How Do I Treat Cold Sores?

What is a cold sore?

Cold sores have many names, such as fever blisters and oral herpes. A cold sore is a small painful blister (or a group of several small blisters) usually found around the lips and mouth. Sometimes cold sores can be found elsewhere on the body or inside the mouth, though that is less common. 

Cold sores are caused by the herpes simplex virus (HSV), a very common virus. HSV types 1 and 2 can both cause cold sores, though cold sores are mostly associated with HSV-1. HSV-1 is different from the virus HSV-2 that causes genital herpes, although either kind of virus can cause cold sores and genital sores.

How does a cold sore develop?

The viruses that cause cold sores can be transmitted from one person to another very easily. Touching someone’s cold sore, and sharing utensils, towels, or other items with someone who has a cold sore are all ways that the virus can be transmitted. 

Most people are infected when they are children, though it is possible to become infected later in life if exposed. Cold sores are extremely common — more than half of the population in the United States has been infected with the virus that causes them. However, only 20-40 percent of those infected develop cold sores. 

Usually the first cold sore after infection is the worst and subsequent outbreaks are less severe. It is common to have additional symptoms during initial infection with the virus, such as sore throat, headache, painful gums, and fever. Once the symptoms of the initial infection go away,  the virus lies dormant until the next time it “wakes up” — causing another cold sore. 

When a cold sore is about to emerge, a person may start to feel tingling, itching, or burning around their lips for a day or two before a blister begins to form. The blisters eventually burst, leaving oozing sores that eventually crust over. 

Cold sores are contagious from when they start to tingle until the cold sore is completely healed and gone. They can even be contagious when not entirely visible. It is not entirely clear what causes the virus to “wake up” and lead to another cold sore, though many things are associated with HSV outbreaks, such as another illness, menstrual periods, sunburn, stress, fatigue, and other factors.

What is asymptomatic shedding?

Herpes can be passed more easily when a person is having an outbreak and active sores or blisters are on the skin. However, herpes can still be passed when there are no sores or blisters.When the virus is present on the skin but there are no signs or symptoms, it is called “asymptomatic shedding”.

Asymptomatic shedding (also called “viral shedding”) can happen at any time.There is no way to tell when the virus is shedding on the skin, and no way to predict when you may be at risk of passing the virus to a sexual partner. Some research suggests that most people get herpes through asymptomatic shedding.Viral shedding is most common right before, during, and immediately after an outbreak.

Treating cold sores

There is no cure for HSV, but there are treatments that can help manage cold sore outbreaks and help the sores heal quickly. Usually, cold sores go away on their own without treatment in a few weeks, but that can be a long time to wait — especially if you are in pain. Moreover, cold sores are contagious, so it would be beneficial to those around you to quicken the healing process. 

First, it is important to be diagnosed correctly by your medical professional so you can treat your symptoms accordingly. There are both prescription and over-the-counter (OTC) treatments available. 

Over-the-counter treatments

OTC treatments should be sufficient if you have mild and infrequent outbreaks. Docosanol (Abreva) is an OTC ointment that can shorten the duration of a cold sore and help alleviate the discomfort associated with them. 

Zilactin and Orajel Cold Sore Gels promote healing of your cold sore while also relieving pain. Cold sore patches (Mederma and Compeed) are available to help promote healing of the cold sores and to help conceal the cold sores. 

One of the newer, and more expensive, advances in cold sore therapy is the Virulite Invisible Light Electronic Cold Sore Treatment Device. This device is a laser treatment approved by the U.S. Food and Drug Administration (FDA) and can be used at home to help get rid of cold sores in a few days.

Prescription treatments

Acyclovir (Zovirax) is a prescription antiviral medication that stops the spread of the cold sore-causing virus in the body. Acyclovir is usually used in a cream formation that is applied several times a day for several days as soon as a cold sore develops. Acyclovir is most effective when applied as soon as a cold sore begins to develop, so if you feel the tingling associated with cold sores, call your doctor. Acyclovir cream is not to be used inside the mouth or in the eyes, so only use acyclovir on external sores on the skin.

Acyclovir comes in pill form as well but it is less commonly used than Valacyclovir as it requires more frequent dosing.

Valacyclovir (Valtrex) is another prescription medication available for the treatment of HSV. Valacyclovir is available as a pill and, once processed by the body, is actually broken down to become acyclovir in the body. Thus, valacyclovir functions the same way as acyclovir (preventing viral spread) but is used as a pill instead of a cream. Although valacyclovir is not available over-the-counter yet in the Canada, you can get a prescription online for valacyclovir. This is the most common form of treatment for recurrent cold sores.

If you get cold sores — you are not alone. There are many treatments available to improve your quality of life and shorten the duration of your cold sore. By shortening its duration, you also prevent the transmission of HSV to someone else. 

Discuss your symptoms with your medical care provider to find the best care for your case of HSV. Living with cold sores can be daunting, but the future is bright!

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