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The Basics on Cold Sores

Written by HeyDoctor Medical Team

Are cold sores common? Is a cold sore the same as herpes? What’s better for treating cold sores, creams or pills?

Are cold sores common?

As you may know, cold sores are caused by a virus - the herpes simplex virus (HSV). There are two types of HSV: type 1 (HSV-1), and type 2 (HSV-2). HSV-1 is often more associated with oral herpes, but both strains can cause oral herpes (cold sores), and both can cause genital herpes (sores on or around the genitals).

An estimated 70-80% of Americans are carriers of HSV, but most people show no or very mild symptoms - meaning they might not ever get outbreaks. An estimated 20-40% of people have at least one outbreak of cold sores in their lifetimes.

Viruses remain in your body permanently, so if you’ve ever had a cold sore, you’re carrying the virus. Most people who have recurrent cold sores only have outbreaks every 5-10 years, while a small number of people have outbreaks monthly or more.

Is a cold sore the same as the herpes virus?

Yes, cold sores are caused by the herpes simplex virus (HSV-1 or HSV-2). Most commonly cold sores are caused by HSV-1, but they can also be caused by HSV-2. The HSV-2 virus is the most common cause of genital herpes but increasingly we are seeing cases of genital herpes caused by HSV1.

Is a cold sore the same as a canker sore?

No. Cold sores and canker sores are different. Cold sores are caused by the herpes virus, which can be contagious. Canker sores are not an infection and are not contagious. Canker sores generally happen on the inside of the mouth while cold sores happen on the outside.

What’s better for treating a cold sore: a cream or a pill?

Actually, doctors often recommend you use both antiviral pills and topical creams to fight the cold sore outbreak on multiple fronts - on the surface, and inside your body. If for some reason you have to choose only one, pills are generally more effective, since creams have to be applied several times a day. That said, the pills are only available by prescription, whereas docosanol (Abreva) is available over-the-counter (and is the only FDA-approved over-the-counter topical cream for cold sores). Since cold sores affect so many people (the majority of Americans, in fact), there are a lot of treatments out there, from over-the-counter creams and antiviral pills, to alternative solutions like blueberry extract and essential oils. Some people take lysine powder as a supplement daily to try to prevent cold sores. The evidence for how well these remedies work is still unclear.

Is there a cure for cold sores?

Unfortunately, there’s no cure for cold sores—treatments are focused on reducing symptoms and shortening the length of the outbreak and preventing outbreaks from happening. How well the various treatments work depends on a lot of things: when you start treatment, what other health factors you’ve got going on, and more. Which means that all cold sore treatments have varying success rates. Some folks who get frequent outbreaks have methods that they swear by, but prescription antiviral pills and topical creams are the most studied, and widely-used treatments.

Should I be tested for cold sore viruses?

If you’ve never had symptoms of an outbreak, talk to your doctor about whether testing is right for you. If you have had outbreaks you may want to be tested to confirm the diagnosis of cold sores, but in most cases, it can be diagnosed by having a doctor look at the outbreak while it is happening. Cold sores tend to have a very common appearance of blisters that ooze, then crust and scab, and then heal without scarring.

Can you get cold sores in areas other than the lips?

Some people do get cold sores (herpes outbreaks) in other locations besides the lips. These types of outbreaks can be a bit more serious and complicated and require a visit to a doctor in person. For instance, sometimes cold sores can affect the eyes - this can lead to blindness if left untreated.

How can I decrease the risk of passing it to someone else?

If you have an outbreak of cold sores, you should refrain from kissing, performing oral sex, and sharing things like food, drinks, and toothbrushes. Although the risk is low, herpes can be transmitted even if you’re not having an outbreak. Although HSV-1 is most often associated with oral herpes, an increasing number of genital herpes cases are actually HSV-1 transmissions from mouth to genitals.

Even if you don’t know your status, using safer sex practices like condoms and dental dams can reduce your risk of getting (or passing on!) HSV. Avoid skin-to-skin contact with the affected areas if you’re having an outbreak.

Should I take preventive medicine for outbreaks?

If you get more than 4-6 outbreaks per year, you might want to talk to a doctor about whether daily preventive medicine is a good idea for you.

The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of HeyDoctor, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.

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