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Everyone has at least once heard of cold sores. But how many really know what it is? For proper prevention it is necessary to know how to come into contact with the virus, what are the main causes that trigger relapses and how you feel psychologically when it occurs. Cold sores are an infection caused by the herpes simplex virus type 1 (HSV-1). The virus often generates an infection on the lips. Once the infection is cured, it can easily reappear because the virus survives throughout our life, remaining latent within the body.
What is cold sore? Herpes simplex definition
Cold sore is very common and is due to a virus that causes mouth ulcers and blisters on and around the lips. To reduce the risk of infection, the mouth ulcer should be treated as soon as possible. The disease appears due to infection with herpes simplex virus (HSV). If you’ve got the virus, it’s left in your body for the rest of your life. However, the symptoms may vary, so it’s not everyone who gets a mouth sore even though they carry on the virus.
Cold sores are highly contagious and infect mainly through direct contact, usually kissing. You can also transmit infection if you use the same cutlery and the same lipstick. The virus is predominantly in the fluid from the wound, therefore, the risk of getting or giving any cold sore is greatest when a person has a sore throat. The mouth is contagious until it is completely dry without cracks.
But a herpes infection does not need to give a cold sore and therefore there are many who do not know that they are the carrier of the herpes virus. As long as you do not get a cold sore, the herpes virus is nothing you would notice. You can also have a mouth sore without necessarily having herpes.
The incubation period, the time from infection to the first symptoms, is a few days up to three weeks. There is no cure for cold sore but antiviral drugs can dampen the symptoms. The most common symptoms of cold sore are mouth ulcer with fluid-filled blisters that are painful, usually the wounds appear on or next to the lips. The trouble starts as tingling and pruritus, after which blisters occur. The blisters break apart and form wounds that then dry and become scabs. These wound corps tear off after a while.
The first time an infection occurs, some people may experience severe symptoms where the entire general condition is affected. You may have pain in the throat, fever and swollen lymph nodes on the throat. After the first infection, the virus is left in the body and can bloom again in the course of cold, stress, strong sun or other type of effort.
Cold sore (herpes simplex) contraction and manifestation
Contact with the herpes simplex virus type 1 (HSV-1) occurs through infected individuals or, in rare cases, by transmission from the mother at the time of birth. Initially, herpes simplex type 1 (HSV-1) manifests itself by causing a slight tingle, accompanied by a sense of warmth on a point of the lips that is reddened at the sight. In a short time some vesicles containing liquid are formed which, once the inflammatory process is over, form a small crust that disappears within about 7-10 days.
Cold sores could create physical and psychological discomfort. Cold sores are both annoying and unsightly on the skin of the lips, so it could affect people’s self-esteem and make them feel uncomfortable with themselves and others. Once contracted, the virus manifests itself on the lips due to a series of triggering factors such as:
- Ultraviolet radiation emitted by the sun and tanning lamps:
it is good to protect yourself from these radiations as they are one of the main causes of the recurrence of cold sores.
- Lowering of immune defenses:
maintaining the correct balance of the immune system keeps the defense system of our organism efficient, also counteracting the recurrence of cold sores.
- Stress (physical or mental):
it affects the immune system by lowering the body’s defenses and increasing the possibility of relapse.
causes a general weakening of the organism which, being weaker, is more exposed to possible infections from viruses, bacteria and fungi.
- Premenstrual period:
every woman during the month undergoes a weakening caused by the menstrual period. This condition favors the possibility of relapses.
Herpes simplex and herpes gestationis: differential diagnosing
Herpes simplex and herpes gestationis are two very different problems that it is good not to confuse. Herpes simplex is a virus known in distinct, among the most common types:
- herpes simplex type 1, the main cause of herpes labialis;
- herpes simplex type 2, responsible for genital herpes.
Both viruses are characterized by similar infectious dynamics. After being contracted the first time they can no longer be eradicated by the host organism in which they reside, from that moment, in dormant mode. Some factors such as solar radiation and psychophysical stress can cause a reactivation of the virus and the appearance of symptomatic recurrences.
Herpes simplex type 1 (HSV1) is a widespread virus (estimated millions of people infected in Italy) responsible for herpes labialis, or cold sore. It is generally characterized by the appearance of symptoms divided into 5 phases that culminate in the visible appearance of the infection with annoying vesicles filled with liquid on the lips or on the face.
