What you need to know about cold sores

Cold sores are a common problem but easy to treat


How common are cold sores?

Cold sores are viral infections on your lips or in the corners of your lips that are caused by the HSV (herpes simplex virus). Cold sores appear as blisters that first ooze and later on form a crust and scab. Fortunately, they then heal without leaving any scars. HSV can be either type 1 or type 2, and we, therefore, talk of HSV-1 and HSV-2. Oral herpes, i.e., the one that shows up on your lips typically is HSV-1, but can also be caused by HSV-2. In fact, a decade ago, both types had equal chances of being behind oral herpes, but now HSV-1 appears to have the upper hand. Both herpes types also can cause genital infections, which are characterized by sores in the genital area.

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In fact, some 70% to 80% of the U.S. population are carriers of HSV, because once a Herpes virus has made entry into your body it’ll be there forever and you can pass it on to others. However, for most people with a normal immune system, there aren’t any breakouts or they only see mild symptoms. That said, a good part of the population — by some counts 20 to 40% — will experience a cold sores outbreak at least once in their lives. Some people will have cold sores recurring more frequently, whether it’s once every odd year or once a month. But high monthly frequency is only seen in a small portion of people. 

A weak immune system, whether chronic or only temporarily weakened, raises the risk of a herpes outbreak. Also, excessive sunlight, like when you are vacationing at the beach, and dry cracked lips can trigger cold sores.

If you are experiencing your first cold sores or you think you never had them before, it might be worth asking your doctor to do some testing to get a firm diagnosis whether you carry herpes viruses in your body. However, an experienced doctor will be able to make that diagnosis by just looking at your cold sores. 

Can cold sores appear in other areas, not just the lips?

Rarely so, but it’s possible for some people to develop cold sores outbreaks in other parts of the face or body other than the lips. This can have more serious consequences. For example, cold sores can appear on the eyes, which if not take care of can cause blindness. Therefore, if you notice cold sores on your body other than the lips, you should see a doctor.

Are cold sores and canker sores alike?

No, the two are different in terms of cause and locations. Cold sores result from herpes virus infection and are contagious, whereas canker sores are not viral in origin and can’t be passed on. Moreover, canker sores sit inside the mouth, while cold sores are located on the outside and on and around the outer lips.

What’s the best cold sore treatment:  creams or pills?

There’s no permanent cure for cold sores, since the herpes virus will always be in your body. As long as there aren’t any outbreaks, there’s no harm in carrying the virus — other than of course that you can pass it on to other people. 

But there are medications that help to fight acute cold sore outbreaks. Doctors often suggest to patients to use both topical creams and antiviral pills. The creams are a local solution that, when applied to the cold sore area several times a day, will ease the outbreak. The good thing about these topical creams is that one of them (docosanol, branded as Abreva) is U.S. FDA approved as an OTC drugs. Pills on the other hand always require a prescription by a doctor, but they tend to be faster acting than creams as they deal with the viral problem from inside the body. Given how prevalent cold sores are in the population, there’s a long list of alternative treatments, ranging from blueberry juice to essential oils. However, there’s no scientific conclusion on how well these alternative remedies work. Current medical knowledge implies that the pills are still your best bet. cgv

If you suffer from recurring cold sores, with 3-6 outbreaks every year, consult with your doctor whether you can take pills preventively to lower the frequency of outbreaks.

How can I minimize the risk of giving herpes to other people?

If you currently are troubled with a cold sores outbreak, avoid close skin-to-skin contact with other people on the affected area, such as kissing or oral sex. In fact, doctors say that a growing number of HSV-1 induced genital infections appears to come from practicing oral sex. Also, when you are currently dealing with an outbreak, don’t share drinks and food with others directly. 

Even if you don’t have a current outbreak, there’s always a risk that you transmit the virus to someone from the lucky 20% to 30% of the population who don’t have herpes yet. However, the risk for this to happen is relatively low and requires repeated encounters of skin-to-skin contact and unprotected sex. So, if you marry someone who doesn’t have herpes yet, it’s almost certain that he or she will get it within the first couple of years of your marriage. 


“Can Cold Sores Be Prevented?” Nih.Gov, Institute for Quality and Efficiency in Health Care (IQWiG), 12 July 2018, Accessed 28 Jan. 2020.

Chi, Ching-Chi, et al. “Interventions for Prevention of Herpes Simplex Labialis (Cold Sores on the Lips).” Cochrane Database of Systematic Reviews, 7 Aug. 2015, 10.1002/14651858.cd010095.pub2. Accessed 28 Jan. 2020.

Pincock, Stephen. “Herpes Increases Because Oral Sex Thought Safe.” BMJ?: British Medical Journal, vol. 333, no. 7567, 2006, p. 516, Accessed 28 Jan. 2020.

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