Herpes and Cold Sores: Myths, Facts & Stats

More irritating than dangerous, incurable but manageable, and very hard to avoid: here’s everything you need to know about cold sores.

Herpes and Cold Sores: Myths, Facts & Stats
Reviewed by Dr. David Zlotnick, Chief Medical Officer at Antidote Health

The world was a very different place 5,000 years ago. People didn’t travel, 9-to-5 wasn’t a thing, and people were on a hunt, but not for the next show to binge. Yet some things that existed then are still around today; herpes simplex virus (HSV), which causes cold sores, is one of them. One theory suggests that around 5,000 years ago, humans began engaging in a strange act of pushing their faces together and touching lips. Kissing allowed one strain of oral herpes to pass between individuals and communities, making it one of the most widespread infections in the world. 

HSV is categorized into 2 types: HSV-1 and HSV-2. They’re both very common (with type-1 being significantly more common than type-2), incurable, and often asymptomatic. In this guide we answer all the questions about the HSV and cold sores. 

What are Cold Sores? 

Cold sores, herpes labialis, fever blisters, or oral herpes, are small blisters around the mouth, nose, cheeks, or chin, caused by herpes simplex virus type-1 (HSV-1). While every cold sore is caused by HSV-1, not all people with HSV-1 will have cold sores. In fact, the majority of people with the virus have no symptoms, meaning that they might not know that they’re carrying it. Like other infections that are either asymptomatic or have an asymptomatic stage, it’s almost impossible to stop the spread of HSV-1. Consequently, the data is astounding: according to the last available estimates, 67% of the world population under 50 has HSV-1. That’s 3.7 billion people worldwide! In the U.S. alone, it is estimated that 47.8% of the population carries type-1 herpes simplex virus. 

Only a third of people with HSV-1 actually develop cold sores. Why do some get cold sores and others don’t? The answer is, in part, genetics. For those people who are predisposed to getting cold sores, they’re usually triggered by various factors, including sun exposure, feeling stressed or run-down, hormonal changes and trauma. In some cases, the trigger may be a fever or a cold, which weaken the immune system. That is how herpes labialis became a “cold sore” or a “fever blister”. 

How Does the Virus Spread? 

HSV-1 is spread though contact with a blister or with infected secretions. Unlike HSV-2, most people don’t get type-1 herpes in a sexual context. In fact, the vast majority of infections happen in childhood, during mundane and innocent activities such as kissing or sharing utensils with a parent with HSV-1. With that said, the virus can definitely be transmitted through sexual contact and even lead to genital herpes. Oral sex given by a person with HSV-1 can cause genital herpes, which appear as sores around the genitals and thighs. (This is not to be confused with HSV-2, which also causes genital herpes and is strictly a sexually transmitted disease.) It is also important to note that while people with HSV-1 are most contagious during an outbreak, they may transmit the virus even when they don’t have any symptoms. 

Because many oral herpes cases are asymptomatic and because HSV-1 infected secretions don’t look abnormal, many people don’t know that they’re carrying and spreading the virus. Add that to the fact that a cold sore episode doesn’t indicate recent infection, and you’ll see why it is often impossible to trace when and by whom people were infected. 

What are the Stages of a Cold Sore? 

Here are three cold sore stages, in order of appearance (and coincidentally in order of grossness):

  • The first sign of a cold sore is tingling or itching around the mouth. Some even report feeling a burning sensation. 
  • Then, a fluid-filled lesion appears, usually around the border of the mouth. 
  • Finally, the blister bursts, crusts, and oozes fluid. This is when the virus is most contagious.

What Should I Do During a Cold Sore Outbreak? 

Oral herpes is incurable but manageable. While there is no vaccine or remedy that gets rid of the virus completely and most cold sores will go away within 10 days, there are steps you can take to ease the pain and discomfort that come with the blisters. 

  • Treat early: apply an over-the-counter antiviral cream as soon as you feel the initial tingling. 
  • Avoid acidity: lemons, oranges, and even tomatoes can irritate the skin.
  • Cold compress: cool a towel and place it on the sore for up to 10 minutes. Make sure that no one uses that towel after you!
  • Don’t break the blister, as it might expose the area to bacterial infection. 
  • Avoid kissing and sharing eating utensils with others while having a cold sore. Remember that now you are most contagious.
  • Wash your hands often.

When Should I See a Medical Professional for my Cold Sores? 

Cold sores are usually thought of as more annoying than dangerous, but in some cases there is a reason to seek professional care. You should contact a clinician if you have multiple oral sores, if cold sores don’t heal within two weeks, if you’re worried that it might be something else (like impetigo or a mouth ulcer), if they’re very painful, if your immune system is weakened, or if cold sores appear on a newborn. 

Cold sore related complications are rare, but possible:

  • In the immunocompromised, HSV-1 can surface more often and cause more severe conditions, including encephalitis (brain infection) and keratitis (eye infection). 
  • HSV-1 can also lead to eczema herpeticum. This rare and life-threatening infection happens when the virus spreads through the skin. If your child has eczema, make sure they don’t come in contact with people who have a cold sore.
  • A rare but deadly condition occurs when an infant is exposed to HSV. Newborns’ underdeveloped immune systems cannot fight the virus, which puts them in a life-threatening situation. Newborns can catch neonatal herpes during birth or if a person with a cold sore kisses them. If you have a cold sore, do not kiss your baby. This condition is pretty rare, but there is no reason to take the chance. 

For most people with cold sores, these periodic blisters are just an inevitable and irritating part of life. We don’t think of them when they’re gone and we can’t stop thinking about them once they appear. Today, there are medications that can treat the symptoms of oral herpes, shorten outbreaks, and reduce their reoccurrence. Whether you are worried about complications or you just want to inquire about antivirals, you are more than welcome to contact Antidote Health’s certified clinicians. At Antidote we provide comprehensive insurance coverage. You can conveniently consult with a healthcare professional and obtain online herpes prescriptions from the comfort of your home, using any device. Our primary and urgent care clinicians are experienced in treating cold sores, along with a wide range of other infections, diseases, and conditions, making our services accessible to all patients.

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