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Cold Sore Information

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The following cold sore information has been compiled from a variety of resources in order to give the reader an overview of cold sores including cold sore treatment options, cold sore symptoms, cause of cold sores, etc..

Cold Sores

A cold sore is a fluid-filled, painful blister which usually occurs on or around the lips. Cold sores are also known as fever blisters, oral herpes, herpes febrilis, labial herpes and herpes labialis. Cold sores most often occur on the external lips which distinguishes them from the common canker sore which is usually found inside the mouth.

Cold sores are caused by the herpes virus. There are some eight different types of human herpes viruses. However, only two of these viruses, herpes simplex, types 1 and 2, cause cold sores. Common belief is that herpes simplex virus type 1 infects above the waist and herpes simplex virus type 2 infects below the waist. However, this is not always the case both herpes virus type 1 and type 2 can cause herpes lesions on the lips or genitals. However, recurrent cold sores are almost always a result of the herpes virus type 1.

Unfortunately, oral herpes is very common. Some 60% - 80% of the population has had a cold sore while almost 25% of those infected will experience recurrent outbreaks. Individuals can become infected by herpes virus and the virus may remain latent for life or the virus may promote frequent recurrent cold sores. The highest risk for spreading the virus is the time period beginning with the appearance of the ulcers or blisters. However, infected individuals do not need not have visible ulcers to spread the infection. In addition, the virus may be present in the saliva of infected individuals without the presence of the cold sore.

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Viruses are not the same as bacteria. Bacteria are independent cells and can reproduce without the assistance from their host. While, viruses enter their host cells and use the host to replicate the virus. The infected host cell is subsequently killed while the virus is released. For example, in the case of cold sores the actual ulcer is formed from the death of the cells and the immune response against the virus. The virus can also remain dormant for weeks or even years until some event triggers the virus to become active.


Active Cold Sore Ulcers

In approximately 95% of the patients with cold sores, the blisters occur at the outer edge of the lips which is called the "vermilion border." Lesions can also form on the nose, chin, or cheek.

The development of a cold sore is usually rapid and occur in the following stages:

  • Prodrome stage - the period before a lesion appears when the skin tingles and itches.
  • Blister stage - a small patch of skin raises and forms a blister.
     
  • Weeping stage - the blister bursts to form a weeping sore.
     
  • Scab stage - natural healing occurs at the site of the sore.

While anyone can be infected by herpes virus that is responsible for cold sores, not everyone will show symptoms. The first symptoms of herpes occur within 2-20 days after contact with an infected person. Symptoms of the primary infection are usually more severe than those of recurrent infections. The primary infection can cause symptoms other than just the actual cold sore including tiredness, fever, headache and swollen lymph nodes in the neck region.

Approximately 95% of the patients with cold sores, the blisters occur at the outer edge of the lips which is called the "vermilion border." Lesions can also form on the nose, chin or cheek. Children may have a very serious primary herpes infection called "gingivostomatitis." This condition causes swollen lymph glands, fever with multiple blisters inside the mouth, as well as, on the lips, and tongue which may form large, open sores. These painful lesions may last up to three weeks and can make feeding difficult.

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Cold Sore Pictures

Cold sores usually are located on the outside surface of the lips, nose, cheeks, chin or possible near the eyes. The lesions are characterized by a prodrome period or the period before a lesion appears when an individual experiences fever, irritability, headaches and a tingling and/or itching in the area where the lesion will appear. A day or so following the initial prodrome period the area will become red and inflamed followed by the appearance of one or more blisters usually found in clusters. These blisters soon erupt resulting in the release of the virus and a grey colored ulcer. The ulcer will eventually crust over and dry up usually without resulting in scare tissue. View medical pictures of cold sores (click here for details)


Cold Sore Treatment Options

Prescription Medications

Prescription medications have been proven in clinical trials to be the most effective treatment option for treating cold sores:

Valtrex is the first and only oral one-day treatment for cold sores. The recommended dose is 2 grams taken at the first sign of a cold sore, such as tingling, itching, or burning and then again, approximately 12 hours later. You should be prepared for subsequent outbreaks of cold sores by having a supply of Valtrex readily available.

Valtrex has been shown in numerous clinical studies to decrease the duration of cold sores, the pain associated with the cold sores, and the frequency of the cold sore outbreaks.  Buy Valtrex online (click here for details).

