Cold sores are a common skin infection primarily caused by the herpes simplex virus (HSV). This virus is divided into two types, HSV-1 and HSV-2, with over 90% of cold sore cases attributed to HSV-1. Once the virus infects the human body, it remains permanently dormant in the nerve ganglia and may reactivate under certain conditions, such as decreased immunity or environmental triggers. Although the symptoms of cold sores are usually not life-threatening, they can affect the quality of life for patients, including social anxiety and physical discomfort.
The transmission route of cold sores is mainly through direct contact, such as kissing, sharing personal items, or touching the affected area. The virus may cause an acute outbreak after the initial infection, but some individuals may not exhibit obvious symptoms. Recurrent outbreaks are characterized by the repeated appearance of blisters around the mouth or specific areas of the face, often accompanied by a burning or tingling sensation. Modern medicine has developed various treatment methods, including antiviral medications and topical care measures, but there is currently no way to completely eradicate the virus.
The causes of cold sores are closely related to infection by the herpes simplex virus (HSV). The HSV-1 virus is primarily transmitted through contact, such as direct contact with the affected area or sharing utensils. The initial infection may trigger a primary outbreak, with symptoms including fever, swollen lymph nodes, and oral ulcers. Although HSV-2 mainly causes genital infections, it can also lead to oral outbreaks under certain circumstances.
Risk factors include decreased immune system function, such as in cancer patients undergoing chemotherapy or individuals infected with HIV, who typically experience higher frequencies and severity of outbreaks. Prolonged stress, ultraviolet exposure (such as after sun exposure), hormonal changes (such as during menstruation), and fatigue can all trigger viral activation. Additionally, the viral load within an individual and the latent state of the nerve ganglia also affect the frequency and severity of recurrences.
The symptoms of cold sores typically develop in stages. The first stage involves prodromal symptoms, where patients may feel a burning sensation, tingling, or swelling in the affected area, usually occurring 1-2 days before the blisters appear. The second stage involves the formation of a cluster of small blisters, which are usually grouped together, often located around the corners of the mouth, nostrils, or chin.
After the blisters rupture, shallow ulcers may form, and the surface may crust over. This process typically takes 7-10 days to heal. The degree of itching and pain varies among individuals, and some patients may experience localized swollen lymph nodes or fever. Symptoms during recurrent outbreaks are usually milder than during the initial infection, but repeated outbreaks may lead to long-term damage to the skin tissue.
Diagnosing cold sores is usually based on clinical presentation. Doctors will observe the typical clustering of blisters and the affected area, and inquire about the patient’s medical history, such as whether they have experienced similar symptoms or had contact with an infected person. In cases where symptoms are atypical or confirmation of the virus type is needed, laboratory tests may be required.
Common diagnostic methods include viral culture, which involves collecting fluid samples from the blisters to confirm the presence of the virus. PCR nucleic acid testing can quickly identify viral DNA, especially valuable in the early stages when obvious blisters have not yet formed. Immunofluorescence tests are used to detect antibody responses, helping to differentiate between primary infections and recurrent outbreaks.
For immunocompromised patients or cases with unusually severe symptoms, doctors may recommend more in-depth examinations. For example, using a Tzanck smear to check for cytological changes or imaging studies to rule out other infectious diseases. These additional tests can improve diagnostic accuracy, but in most cases, clinical observation is sufficient for diagnosis.
The goal of treating cold sores is to shorten the duration of the illness, relieve symptoms, and prevent complications. Antiviral medications such as acyclovir are the first-line treatment, available for oral or topical application, which can inhibit viral replication and accelerate healing. Emerging medications like valacyclovir, due to their high absorption rate, are suitable for patients with severe or frequent recurrences.
Topical care measures include using anesthetic ointments to relieve pain and keeping the affected area clean to prevent bacterial infections. Ice packs or anti-inflammatory ointments can reduce redness and swelling, while vitamin E ointment helps repair damaged skin. In cases of severe secondary bacterial infections, short-term use of antibiotic ointments or oral antibiotics may be necessary.
