Why do patients find cold sores embarrassing?

While there is nothing to be ashamed of, many cold sore sufferers feel embarrassed by their condition. The sores are very noticeable during speaking and eating, and cold sores can draw unwanted attention to daily interactions. The virus that causes these blisters to form also causes genital herpes, many people have experienced embarrassment due to the social stigma about how they may have contracted the virus. Others may be wary of a person with an active lesion because they are contagious on contact or indirectly through fluids from the mouth.

The Difference between Cold Sores and Canker Sores

There is a lot of confusion surrounding the difference between cold sores and canker sores.

As explained above, cold sores are the result of a contagious virus, HSV-1, spread from person to person. The sores occur on the external mouth, or less commonly, other areas of the face like the cheeks or chin. Many people test positive for this virus, though some will never show symptoms.

Canker sores, or aphthous ulcers are non-contagious lesions that cannot be passed between people, and occur on the soft tissues of the oral cavity, including the cheeks, tongue, and inside the lips. The exact cause of canker sores is unknown, but there is a familial link, and young people and women tend to be more susceptible. Many people notice the ulcers after they have eaten acidic or spicy foods, or experience some other intraoral irritation, like slipping with your tooth brush. Cold sores and canker sores are not at all related.

Herpes simplex type 1 is highly contagious, many people have the virus but will not necessarily suffer a cold sore outbreak. It is thought that most people contract the virus at a young age, especially when parents show their children affection and inadvertently pass along HSV-1 when they are asymptomatic. It is estimated that over 90% of the population have been exposed to the virus by age 50. Once infected, a person will have herpes simplex virus for the rest of his or her life.

The strain of herpes simplex virus usually responsible for cold sores is known as HSV-1. In rare cases, cold sores can also be caused by the herpes simplex virus type 2 (HSV-2). This can be the result of having oral sex with someone who has genital herpes, usually clear up without treatment within 7 to 10 days.

You may not have any symptoms when you first become infected with the herpes simplex virus. An outbreak of cold sores may happen some time later. Cold sores often start with a tingling, itching or burning sensation around your mouth. Small fluid-filled sores appear, usually on the edges of your lower lip.

Some people have frequently recurring cold sores around two or three times a year, while others have one cold sore and never have another. Some people never get cold sores at all because the virus never becomes active.

Cold sore triggers

Factors thought to trigger outbreaks of cold sores include:

• Having another infection, such as a respiratory tract infection
• Having a high temperature (fever)
• Emotional upset or psychological stress
• Tiredness and fatigue
• An injury to the affected area
• Menstruation (periods)
• Strong sunlight

However, in many cases there’s no obvious trigger for an outbreak.

Cold sores are usually mild, but may cause complications in rare cases. People with weak immune systems caused by illness or treatments such as chemotherapy are particularly at risk of complications.

The herpes simplex virus can also spread to other parts of your body as skin infections – these often occur if the virus comes into contact with broken skin, such as a cut or scrape, or a skin condition such as eczema:

• herpetic whitlow (whitlow finger) – this causes painful sores and blisters to appear on and around your fingers
• herpetic keratoconjunctivitis – this causes swelling and irritation (inflammation) of your eye area and sores to develop on your eyelids

Preventing infection

It’s not possible to prevent infection with the herpes simplex virus or prevent outbreaks of cold sores, but you can take steps to minimize the spread of infection.Cold sores are at their most contagious when they burst (rupture), but remain contagious until they’re completely healed. Avoid close contact with others until your cold sore has completely healed and disappeared. However, there’s no need to stay away from work or miss school if you or your child have a cold sore.

You can help minimize the risk of the cold sore virus spreading and cold sores recurring by following the advice below:

• Avoid touching cold sores unless you’re applying cold sore cream – creams should be dabbed on gently rather than rubbed in, as this can damage your skin further.
• Always wash your hands before and after applying cold sore cream and after touching the affected area.
• Don’t share cold sore creams or medication with other people as this can cause the infection to spread.
• Don’t share items that come into contact with the affected area, such as lipsticks or cutlery.
• Avoid kissing and oral sex until your cold sores have completely healed.
• Be particularly careful around newborn babies, pregnant women and people with a low immune system, such as those with HIV or those having chemotherapy.
• If you know what usually triggers your cold sores, try to avoid the triggers – for example, a sunblock lip balm (SPF 15 or higher) may help prevent cold sores triggered by bright sunlight.

Herpes Simplex Virus (HSV-1)

Primary Infection In Children

Symptoms of the primary infection are most likely to develop in children younger than five years old. Symptoms include:

• Swollen and irritated gums with small, painful sores in and around the mouth – this is known as herpes simplex gingivostomatitis.
• Sore throat and swollen glands
• Producing more saliva than normal.
• High temperature (fever) of 38C (100.4F) or above
• Dehydration.
• Feeling sick (nausea)
• Headaches

Herpes simplex gingivostomatitis usually affects young children, but adults can also develop it. It can last 7 to 14 days, with the sores taking up to three weeks to heal. However, gingivostomatitis doesn’t usually recur after the primary infection. See your MD or Pedodontist for treatment.

In Adults

Primary herpes simplex viruses are rare in adults, but the symptoms are similar to those experienced by children. You’ll usually have a sore throat with or without swollen glands. You may also have bad breath (halitosis) and painful sores in and around your mouth. These can develop into ulcers with grey or yellow centers.
If you develop the herpes simplex virus at an early age, it may be triggered periodically in later life and can cause recurring bouts of cold sores. After the primary infection, the symptoms are usually reduced to just the cold sores themselves.