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I kissed someone with a cold sore. What should I do?

The dos and don’ts

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Herpes Simplex Virus (HSV for short) is a viral infection that can either result in cold sores, genital sores, or both. HSV can come in 2 forms, type 1 and 2. The World Health Organisation estimates that 3.7 billion people under 50 have HSV-1 globally, while 491 million people aged 15-49 have HSV-2. 

HSV-1 usually causes cold sores, and HSV-2 typically results in genital herpes. However, either type of infection can result in cold sores and genital herpes. HSV-1 is usually contracted through oral-to-oral contact but can sometimes be acquired after oral-genital contact. HSV-2 is exclusively contracted during sex and is considered a sexually transmitted disease.

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Individuals contracting HSV-1 are usually asymptomatic until they develop their first cold sore. Adults are less likely to develop symptoms after primary infection compared to children. The usual symptoms to look out for are sore throat, swollen glands, painful sores in and around the mouth. Along with these symptoms, individuals might also have flu-like symptoms such as fever, nausea, and headaches. 

Cold sores are tiny blisters or sores usually emerging on or around the lips. With 2.5 out of every 1,000 people experiencing a cold sore during their lifetime, this condition is widespread. While cold sores do tend to heal without treatment, they can persist for 1 to 2 weeks before clearing up. You can experience multiple cold sore outbreaks during your life as the virus will remain dormant in your body. Cold sores are highly contagious, so doing something like kissing is quite risky. The risk of contracting HSV-1 is significantly higher when kissing someone with a cold sore. 

 

Stages 

There is a cold sore healing process from when the sore appears, becomes an open sore, then heals and disappears. There are eight stages to this healing process:

  1. Latent period - when the virus is dormant 
  2. Prodromal stage - usually causes tingling and skin reddening around the lip 
  3. Inflammation stage - the start of the cold sore process
  4. Pre-sore stage - painful cold sores begin to develop around the lip
  5. Open herpes lesion stage - the cold sores will open and become an exposed sore 
  6. Crusting stage - active healing of the cold sore to form a brown crust
  7. Healing stage - scab has now fully covered the sore, and new skin is forming underneath 
  8. Post-scab stage - the sore has now healed, and skin should be returning to normal

While cold sores usually develop around the lips (herpetic labialis), they may sometimes form inside the mouth (herpetic stomatitis). You may think it is safe to start kissing your partner from stage 6, however, contagion persists during all 8 stages and kissing should be avoided at all costs.


Spreading the virus

Cold sores spread through contact. HSV-1 can lay dormant for years, and individuals might not even realize they have contracted herpes until their first cold sore outbreak. Events like stress, illness, and having a period can trigger a cold sore outbreak. You can get HSV-1 through an innocent kiss, using utensils with shared saliva, or being intimate with your sexual partner. 

Only a very minute percentage of people with an HSV-1 or HSV-2 infection develop cold sore symptoms. You might have an HSV infection and not even know it! It is important to take precautions with your partner even if you are pretty sure you both have or don’t have an HSV infection. 


To kiss or not to kiss

You definitely should not kiss someone with a new cold sore. It is best to just be abstinent until the sore or scab has completely disappeared before kissing or partaking in oral sex. Without a completely healed cold sore, the virus can continue shedding. After an outbreak, the longer you wait, the lower your chances of contracting or passing on the virus. 

 

Healing and treatment

Cold sores not only acts as a hindrance to intimacy, but also carry a heavy social stigma and can make casual social situations awkward and stressful. Effective antiviral medications are available and widely used for HSV. These antivirals including acyclovir, famciclovir, and valacyclovir, can reduce the frequency and severity of the outbreaks.  Sadly, HSV is a lifelong infection. There is currently no cure, just a treatment to suppress symptoms. 

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