Cold Sores

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What is it?

Cold sores are an infection caused by the herpes simplex virus (HSV-1) that results in blisters which typically form on the lips and around the mouth. According to WebMD, during their cycle, usually lasting 7 to 10 days, the blisters are contagious until they heal and crust over completely. Although the healing process eliminates any outward sign of the infection, herpes simplex (HSV-1) is a virus that remains dormant in the facial nerves where it can then be reactivated. It can then travel to the site of the original infection, and thus manifest as a new cold sore.

Causes

Cold sores are typically caused by HSV-1 which is primarily transmitted by human contact including but not limited to: kissing an infected person, sharing eating utensils, towels, or razors. It is important to note a clinical distinction between cold sores and genital herpes.

While cold sores can be transferred to genitalia in the form of genital lesions, these lesions are manifestations of the HSV-1 virus that primarily affect sites on the facial region. HSV-2, commonly known as genital herpes, targets sites on the genital region. Although the two variations of the virus are transferable to the distinct locales on the body the viruses target, most cases of cold sores are caused by the HSV-1 virus, whereas most cases of genital herpes are caused by HSV-2. As cited by WebMD, it is important to acknowledge that although 90% of the population is infected with the HSV-1 virus, only around 40% of people experience a cold sore outbreak (www.webmd.com/skin-problems-and-treatments/guide/understanding-cold-sores-basics). This is for the reason that the virus is often triggered by stress, local skin trauma, colds, allergies, sunburns, and menstruation which reduce the immuno responses of susceptible individuals with HSV-1.

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Symptoms

In genera,l herpes infections show no outward symptoms, and when they do appear the viral life cycle from start to fully healed is roughly two weeks. Symptoms progress linearly in stages beginning with the latent virus travelling to the original site of infection. During this stage “asymptomatic shedding” of contagious virus particles can occur. The next stage is typically accompanied by a tingling or itching at the site of remission which can last from a few hours to a few days. After the first sensations, the site is then poised for the inflammatory stage. This stage is where the virus begins reproducing and infecting healthy cells. These healthy cells then act in response to the infection by swelling, which is typically accompanied by redness. This stage typically occurs in conjunction with the appearance of tiny fluid filled and inflamed vesicles that are painfully sensitive, and often itch. The most painful and contagious symptoms occurs in the open lesion stage, where the fluid filled vesicles burst and merge, creating an unified blister which is extremely sensitive, weeping with active herpes simplex particles. After this stage, when the lesion scabs, new skin begins to form underneath as the virus retreats into its latent period.

Diagnosis

Since HSV-1 is a herpes virus, blood tests detecting if the herpes virus is present can distinguish between type 1 and type 2. As discussed above, since type-1 and type-2 attack different sites on the body (facial vs. genital), a blood test alone cannot accurately determine the original site of infection between the facial or genital region. Thus, the herpes virus in general can be detected but to determine if it is type 1 or type 2 lesions must be analyzed, and lesions only manifest on a physical location of the body. Therefore, it is not possible to diagnose herpes if the person in question is asymptomatic.

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Treatment

Treatment options typically revolve around the effectiveness of antiviral medications. Since cold sores are caused by the herpes simplex virus, treatment often utilizes methods and medications used to treat viruses in general. These antiviral medications can increase the rate of healing by up to 10%. Medicines whose mode of action do not occur in the virus cell itself can be found in pharmacy’s without a prescription, particularly in the form of creams and applicators. Doconosol is often the ingredient in these treatments which speeds up the healing process by protecting healthy cells.