Cold sores are small, painful, fluid-filled blisters that usually occur on the lips, gums, or roof of the mouth.
They are caused by the herpes simplex virus and are contagious. There may be pain or tingling one to two days before the cold sores appear.
Cold sores generally clear in seven to ten days. They are sometimes confused with canker sores, which are not contagious but produce small, painful ulcers in the soft tissues of the mouth, such as the tongue and the walls of the mouth.
Skin Eruptions and Pain. The first time a person experiences a herpes simplex outbreak, skin eruptions appear two to 12 days after the initial exposure to the virus. They may take the following course:
- The first sign of infection is fluid accumulation (edema) at the infection site, which is quickly followed by small, grouped blisters-- the characteristic HSV lesions.
- These form on an inflamed skin base, which is more visible in dry skin areas.
- The blisters then dry out and heal rapidly without scarring with a week to 10 days. Blisters in moist areas heal more slowly than others. The lesions may sometimes itch, but itching decreases as lesions heal.
- When the crust falls off, the lesions are no longer contagious. (The virus may still be active in nearby tissue, but such persistence is rare.)
- Once HSV gains entry to a site in the body, the virus can also spread to nearby mucosal areas through nerve cells. This characteristic spreading can cause fairly large infected areas to erupt at some distance from the initial crop of sores.
The primary skin infection with either HSV-1 or HSV-2 lasts up to two to three weeks, but skin pain can last one to six weeks in a primary (the initial) HSV attack.
Latency. After an outbreak, the herpes simplex virus goes into a stage known as latency. During that phase, HSV produces no symptoms at all and the virus is not transmissible.
Asymptomatic Shedding. At certain times, the virus undergoes shedding. During this phase the virus replicates and is capable of being transmitted through fluids and infecting other people. This occurs during an outbreak, but unfortunately, in a third to half of cases shedding occurs without any symptoms at all. One study reported that about 40% of all HSV-infected people experienced asymptomatic shedding of the virus more than 5% of the time. (Other evidence suggests shedding occurs much more often--between 9% and 28% of the time.) About half of asymptomatic shedding episodes occurs within a few days before or after an outbreak and lasts about one and half days. Asymptomatic shedding is much more common with HSV-2 than with HSV-1.
Symptoms of Recurrence. Herpes simplex nearly always recurs. The anatomic site and the type of virus influence the frequency of recurrences. It usually takes the following course:
- Prodrome. The outbreak of infection is often preceded by a prodrome, an early group of symptoms that may include itching skin, pain, or an abnormal tingling sensation at the site of infection. The patient may also experience headache, enlarged lymph glands, and flu-like symptoms. The prodrome, which may be as brief as two hours or as long as two days, terminates when the blisters develop. In about 25% of cases, recurrence does not develop beyond the prodrome stage.
- The Outbreak. Recurrent outbreaks of HSV feature most of the same symptoms at the same sites as the primary attack, but they tend to be milder and briefer. After blisters erupt, they heal in approximately six to 10 days. Occasionally, the symptoms may not resemble those of the primary episode but appear as fissures and scrapes in the skin or as general inflammation around the affected area.
Triggers of Recurrence. It is not completely known what triggers renewed infection, but a number of different factors may be involved, such as sunlight, wind, fever, local physical injury, menstruation, suppression of the immune system, or emotional stress. One study linked recurrence in genital herpes to persistent stress (lasting longer than a week) and high levels of anxiety. Temporary mood changes, short-term stress, and life change events were not linked to recurrence. (A study on ocular herpes also found no association between stress and outbreaks of this eye infection and suggested that people may incorrectly recall the stress associated with herpes outbreaks.) Reactivation of oral herpes can be provoked within about three days of intense dental work, particularly root canal or tooth extraction, as well as after laser skin resurfacing, a popular form of cosmetic surgery.
Timing of Recurrences. Recurrent outbreaks may occur at intervals of days, weeks, or years. For most people, outbreaks recur with more frequency during the first year after an initial attack. During that period, the body mounts an immune response to HSV, and in most healthy people recurring infections tend to become progressively less severe and less frequent. The immune system, however, cannot eradicate the virus completely.
- Lysine Supplements 1,000 mg taken three times a day.
- Lemon Balm cream may decrease the frequency of recurrences.
- Reishi has been found to inhibit the spread of the herpes virus.
- Astragalus has been found to improve immune function in people with herpes simplex.
- Resveratrol has been shown to be active against the herpes simplex virus in laboratory studies.
- Peppermint oil was also found to be active against an acyclovir-resistant strain of the herpes simpex virus.
- Propolis, also called bee propolis is sold in health food stores.
- Self-Heal Extract is a herb that has been found to be effective against both herpes simplex 1 and 2 viruses. It is also believed to work against acyclovir-resistant strains of the herpes virus.
- Colloidal Silver
- Olive Leaf Tincture
- Tea Tree Oil
- Hamamelis Virginiana Extract (witch hazel)
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