Patients with frequent recurrences (more than 6 times a year) may consider long-term low-dose antiviral medication for prevention. Such treatment should be conducted under medical supervision to avoid the development of drug resistance. Topical antiviral creams applied during the prodromal phase (such as when tingling is felt) can also effectively suppress outbreaks.
The key to preventing the transmission of cold sores is to avoid direct contact with the affected area. Infected individuals should avoid kissing, sharing utensils, or razors during outbreaks, and keep the affected area dry and clean. Thorough handwashing after contact with the affected area can effectively reduce the risk of transmission. For high-risk groups (such as immunocompromised patients), contact with known sources of infection should be avoided.
Daily protective measures include using UV-blocking lip balm, as sun exposure is a common trigger. Methods to boost immunity, such as regular exercise, adequate sleep, and a balanced diet, can reduce the frequency of recurrences. Although the herpes simplex virus vaccine has not yet been widely adopted, related research is ongoing.
It is essential to pay special attention to the separate use of personal hygiene items in the household, such as towels and toothbrushes. During cold sore outbreaks, avoid contact with infants or individuals with immature immune systems. In public places, avoid contact with suspicious skin lesions and maintain hand hygiene.
If unexplained blisters appear around the mouth, symptoms worsen, or are accompanied by a high fever, immediate medical attention should be sought. Patients with compromised immune systems (such as those undergoing chemotherapy) should seek medical care early, even if symptoms are mild. If blister infections lead to cellulitis, eye involvement, or symptoms persist for more than two weeks without improvement, a professional medical evaluation is necessary.
Special situations include first-time outbreaks accompanied by severe pain, symptoms affecting daily eating or breathing, and infections during pregnancy. These cases may require medication treatment or hospitalization to avoid severe complications or vertical transmission to the fetus. Doctors may adjust treatment plans based on medical history and laboratory test results.
The following situations should be considered emergencies:
Timely medical attention can effectively prevent scar formation and secondary bacterial infections, especially in cases with a high risk of facial nerve damage.
During an outbreak, topical antiviral ointments (such as acyclovir cream) can shorten the duration of the illness and relieve pain. Cold compresses or clean cotton cloths can also help reduce swelling, and it is important to avoid scratching or rubbing the affected area. If pain is significant, short-term use of pain relievers may be necessary, but should be used as directed by a physician.
Are cold sores contagious? What are the transmission routes?Cold sores are caused by the herpes simplex virus (HSV-1) and are indeed contagious. The virus is primarily transmitted through contact, such as touching the secretions from the affected area, sharing utensils, or kissing. The virus is most contagious during the blister rupture and exudate stage, and it is advisable to avoid contact with others until the crust falls off.
How can recurrent cold sores be prevented?Stress, fatigue, or ultraviolet exposure can trigger outbreaks. Daily routines can include regular schedules, supplementation of B vitamins and vitamin C, and proper lip sun protection (using SPF-containing lip balm). If outbreaks are frequent, a physician may prescribe low-dose antiviral medications for ongoing prevention.
What precautions should be taken if cold sores occur during pregnancy?During pregnancy, it is not recommended to use ointments or medications without medical advice; prompt evaluation by a physician is necessary. The doctor will choose the treatment plan that has the least impact on the fetus based on the gestational age and severity of symptoms. During outbreaks, contact with the fetus should be avoided, and personal hygiene should be enhanced to prevent vertical transmission.
Is it true that using toothpaste or alcohol can treat cold sores?This claim is inaccurate. Regular toothpaste or alcohol may irritate the skin and worsen redness and pain. The correct approach is to clean the affected area and use specialized ointments while keeping it dry. If symptoms worsen after trying non-medical products, they should be discontinued immediately, and medical attention should be sought.
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