Herpes simplex type 1 is a virus of the Herpesviridae family of which there are 8 other herpes viruses, among the most widespread:
- herpes simplex type 2, responsible for genital herpes;
- shingles due to chickenpox.
The viruses of this family can be transmitted only from person to person and not in contact with the animals, with which they are incompatible.
Cold sores caused by Herpes simplex type 1 are known by many different names such as ‘lip fever’ or ‘dull fever’. In fact, it owes its name to the Greek ‘herpo’ which means ‘to crawl’, probably due to the particular characteristic of ‘hiding’ inside the organism. Infection can occur by contact with infected individuals or, more rarely, between mother and child at birth. After the first infection, which occurs more commonly in childhood, the body is not able to eradicate the virus that is permanently inserted into the body.
Herpes simplex type 1 is part of the virus categories:
- So-called ‘neurotropics’ because, once they enter the body, they are established at the level of the nerve ganglia;
- ‘Epidermotropy’ because, when reactivated, they need skin cells to replicate and give rise to symptoms.
The herpes simplex virus 1, in fact, can remain hidden and inactive for a long time in perfect balance with the immune system until the moment when, for various causes and reasons, often unpredictable, this balance is altered by lowering the immune system and leaving space to the virus that manifests its symptoms on the skin.
The so-called ‘herpes gestationis’ is, instead, a pathology that occurs during pregnancy and in the period following childbirth. This disease is characterized by intense itching and the widespread appearance of a bullous eruption on large areas of the body. The name with which it is known could deceive but this disease has no cause related to the herpes virus, or to any other virus. The pathology is, in fact, triggered by a substance normally contained in the placenta that, in some predisposed subjects, causes an autoimmune response of the body.
The association with the cold or genital herpes, which gives the name of ‘herpes gestationis’ to this pathology, is given by the similarity of the cutaneous symptoms. However, generally, the areas of choice for herpes gestationis symptoms are different from those of real herpes. Usually the disease appears on the abdomen, with a particular incidence in the area around the navel and on the upper part of the legs, saving the face and the genital mucous membranes.
Cold sore without symptoms
Many contract the herpes simplex virus type 1 but it is estimated that between them only a small part is actually subject to frequent relapses, in fact, the infected people are generally divided into 4 categories:
- those who never manifest any symptoms throughout their lives, the so-called healthy carriers of herpes;
- those in whom sporadic or occasional manifestations occur throughout their lives;
- those who present on average 2 or 3 annual events;
- those who present continuous manifestations of chronic herpes (at least 1 per month).
Given that the herpes simplex virus type 1 cannot be eliminated from the body, the people who contract it are always potentially contagious even when they do not show the symptoms of the infection. It is therefore good to observe some good practices and remedies to avoid spreading the virus and learn how to protect yourself from relapses with the help of specific products.
What causes cold sore?
The causes of cold sores are related to its particular nature. That caused by the herpes virus, is, in fact, a latent infection subjected to periodic reactivations, called recurrences, which appear as vesicular lesions on the skin of the lips. The causes of the reactivation of the virus are multiple and all linked to a lowering of the immune system: globally, when the whole body is in a state of particular physical or psychological pressure, or locally, as when external factors contribute to compromise the well-being of the skin.
A prominent role of the sun has been highlighted among the causes of reactivation of the herpes labial virus. Not all radiation emanating from the sun is beneficial for the skin and especially for the delicate of the lips.
Ultraviolet rays (UVA and UVB) are responsible for numerous processes harmful to tissues such as:
- the increase in oxidative stress, a condition that breaks the natural balance of skin cells;
- photoaging a variation in the orientation of the elastin and collagen fibers which causes the loss of elasticity of the skin;
- damage to blood vessels, which compromises the microcirculation.
Moreover, the most harmful UVB rays can penetrate very deeply, affecting the dermis, the skin’s supporting structure. Moreover, the sun is able to significantly compromise the hydration of the lips, which are made of epidermis much thinner than the rest of the body. Dryness can thus result in lacerations of the hydrolipidic film covering the surface layer of the skin responsible for primary defense against viral attacks.
