Oral Herpes: Causes, Symptoms, and Treatment

What is it?

Oral herpes is caused by a very common virus called herpes simplex type 1 (HSV-1). According to the World Health Organization, 67% of the world’s population is a carrier. It is also possible to develop cold sores after coming into contact with genital herpes lesions during oral-genital sex.

HSV-1 is usually acquired during childhood. At the time of this first infection, the person may have symptoms that are more akin to a respiratory infection and may not have a cold sore. After the initial infection, the virus remains dormant in the body. It can awaken later in life to cause cold sore outbreaks.

The frequency of cold sore outbreaks is unpredictable and varies from person to person. Many people will have only a few outbreaks in their lifetime, but for about 25% of people with HSV-1, outbreaks will be frequent and bothersome.

How do you recognize a cold sore?

Oral herpes lesions develop in a very typical way.

• The first sign is a slight burning or tingling sensation, called a prodrome, in the area where the cold sore will then appear, usually around the mouth, but more rarely on the cheeks, chin or, even inside the nose.
• A cluster of vesicles (small blisters) then appears, usually within 24 hours of the prodrome. These blisters contain a clear fluid that is highly contagious. The skin around the blisters is red and often painful. There may also be itching or tingling.
• After a few days, the blisters burst and the fluid dries up, forming a yellowish crust.
• The scabs disappear on their own in a few days, with or without treatment.
• Once the lesions are gone, the virus goes dormant. It remains dormant until it is reactivated.

How to prevent cold sores?

Cold sores are highly contagious, from the onset of the first symptoms of the prodrome until the lesion is completely healed.

Spread to another person can occur through direct contact with the lesion, such as through a kiss, or indirectly, such as through a glass, towel or utensil that has been in contact with the cold sore.

If a person does not wash their hands after touching a cold sore, there is a small risk of spreading the infection to other parts of the body.

HSV-1 can also cause sores on the penis or vulva. Transmission of the virus to the genitals occurs through orogenital contact. This is a type of genital herpes.

Here are some tips to reduce the risk of spreading the virus:

• Wash your hands regularly, but especially after touching the sores or before coming into contact with someone.
• Avoid intimate contact with others until the sores are healed;
• Do not share utensils, glasses, towels or other objects that may have come in contact with a cold sore.
• Avoid touching, pinching or scratching the blisters;
• Avoid touching your genitals and eyes after touching a cold sore; the cornea is especially vulnerable to the herpes simplex virus;
• Avoid contact with people who may have complications if they contract the virus (e.g., children, pregnant women, or people with weakened immune systems).

If the person with a cold sore is unable to stop touching it (e.g., due to young age or cognitive impairment), a bandage may be applied to the lesion to protect it.

How to relieve pain and discomfort?

Applying cold compresses to the lesions for a few minutes, as often as needed, can help relieve pain and reduce inflammation. If this is not enough, an over-the-counter pain reliever (such as acetaminophen, ibuprofen, or naproxen) can be taken.

Once the sores have scabbed over, applying a lip balm will prevent the lips from splitting or cracking, reducing discomfort and promoting healing. To avoid contamination of the lip balm, you can use a cream product that can be spread with a finger to avoid direct contact with the product.

Treatment of cold sores

A cold sore will heal on its own, usually within one to two weeks, although the first episode may last longer.

Over-the-counter and prescription treatments generally do not prevent cold sores from developing, but they can relieve symptoms and shorten the healing time.

Over-the-Counter Medications

Topical cold sore products are available over the counter. To be effective, they must be applied several times a day and treatment must begin as soon as symptoms appear. Their effectiveness is modest. Your pharmacist will be able to recommend an appropriate product based on your needs.

Prescription Drugs

Prescription antiviral medications can help relieve pain and speed healing. Some are applied to the sore and, others are taken by mouth. They must be prescribed by a healthcare professional (including pharmacists in most provinces).

Antiviral treatment is most effective when started as early as possible, ideally during the prodrome. Therefore, do not hesitate to consult your pharmacist as soon as you feel the warning signs or a sore appears to find out if he or she is able to prescribe treatment, as certain criteria may need to be met depending on the province in which you live.

People who have recurrent cold sore outbreaks may be able to take an antiviral medication daily to reduce the risk of new outbreaks. If this is your case, don’t hesitate to discuss it with a healthcare professional.

Use Caution With Home Remedies

Recognize the warning signs

Most people who suffer from cold sores can recognize the “prodrome,” or the period when the warning signs appear. In most cases, this period includes tingling, itching or burning sensations approximately 12 to 24 hours before the blisters start to form. It’s important to recognize these warning signs because the sooner you start treatment, the fewer blisters you’ll have and the less severe your symptoms will be.

What are the triggers?

There are several situations that can cause the virus to reactivate and cause cold sores. Triggers vary from person to person and may include:

• an infection, such as the common cold, especially if it causes a fever
• physical stress (such as surgery or tooth extraction) or emotional stress
• fatigue;
• menstruation or other hormonal changes;
• cold weather;
• sun exposure;
• dry, irritated or chapped lips.

It is important to try to identify your triggers so that you can avoid them as much as possible to reduce the risk of another outbreak. For example, regular use of a lip balm with a sun protection factor (SPF) of 30 or higher will help keep your lips moisturized and reduce the risk of viral reactivation.

Your pharmacists are there for you