Why do I keep getting cold sores?

Cold sores can be tiny and painful, and for some, they keep appearing over and over again.

“Many people are infected with this virus but most have no symptoms at all. We spread the cold sore form of this disease through saliva and close personal contact to the saliva of others,” the infectious disease specialist explained.

The appearance of a cold sore can feel slightly embarrassing, especially in social gatherings or work, but Zoutman says the infection is very common.

“They affect your appearance on your lips and face, which may lead to feeling self-conscious. If they recur frequently, they can be very distressing and a reason to seek the help of your doctor.”

“We used to think of HSV-1 as classically the more common, above-the-belt type [that caused cold sores], and HSV-2 was below-the-waist [and causes genital herpes],” Hanna said.

Herpes simplex virus type 1 is transmitted through mouth-to-mouth contact or oral secretions, Hanna said, while HSV-2 causes genital herpes via sexual contact.

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Stages of cold sore development: What to know

Cold sores, also known as herpes labialis, are caused by nongenital herpes simplex virus type 1. People can develop a cold sore on their lips or in their mouth.

Transmission of the nongenital herpes simplex virus type 1 (HSV-1) occurs during childhood through nonsexual contact, but adults can contract the infection through sexual activity. HSV-1 hibernates inside skin cells and neurons under the skin until a trigger stimulates it.

Stages of a cold sore

A cold sore develops in five stages and will typically last between 9 and 12 days.

Stage 1


Initially, people will feel a tingling, itching, or burning sensation underneath the skin around the mouth or base of the nose. Doctors call this the prodrome stage.

Other symptoms that may occur during this stage include:

malaise
fever
tender or swollen lymph nodes
At this first stage of the cold sore, people will not see a blister. People with recurring cold sores may present milder symptoms. Doctors recommend starting treatment as soon as these symptoms begin.

Treatment for cold sores may include oral or topical medications. Sometimes people will use both types to treat a cold sore.

Oral medications for cold sores include:

acyclovir (Zovirax)
famciclovir (Famvir)
valacyclovir (Valtrex)
Topical treatments for cold sores include:

acyclovir (Zovirax) cream
docosanol (Abreva)
penciclovir (Denavir) cream
Treatment aims to shorten the duration of the cold sore. In one study published in Antimicrobial Agents and Chemotherapy, researchers found that high doses and short courses of valacyclovir may reduce the duration of a cold sore by about 1 day.

Taking medication when symptoms first appear can prevent or block the cold sore from appearing.

Stage 2


If the person does not use any medication, a fluid-filled blister will likely develop around 1 to 2 days after the initial symptoms.

Stage 3


The third stage, which occurs around day 4, involves the blister opening up and releasing its fluid. Doctors call this stage the ulcer or weeping stage. If another person comes into contact with the blister’s fluid, they may develop a cold sore as well.

Cold sores are contagious and tend to be painful during this stage.

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