All about Cold Sores (Non-genital Herpes)

What are Cold Sores?

Cold sores or Non-genital Herpes is a viral infection which occurs elsewhere in the body other than the genital region. It is commonly caused by Herpes Simplex virus type 1 (HSV 1). Genital Herpes is caused by HSV 2 virus. HSV 1 is worldwide and is much commoner than genital herpes.

What are the common sites for Non-genital Herpes?

When the infection occurs in the mouth it is called oral herpes, which involves the oral mucosa (the lining which covers the mouth) with or without the involvement of tongue and gums.

When it involves the lips it is called Herpes Labialis. The term Cold sores is commonly used when a patient gets lesions around the mouth (mainly upper lip), and around the chin. It is also called “Fever blisters”.

Herpes infection can also occur in the face such as around the nose and cheeks. It is serious if the eyes get infected.

Is Non-genital herpes contagious?

Yes, it is contagious. This means it can spread from person to person. When the infected person has lesions in the lips or mouth, it can spread due to contact with blister fluid. Sometimes the infected person can spread the infection from his/her saliva, even when there are no visible lesions.

Both HSV 1 and HSV 2 viruses can be transmitted by saliva and body secretions, through direct contact from the skin to skin, by kissing or sex (vaginal/anal or oral routes).

Commonly HSV type 1 is associated with cold sores and HSV type 2 is associated with genital herpes.

Cold sores (by HSV 1) although can spread through sexual contact is not usually considered an STD.

What are the symptoms of Non-genital Herpes?

• Some are asymptomatic, this means there are no visible symptoms
• Pain – The pain can vary from no pain at all to severe unbearable pain. Sometimes there can be only a tingling sensation.
• The person who gets infected with the virus may feel a tingling sensation leading to small firm painful spots. These rise up and form fluid-filled blisters. They can occur as clusters. Later they break or burst, forming sores or ulcers which appear red. They can ooze liquid. Crusting can occur over the sores. The blisters and sores are superficial.
• The lesions can occur inside the mouth (oral mucosa), tongue and gums (oral herpes). The lesions can appear over upper lip or lower lip or both inner and outer surfaces of lips (Herpes labialis).
• The blisters and sores may last for 2 -3 weeks.
• Since the lesions are not deep they heal without leaving scars.
• Sometimes systemic symptoms are associated like fever, headache, muscle aches, and body pains etc.
• There may be swollen lymph nodes.

Home Remedies for Cold sores

• Get adequate rest, stress reduction
• Apply Cool compresses or ice packs over the lesions several times a day – For temporary relief
• Do not squeeze blisters as blister secretions can spread the lesions
• Wash and gargle mouth with warm salt water
• Take adequate fluids to prevent dehydration and proper nutrition for early recovery

What are the available over the counter products which can be used for cold sores?

• Topical acyclovir or penciclovir (Denavir) – apply topically over the lesions
• Products containing Docosanol (Abreva) or benzyl alcohol may help to reduce the duration of cold sores

Make sure to comply with the instructions given in the leaflet. Also before buying any OTC product check for expiry date.

• Pain relief – with acetaminophen (Tylenol) or Ibuprofen or aspirin
• Fever relief (can use the same OTC medications used for pain)

Be cautious with the dose and frequency of administration

• Aloe vera gel to soothe the lesions
• Lemon balm – for cooling effect
• Taking a supplement containing Lysine, Vitamin C and zinc may help to recover sooner.

Even without treatment, the lesions will heal spontaneously.

However, there is no cure, as the virus lies dormant within the nerve cells underneath the skin, even when the person is completely free from lesions.

How do the lesions reappear?

As the virus lies dormant in your body it can flare up any time. This can occur during a viral infection or fever episode, stress or during periods of reduced immunity etc.

When to see a doctor?

• When blisters and sores are very painful
• When symptoms are severe with high fever
• When the lesions last more than 2 weeks
• When a person gets frequent cold sores
• Herpes infection occurring in the eyes
• When a person has other immune compromising diseases like cancer, immunity disorders, chronic kidney disease etc.

A course of oral Acyclovir will be prescribed by the doctor for which patient should comply and take as prescribed.

Herpes Eye Infection

When the eyes become infected with HSV 1 or Varicella Zoster (the virus which usually causes Chickenpox) it is called Herpes eye infection. One or both eyes can get affected. The symptoms are;

• Pain in and around the eye which can be severe, along with a headache and fever
• Sores can occur over eyelids
• The eye will be red
• The blurring of vision may occur due to swelling of the cornea of the eye
• Feeling “grit” in the eye, irritability
• Tears overflow

Use separate clean washcloths to each eye. Can try cold compresses to soothe the eye pain.

Do not waste time trying home remedies but visit an ophthalmologist (eye doctor) soon. Otherwise, it can lead to serious complications.

The doctor once the analyze done will prescribe antiviral eye drops or ointment with an added course of oral acyclovir or any other preferred anti-viral medication.

The infection can spread from one eye to the other. But spread to another person’s eye is uncommon.

Prevention of Non-genital Herpes

• Do not share eating utensils, razors, towels, lip balm or lipstick with others
• Avoid oral sex or kissing with a person having the infection with herpes
• Frequent hand washing will prevent the spread
• Avoid stress – Practice relaxation techniques, medication
• Sometimes excessive sun exposure can cause flare-ups. Using a good sunscreen with SPF 30 -50 will help