Diet

Proper diet may have an effect on the recurrence, as well as, the duration of cold sores. In general, cold sore sufferers should eat a healthy diet of unprocessed foods such as vegetables, fruits, and whole grains. Individuals should avoid alcohol, chocolate, nuts, caffeine and sugar.

Herbal Supplements

Certain amino acids and vitamins have been found to influence the recurrence and duration of cold sores..

An imbalance in the amino acids lysine and arginine has been shown in studies as a contributing factor in cold sore outbreaks. A diet that is rich in the amino acid lysine may help prevent recurrences of cold sores. Foods which contain high levels of lysine include most vegetables, turkey, legumes, fish and chicken. Individuals may also take supplemental doses of Lysine. The recommended dose for the prophylactic treatment of cold sores is 1,000 mg of lysine three times a day during a cold sore outbreak and 500 mg daily.

In addition to taking increase amounts of Lysine individuals should limit their intake of arginine. Foods that contain contain high quantities of arginine include peanuts, almonds, chocolate, and other nuts and seeds.

Vitamins

Vitamin C and bioflavonoids (a substance found in fruits that assist the body to absorb and use vitamin C) have been shown to reduce the frequency and duration of a cold sore outbreaks. Vitamin B complex also include important vitamins that support the nervous system where herpes viruses are dormant. Vitamin B complexes can also help manage stress, one of the contributing factors to the outbreak of cold sores. Studies have shown that correcting iron, vitamin B12, folate or vitamin C, deficiencies will improves cold sores. The direct topical application of vitamin E can also decrease the duration of cold sores.

Additional Practices

The following practices can help prevent cold sores:

  • Avoid excessive sun exposure to the face
  • Wash hands frequently
  • Avoid contact with those individuals who have active lesions
  • Do not touch cold sores (this can spread the virus to other regions)
  • Avoid kissing the lips or eyes of infants under six months of age
  • Maintain a healthy lifestyle (proper diet, adequate sleep, exercise)

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Diagnosis of Cold Sores

Secondary to how common cold sores are in the general public they are usually diagnosed primarily by clinical symptoms and history. However, the following represent the most accurate methods in which to diagnose the herpes virus.

Virus Culture Detection Tests

In order to prepare a viral culture a physician must collect cells at the base of the genital lesion using a sterile cotton swab The sample is then tested in the laboratory. An individual must have a active or live infection at the time of the swab test to produce a positive result. If the herpetic lesions or ulcers have begun to heal the test may give a false-negative report. However, when active lesions are present, this method is seen as the gold standard for diagnosing genital herpes.

Serology Blood Tests


When an individual becomes infected with the herpes virus the body will produce antibodies designed to fight the virus. These antibodies are specific to each virus and remain permanently in the bloodstream. A blood test for a herpes simplex virus can indicate if someone has been infected at some time during their life.


However this form of testing cannot indicate when or where on the body the initial infection took place, i.e. around the genital or facial region. When an individual who does not have HSV-2 first acquires the virus, their body starts to produce antibodies. They undergo a process called seroconversion which means they go from having no detectable antibodies seronegative to having detectable antibodies seropositive. The length of time from first infection to when antibodies are detectable varies from person to person, and with the ability of the test to detect antibodies in early infection. Therefore, it is possible for a person in the early stages of infection to give a negative result on a blood test despite having herpes.

Therefore, if an individual believes that he/she has been infected with the virus and the test is negative this individual should repeat the test in three to four months. The older blood tests could not reliably tell the difference between HSV-1 and HSV-2 antibodies, however, there are new commercially available tests that have recently been developed bringing new options for diagnosing HSV:

The HerpeSelect™ type-specific HSV antibody detection tests produced by Focus Technologies can effectively distinguish between HSV-1 and HSV-2. These kits after collection must be sent back to a central laboratory for results.

The POCkit® HSV-2 Rapid Test is a single unit, membrane-based immunoassay for the qualitative determination, either in heparinized capillary whole blood taken by finger stick or in serum, of circulating IgG antibodies specific for herpes simplex virus type 2 (HSV-2), which arise as a result of infection with HSV-2. It is intended for in-vitro diagnostic use by health professionals in Point of Care testing (the lab work does not need to be sent to a central laboratory). The presence of antibodies to HSV-2 may be indicative of a previous infection with HSV-2 and may be of value in determination of previous immunological experience and to aid in the diagnosis of HSV associated disease. This assay will not differentiate whether infection is currently in a latent or active state nor does the test diagnose HSV-1.

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