This picture of lip vulnerability can create conditions favorable to the replication of the herpes labial virus and the consequent appearance of the symptoms.
We often make the mistake of thinking that protecting the skin from the sun is a task to be performed only while on vacation at the beach. In fact, the UVA and UVB rays affect the city all year round, especially in those areas of the body that are difficult to protect with gloves and hats such as the face and lips. A special case is that of the mountain where altitude, temperature and air rarefaction contribute to exponentially increase the exposure of the skin to the sun and its negative effects favoring the appearance of cold sores. It is important for these reasons to know which products are specific to protect the lips from recurrence of the cold sores caused by UV rays.
It is known that there is a strong link between physical and mental stress and the lowering of immune defenses; because of this tension and tiredness they can be counted among the causes of cold sores.
A stressed individual often neglects their diet, spends many hours in activities that require concentration and energy, does not carry out adequate physical activity (or does too much) and does not rest the right time required by his body. In this way the body does not have sufficient energy to carry out its numerous and vital maintenance and defense tasks.
Stress and tiredness, as it happens on the lips with the sun, can therefore disturb the balance between the immune system and the virus of the cold sores in latency, facilitating the reactivation and causing the appearance of relapses.
Can cold sore herpes contaminate the genitals?
Oral herpes is an infection caused by the herpes simplex virus type 1 (HSV-1), unlike genital herpes, which is caused by herpes simplex type 2 (VHS-2). But can there be interactions between the two viral strains?
Once an individual has contracted the oral herpes virus, they are contaminated for life because there is no treatment to eradicate it permanently. From then on, the viral load will reappear punctually, in the form of herpes outbreaks, at a variable frequency depending on the person. In cases of uncomplicated herpes, the management of a relapse is relatively simple since it consists of the administration of analgesics, to relieve pain, and the local application of an antiviral ointment (aciclovir).
Characterized by small vesicles occurring punctually in the sexual organs, genital herpes is part of sexually transmitted infections. Caused by the herpes simplex virus, this disease can be contracted during sexual intercourse with an infected person. But is there a risk of transmission during oral sex?
It should be noted that the oral herpes virus and that of genital herpes have strong similarities. Thus, the transmission of cold sores to the genital organ can occur at the time of an oral sex with an infected person. Indeed, it is the direct contacts with the epidermis and the mucous membranes that are at the origin of the transmission of the virus. The reverse, that is to say the transmission of genital herpes to the mouth, is also possible even if it remains much less common.
The sexual way remains nevertheless the mode of major contamination of the genital herpes. Indeed, the virus is transmitted primarily during unprotected sex with a person previously contaminated. The herpes outbreak is the time when the risk of contracting the virus is highest. As such, it is recommended to abstain from vaginal or anal intercourse during this period. The vesicles containing the virus remain contagious until their complete healing. Condom use is not enough protection because it does not always cover all the lesions.
Cold sores during pregnancy and lactation
Herpes viruses can be of different types. The most common ones are herpes simplex type 1, responsible for herpes labialis, herpes simplex type 2, the main cause of genital herpes, and herpes zoster, origin of varicella and shingles.
Type 1 simplex herpes virus is responsible for a so-called ‘latent infection’. The virus, after being contracted for the first time, can never really be eradicated from the body but it is only possible to try to reduce the duration and the annoying effects of its recurrences.
The same latent mechanism also occurs for the type 2 simplex herpes virus which is known to have potentially quite serious repercussions on the health of the unborn child especially if contracted by the mother for the first time in the last months of pregnancy. On the other hand, women with a history of genital herpes recurrences present a very low risk of transferring the virus to the child during pregnancy or childbirth.
Recurrences of cold sores are quite rare in pregnancy and potentially less dangerous than genital ones. It is important, however, to avoid contracting the first labial herpes infection during gestation. For this reason pregnant women who have never had symptoms of herpes or that are negative for the presence of the virus in the blood, it is good that they do not come in contact with the active lesions of other people (the virus, in truth, can be transmitted also in the absence of visible symptoms but the viral load, and therefore the risk of contagion, increase when a relapse appears).
Especially for those who are subject to frequent episodes, the use of specific products for the protection from recurrence caused by UV rays is useful to prevent one of the most common causes of cold sores.
