Cold Sores (Oral Herpes): Warning Signs, Triggers and When to Be Seen

What it involves

MedlinePlus describes oral herpes as an infection of the lips, mouth, or gums by the herpes simplex virus that causes small painful blisters, commonly called cold sores or fever blisters. It is usually caused by herpes simplex virus type 1, and most people in the United States are infected by age 20.

Who this is for

• Patients who feel itching, burning, or tingling on the lip and want to know about early treatment
• Patients whose cold sores keep coming back and interfere with work, sleep, or social life
• Patients with a blister near an eye or a weakened immune system who need to be seen promptly
• Parents wondering how cold sores spread within a household

What to expect

• Questions about when the first tingle started, how often outbreaks recur, and what seems to trigger them
• A look at the lips, mouth, and the area around the eyes, because a provider can usually diagnose it by looking
• A review of your health conditions and medicines, especially anything that weakens immunity
• A plan that may include a prescription antiviral medicine, comfort measures, or an eye specialist referral

How the virus behaves

MedlinePlus explains that after the first infection the virus goes dormant in nerve tissue in the face and can wake up later, causing a cold sore. Later outbreaks are usually milder. It spreads most easily from someone with an active sore, through close contact or by touching a sore or items such as razors, towels, and dishes that have touched it. Parents can pass it to children during everyday activities.

The sequence of an outbreak

Warning signs, according to MedlinePlus, come first, followed by blisters:

• Itching, burning, or tingling on or around the lips
• Sometimes a sore throat, fever, swollen glands, or painful swallowing before the blisters
• Small fluid-filled blisters that break open and leak
• A yellow crust as the sore heals, which turns into pink skin

Common triggers

MedlinePlus lists menstruation or hormone changes, being out in the sun, fever, and stress. Lip protection with a balm that contains zinc oxide or sunscreen before going outside is one prevention tip it gives. The sunburn guide covers sun protection more broadly, and the fever in adults guide covers fever.

Treatment timing matters

MedlinePlus says cold sores clear on their own in one to two weeks. Prescription antivirals such as acyclovir, famciclovir, and valacyclovir can reduce pain and shorten the outbreak, and they work best when started at the first warning signs, before blisters form. People with frequent outbreaks may take them continuously. It says antiviral creams are costly and usually shorten an outbreak by a few hours to a day.

Comfort steps

MedlinePlus suggests applying ice in a washcloth or a warm cloth, washing blisters gently with antiseptic soap and water to avoid spreading the virus, avoiding hot drinks, spicy and salty food, and citrus, rinsing with salt water, gargling with cool water, and taking acetaminophen or ibuprofen. If the sore is inside the mouth and not on the lip, the canker sores guide may fit better.

When it is more serious

MedlinePlus says herpes can be severe if it occurs in or near the eye, and that herpes infection of the eye is a leading cause of blindness in the United States. It can also be dangerous with a weakened immune system. It advises contacting a provider for severe symptoms, symptoms lasting beyond two weeks, blisters near the eyes, or herpes symptoms with weakened immunity. The pink eye guide covers common eye redness.

Not sharing it

MedlinePlus advises avoiding direct contact with sores, not sharing utensils, straws, glasses, towels or linens, washing linens in hot water, and avoiding oral sex during an outbreak, since the virus can spread even when no sore is visible.

Sources

• MedlinePlus — Herpes, oral
• MedlinePlus — Cold Sores health topic