!  If you suffer from cold sores you are not alone.  More than 80% of the population in the United States carries the virus that causes cold sores.  Not only are you not alone, but you don’t have to live with them anymore. 

Cold sores, or fever blisters, are actually lesions caused by the Herpes Simplex Virus (HSV).  These lesions appear as a cluster of blisters that are filled with fluid and are considered painful! There are two types of HSV, HSV-1 and HSV-2. Both types of HSV will cause blisters (lesions) around the lips or genitalia. Traditionally, HSV-1 has been associated with outbreaks above the waist, or oral herpes, and HSV-2 is associated with outbreaks below the waist, genital herpes.  However, either type can cause lesions in either area. The distinction between the two types of viruses and their origin of outbreak is not as distinct as it once was.  It appears now that the biggest difference in the types of viruses is the social stigma associated with them. 

Cold sores are considered highly contagious. It is contracted through contact with an infected person through a break in the skin.  It is possible for a person to have a microscopic break in their skin and be unaware that they susceptible. When considering that over 80% of the US population carries some form of the virus, it is a statistical certainty that you will come in contact with an infected person.

 Direct contact with an infected person can be
  • Kissing
  • Sharing a razor
  • Sharing eating utensils
  • Drinking after others
  • Various types of sexual contact
  • Any type of close contact

A large majority of people contract the virus from their parents or caregivers as an infant or small child. It is possible for someone to be contagious and spread the virus without knowing they have the virus, or being symptomatic (having a lesion).

There are two phases of the virus when it is contagious: active phase (outbreak phase) and shedding phase.  It is possible for a person to never experience an outbreak and still experience a shedding phase.  In fact, a great majority of people who are infected with HSV never have an outbreak, but do shed the virus still.  Thus, the person is contagious, but has no way of knowing that, as they are symptom free of the virus.  People that do experience outbreaks can still experience the shedding phase between outbreaks.  The majority of people who contract HSV do so from an infected person during the shedding phase.  It is impossible to determine if someone is contagious or not just by the absence of a lesion.

If you do experience an outbreak, the cold sore will pass through many phases and this is what you can expect –

Prodromal phase – this is the phase before the actual blisters show up.  People experience tingling and/or itching on, around, or in the mouth 1 to 2 days before the blisters appear.  People are contagious during this period.

Blisters – These often form in clusters.  Blisters will be clear and filled with fluid and they will be painful.  People are often contagious during this time.

Oozing and Crusting – The blisters will pop and leave a lesion that will scab over.  People are contagious during phase as well.

The entire cycle if left untreated can last on average of two weeks. The rate of outbreaks varies per person, but range from never to 12 times a year.  After the initial year, the average person experiences 3 outbreaks a year.

Initial outbreaks can last longer, be more severe and have additional symptoms
  • Sore throat
  • Swollen glands around the throat or other areas of the body
  • Small children will often drool just before an outbreak
  • Headaches and Muscle aches

HSV outbreaks are often painful and embarrassing.  There is no cure for HSV!  When a person is not experiencing an outbreak the virus lays dormant in the nerve cells near the spinal cord. The good news is that HSV is not fatal and it can be treated!  Thanks to modern medicine there are things that can minimize outbreaks, reduce the rate of transmission, and shorten the outbreak cycle.

Things to do to minimize outbreaks

Avoid excessive sun exposure. 

Stay Healthy – exercise and eat well.  A healthy immune system keeps the virus dormant. People often get cold sores when they are sick, hence the name fever blister and cold sore.

Minimize stress – Again this helps to maintain a healthy immune system

Get lots of rest

Consult with your dentist or physician about possible medications – There are some medications that help to suppress the virus to keep outbreaks at bay and minimize transmission.  Some of these medications if taken early can shorten the outbreak phase.

Laser Treatment – Dr. Cisneros recommends treatment with a laser during the prodromal phase.  This is the tingling and itching just before the blisters appear.  This has great results and is the best option if an outbreak is imminent.

Consult your doctor immediately if…

  • You have a compromised immune system
  • Cold sores last longer than two weeks
  • Symptoms are severe
  • You have irritation
  • You experience frequent outbreaks

While HSV is not pleasant, living with it doesn’t have to be unbearable.  Talk to your dentist about your options!  
Written by Carrie Owens

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit


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