Cold sores in babies
When we talk about newborns we do not speak in general about babies born recently but we refer to a specific period of child development, called, precisely, neonatal, which occurs between the birth and the 4 weeks that follow. In this period of time any type of infection can compromise, even seriously, their health because the immune system is still extremely fragile in the face of external attacks.
The most common types of herpes and therefore can more easily be transmitted to a newborn are generally 2:
- cold sores, caused by the herpes simplex virus type 1;
- genital herpes, generated by type 2 herpes simplex.
Both types of herpes are characterized by the ability to develop a latent infection inside the body of the host, hiding permanently in the body, even when the symptoms are not visible. The reason is that the defenses are not able to eradicate pathogens but only to limit the spread and replication in the skin. These types of viruses, in the still delicate and defenseless organism of the newborn, could spread rapidly, and without finding great obstacles, giving rise to widespread infections of the organs and of the central nervous system.
Herpes simplex of type 2, a serious risk for the newborn
Neonatal infection by the genital herpes virus is a disease that can have very serious consequences. The transmission can occur in utero or at the time of delivery and, for this reason, it is important that the infected mothers, with or without symptoms, are confronted with their gynecologist to adopt special measures that prevent the infection of the unborn child.
Labial herpes is less frequent that cold sores are transmitted during childbirth, except for the presence of type 1 herpes simplex lesions in the vaginal tract. A child born of a mother with a history of recurrent cold sores could have developed antibodies to the virus through breast milk or in utero, but they are insufficient to protect it completely.
Cold sores can be transmitted to the baby mainly by contact with the secretions of infected people who take care of it especially if they have visible symptoms of a recurrence (acute episode that increases infectivity). In this case it is advisable to take care of the baby with a nose-to-mouth mask avoiding to let the baby in direct contact with the injuries or with the hands after touching the lesions.
The symptoms of herpes in the newborn
The symptoms of a herpes infection in the newborn occur between the first and second week of life but may not appear until the 4th week. The most common sign of the infection is represented by cutaneous vesicles which, if left untreated, frequently induce within 7-10 days a progressive and more serious form of disease.
As already mentioned, a neonatal infection with cold or genital herpes can give rise to very serious consequences for the health and development of the newborn. It is therefore essential that mothers who are aware of infection are referred to their doctor during pregnancy and protect their child from the possibility of infection with herpes simplex, especially during the first 4 weeks of life.
Cold sores or herpetic disease?
Sometimes the initial stages of another disease caused by the herpes virus can be confused with cold sore. Herpetic gingivitis, or herpetic disease, is a condition that typically affects younger children. Herpetic disease is related to 2 types of Herpes virus simplex. HSV1 is classically related to herpes infections of the upper body (especially orofacial); HSV2 at the lower body (although this distinction needs to be nuanced). Among cutaneomucous herpes, only acute gingivostomatitis is detailed here.
The causative agent is a DNA virus of the Herpesviridae family: HSV1 or 2. HSV1 is the type of HSV most commonly responsible for oral herpes in children. Primary infection corresponds to the first contact mucous or skin infective, symptomatic or not. The incubation time after infective contact lasts 5-7 days.
The disease confers immunity but partial, not preventing reactivations. The reactivations correspond to periods of viral replication, separated by periods of latency, occurring either in the form of clinical recurrences or by asymptomatic viral shedding. Transmission is by direct contact with a subject excreting the virus, cutaneous or genital (lesions) but also by asymptomatic viral excretion (saliva). Contagiousness is possible in the different forms of viral shedding. It is maximal in the first hours of constitution of the vesicles and decreases thereafter. In the course of a primary oral infection, the duration of contagiousness by viral excretion varies from 8 to 20 days.
Primary infection with HSV1 occurs most often between the ages of 1 and 4 years. About 80% of children ≥ 5 years of age have HSV1 antibodies, which does not prevent reactivation. This primary infection is most often asymptomatic. When symptomatic, she may have an acute gingivostomatitis chart.
Rare and related complications are immunocompromised, atopic dermatitis (Kaposi-Juliusberg syndrome); in association with visceral involvement: meningitis, encephalitis, hepatitis.
