What you need to know about the connection between cold sores and herpes

The two are closely related.

Written by
Leeza Schwarzkopf
Medically reviewed by
Last updated
June 6, 2022
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You're probably familiar with what cold sores are, even if you don't get the small blisters yourself. Chances are that someone you know experiences the dreaded cold sore outbreak every now and then.

But, if you've ever heard of cold sores being referred to as oral herpes, you might be a little confused. We often associate herpes with the genital area, so what does that have to do with the cold sores that appear on the lips?

Well as it turns out, the two are very closely related, very common and very easily treated.

What are cold sores?

Cold sores are small blisters that form on your lips and around the mouth, including in the space between your upper lip and nose. For some people, cold sores can even appear inside the mouth. The skin where the cold sore appears can become swollen, red and painful.

Cold sores are caused by the herpes simplex virus type 1 (HSV-1). The virus can live dormant in your body without any symptoms until it is triggered by something that has weakened your immune system, such as emotional or physical stress, excessive sun exposure or illness.

Once triggered, your body may then develop cold sores. It's also pretty common to have a cold sore outbreak and fall sick with a cold or flu at the same time. This is the reason why we know these blisters as 'cold' sores and why they are also called fever blisters.

How common are cold sores?

One thing that needs to be stressed about the cold sore virus is that it's an extremely common viral infection.

In fact, up to 80 per cent of Australian adults have the virus. Although, not all of them experience symptoms and a lot of them may be unaware that they even have it. About one-third of people with the virus experience cold sores.

The virus is commonly spread through oral fluids and is often picked up when sharing a drink bottle or cutlery, or if you've come into contact with another person's saliva or fluid from a cold sore.

What are the symptoms?

The most obvious symptom of a cold sore is the sore itself. These are small, fluid-filled blisters that are often red and swollen. The clear fluid may ooze out of the cold sore during an outbreak, which can last around seven to 10 days before the sores heal.

However, when you are first infected with the simplex virus, the initial symptoms you may experience before you even develop an actual cold sore are similar to a cold or flu. This includes fever, lack of energy, headache, muscle aches, sore throat and swollen lymph nodes.

For those people who get cold sores, there's usually a warning period before the blisters form, with signs like itching, burning or a tingling sensation.

The initial infection usually has more severe symptoms compared to following flare-ups. Around 35 per cent of people who experience cold sores will get the blisters in the same place each time, though they become progressively milder and don't last as long.

Are cold sores herpes?

As previously mentioned, cold sores are caused by the herpes simplex virus type 1. There is another form of herpes simplex called herpes simplex virus type 2 (HSV-2) which is most commonly associated with genital herpes because it is transmitted through sexual contact.

However, it is possible for both forms of the herpes simplex virus to cause cold sores around the mouth or genital infections. This can happen because of oral sex or even through indirect contact such as sharing towels.

All cold sores around the mouth are caused by either one of the herpes simplex viruses, although not all of them are caused by HSV-2, which is mostly associated with genital herpes. Cold sores do not develop as a result of any other virus or bacterial infections.

Can you get herpes without a cold sore?

Yes, it is possible to get herpes from someone without the presence of a cold sore. This is likely why the herpes simplex virus is so widespread — without any visible blisters, it's easy to pass on the virus unknowingly.

When a person has either form of the herpes simplex virus, their body could be releasing the virus even if they don't have any active blisters.

That means they can still pass on the virus to another person and it could manifest in the form of cold sores or genital herpes, regardless of whether the first person usually experiences oral blisters, genital sores or neither one of those physical symptoms.

Are cold sores contagious?

Yep, cold sores are highly contagious. The body releases the herpes simplex virus through cold sore blister fluids, saliva and genital fluids. Someone who comes into contact with these fluids can then become infected with the virus and experience cold sores.

This generally comes in the form of skin-to-skin contact, with the most common being kissing — although, even contact sports like rugby can be a way that the cold sore virus is spread.

It can also happen indirectly by sharing items that touch the mouth like drinking glasses, eating utensils, lip balm, razors or towels.