The diagnosis of acute gingivostomatitis is primarily clinical. Complementary confirmatory tests are mainly justified in severe (risky) or complicated forms. Possible confirmatory biological examinations that your doctor may appoint are identification by viral culture on a lesion sample and (not obligatory) serology for diagnosis when clinical lesions are suggestive.
Treatment is primarily ambulatory and symptomatic. Parents must ensure that the child is hydrated and fed sufficiently. The pain should be treated adequately (level 1 or 2 analgesics). The addition of local treatment (mucous membranes) is difficult to administer and has no demonstrated interest.
Local cutaneous surinfection is rare. Hospitalization is required only in the case of severe or complicated forms. Antiviral treatment with aciclovir (Zovirax) may be recommended. Its effectiveness is related to the early administration compared to the onset of symptoms (24-48 h), for a period of 5 to 10 days. The IV channel can be used when feeding is impossible.
School eviction is not compulsory. Attendance to a community in the acute phase of the disease is not desirable. Information on the transmissible nature of this infection should be given to the parents, especially in case of contact with a child with atopic dermatitis in thrust.
To date, there is no vaccine against this virus. After recovery from primary infection, recurrences may occur in the same territory despite the presence of antibodies: bunch of vesicles at the junction of the skin and the oral mucosa and on the edge of the lips; it is recurrent labial herpes. Avoid contact with an atopic child because of the risk of Kaposi-Juliusberg.
The loss of appetite in children is often due to pain (tingling and pain in contact with certain foods) and the analgesic will alleviate this problem. It is important to moisturize the mucous membranes of the mouth (drink plenty of water). To help the recovery of appetite, it is often necessary to replace a solid food with almost liquid foods.
Why herpes virus recurs?
The word herpes designates a family of viruses with similar characteristics but which give rise to different pathologies and symptoms. The best known are herpes labialis, caused by herpes simplex virus type 1, genital herpes, caused by herpes simplex type 2 and herpes zoster origin of chickenpox and shingles.
The pathological dynamics of labial herpes (similar for the genital and different for the zoster, which tends to not recur) is as follows:
- Labial herpes virus is generally transmitted by kissing, close contact, sharing food and cutlery from an infected person.
- A person with cold sores can be contagious even when there is no visible symptom.
- Transmission is facilitated when an infected person comes into contact with the injured skin (especially of the lips) or with the mucosa of a healthy person.
- Labial herpes virus, unlike other common viruses, is permanently inserted into the host’s body generally at the level of the trigeminal nerve ganglia.
- The body begins to develop antibodies specific to the virus that, while not being able to eradicate it, manage to keep it in a state of quiescence, preventing it from multiplying continuously in the skin.
- Some factors, such as solar radiation, psycho-physical stress, temperature changes, dehydration and the recurrence of other infections, can lower the immune system and break the ‘balance’ that has arisen between the herpes virus and its natural antagonists.
- The virus, finding fewer obstacles, replicates in the skin until it gives rise to its annoying symptoms.
- This periodic ‘reawakening’ process of cold sores gives rise to relapses, or to symptomatic flare-ups of the virus. If the first symptomatic manifestation of herpes labialis is generally the most bothersome and can be accompanied by fever, swollen lymph nodes and malaise, relapses tend to present the typical localized symptoms without involving other areas.
Some of the factors stimulating the onset of relapses may be unpredictable, while others, such as the sun or stress, can be prevented by maintaining a healthy life and a good night’s sleep and using specific skin protection products of lips from recurrences of herpes simplex-1 caused by UV rays.
Cold sore prevention
UV exposure is recognized as a major cause of recurrence of cold sores. The solar radiations, in fact, have debilitating effects on the skin of the lips, lowering the immune system and facilitating the replication of the virus. It is good, therefore, to learn how to prepare and to protect yourself adequately from UV radiation to prevent its harmful effects.
1. Know your phototype.
Not all people have the same skin. The genetic characteristics of each, in fact, can determine very different reactions to the sun. A first step of evaluating your skin, before exposing yourself to the sun, is the analysis of the phototype. It is a classification that estimates the presence in the skin of melanin, a natural mechanism of protection from sunlight.
There are 6 phototypes:
Phototype 1: white or very light complexion with freckles or ephelidae; light eyes. It burns easily and never tans;
Phototype 2: fair complexion, light eyes, blond or light brown hair. It burns frequently and tans very little;
Phototype 3: normal complexion, dark blond or brown hair. It burns moderately and tans in a gradual manner;
Phototype 4: slightly dark complexion, dark brown hair and eyes. It burns little and tans quickly;
Phototype 5: dark complexion, dark brown or black hair, dark eyes. It burns infrequently, tans intensely and after a few exposures.
Phototype 6: very dark complexion, eyes and black hair. Always pigmented, it never burns almost never.
2. When in the sun, do not put on too much makeup and fragrance.
When exposed to the sun, it is not recommended to use cosmetics that do not show specific indications in this regard. Some facial make-up products, in fact, can contain components, called photosensitizers, which could cause irritation reactions on the skin. Likewise, perfumes based on denatured alcohol (which contains petroleum derivatives) are also to be avoided, which can cause photo-toxic reactions, including the appearance of small dark spots on the areas where it has been sprayed, very difficult to remove.
3. Choose the right products.
The sun is not just a phenomenon to deal with in the summer, especially for those suffering from frequent recurrences of cold sores. In fact, the UV rays, also conveyed by the tanning lamps, can affect the skin of the lips at any time of the year. It is advisable to use specific products for lip skin recurrences for the skin of the lips, because the generic cocoa butters or lipsticks, unless indicated on the package, may not repair the lips from UV rays.
For the rest of the body, the choice is for products appropriate to their skin type and the needs of their skin, taking care not to forget the ears, neck, back of the feet and groove of the knees, often subject to forgetfulness and ‘burning’ disappointments from tan. It is also good to cover your head with a hat, spread the cream at least half an hour before exposing yourself to the sun and choose water-resistant sunscreen products.
It often happens, especially in the mountains, to tan or burn yourself even when the sky is cloudy. This happens because the clouds are only partially able to filter the sun’s rays (both visible and invisible and harmful as UV rays). We must not forget to protect the skin of the lips and the body when we are outdoors, even if there is no good weather. In general, exposure to the sun should be avoided between 12.00 and 16.00 in the Mediterranean areas and from 11.00 to 17.00 in the tropical areas where the sun is much stronger.
5. Keep your hydration routine exact.
Sun and heat weaken the whole system of our body, so it is important not to forget to drink and privilege a diet rich in raw vegetables and fruit. Even the skin exposed to solar radiation must be adequately hydrated, with particular attention to the most delicate areas such as the lips, especially for those who are subject to the appearance of frequent recurrences of cold sores, through the use of specific products with high moisturizing value.
Cold sore sum-up
Once you have been infected with cold sore, the virus remains in the body for the rest of your life. There is no treatment that removes the virus, but the mouth ulcer heals out of their own.
Important when you have cold sore is to keep clean and dry around your wounds. Wash your hands thoroughly if you touch the mouth because the virus is very contagious. As a treatment against the mouth ulcer, one can use an antiviral cream that inhibits the virus’s ability to multiply and shortens the healing process. There are several prescription options at the pharmacies. Note that only antiviral drugs that have this effect, mouth ulcer without these antiviral substances (so-called herbala products) do not have this effect. Treatment with antiviral drugs should be ironised already at the first signs of mouth ulcers. Note that hand hygiene is important also when lubricating antiviral creams.
The latest treatment that has come is a combination preparation (acyclovir and hydrocortisone) that has both antiviral properties but also hydrocortisone that suppresses inflammation. These properties provide a more powerful effect by combating both viruses and inhibiting inflammation.
For those with severe symptoms and problems with recurrent outbreaks, there are prescription drugs in the form of tablets. They relieve the symptoms and prevent the spread. As with the prescription products, treatment should start early to give the best effect.
Sad but true, avoiding kisses (including kisses and oral sex) in conjunction with mouth ulcers when the infection can easily be passed on. Also take care of things that touch your mouth like cutlery, lipstick, mugs, glasses and cups and keep them separate from others as long as you have a cold sore. Also, remember that the stage with redness, swelling and lumps / bladders is contagious. Nor should you pinch or pierce the blisters, as it delays the healing process and may spread the infection to other places on the body. If you have been on your mouth ulcer, wash your hands carefully afterwards.