If you have active cold sores, it's best to avoid sharing the above items to prevent spreading cold sores to other people. The infectious period can last anywhere between seven to 12 days.

Who is affected by cold sores?

It can't be stressed enough that cold sores and the herpes simplex virus are incredibly common. The majority of Australian adults carry HSV-1 and about one in eight Australian adults live with HSV-2. Cold sores can affect all people, regardless of age, and it is thought to affect all genders and ethnicities equally.

Having said that, there are some risk factors that can increase the likelihood of cold sores. This includes having a weakened immune system, for example, if you are an organ transplant patient, or being treated for cancer or HIV.

And, because HSV-2 is sexually transmitted, having multiple partners and unprotected sex increases your risk of cold sores and genital herpes. Although, with the use of antiviral medication, the risk of transmitting the virus drops to two per cent or even less than one per cent with the use of condoms.

When it comes to the recurrence of cold sores, this can vary significantly from person to person. Most people who experience cold sores will typically have one or two outbreaks a year. However, for others, it may be a rare occurrence that happens every few years, or they may have a cold sore outbreak every month.

Those who experience regular cold sore outbreaks may particularly benefit from suppressive therapy as it helps keep the virus and cold sore breakouts at bay.

Can you prevent cold sores?

There's no cure for cold sores and we can't get rid of the herpes simplex virus from our bodies completely. But, the good news is there are quite a few different ways you can prevent and limit the frequency of cold sore outbreaks.

Taking care of yourself and your immune system can help, because cold sores often appear when you're feeling run down. This means avoiding triggers such as sleep deprivation, stress, as well as colds and the flu.

Sun exposure can also be a trigger for cold sores, so practise sun safety and wear lip balm with SPF to reduce your risk.

There's also suppressive therapy, which involves taking daily oral antiviral medication to stop the herpes virus from multiplying and spreading to other cells. Antiviral medications reduce the frequency of cold sore recurrences and although it's not guaranteed, some people find that they have no further outbreaks.

Pilot offers suppressive therapy treatment, which reduces recurrences by 80 per cent and reduces transmission of the virus by around 50 per cent. And, you can access treatment online.

Simply complete our text-based quiz, and an Australian doctor can help you with a fast and effective treatment. Medication is delivered discreetly to your door and there's no need for a face-to-face appointment.

The best way to treat cold sores

If you currently have a cold sore or feel like you're about to have one, Pilot's outbreak therapy can quickly relieve symptoms and reduce the length of the outbreak by 50 per cent. This is a one-off course of antibiotics that helps to dry up the blisters quickly.

Early treatment is really important as the sooner you start the treatment, the more effective it will be. This means starting the treatment as soon as you feel a tingling or burning sensation, which is the warning period just before a cold sore develops.

Pilot's outbreak therapy is express shipped so that you can discreetly receive your medication and begin taking it as soon as possible.

There are also several over-the-counter treatments available including antiviral ointments that should be applied to a cold sore several times a day in order to help to lessen the symptoms. The downside with these products is they must be used at the first sign of a cold sore to be effective.

Over-the-counter painkillers can also be taken to reduce pain and treat any related cold and flu symptoms, such as fever.

Although it's often not discussed, a huge chunk of the population experiences cold sores or genital herpes as a result of a herpes simplex infection and there should be no shame attached to this. The most important thing to remember is that both can be easily prevented and treated to drastically minimise any impacts on your day-to-day life. We're here to help.

Photo credit: Getty Images

References

  1. Cold sore (fever blister), RelayClinical Education, 2012.
  1. https://dermnetnz.org/topics/herpes-simplex
  1. FREY, Rebecca. and CAFFREY, Cait. Cold Sores, The Gale Encyclopedia of Children's Health: Infancy through Adolescence, 2021.
  1. Oral Herpes Simplex, AltCareDex Medicine Modality, 2015.
  1. ROWLAND, Belinda. et al. Herpes Simplex, The Gale Encyclopedia of Children's Health: Infancy through Adolescence, 2021.
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