Disease: Cold Sores
(Nongenital Herpes Simplex Infections)

    Herpes simplex infections (nongenital cold sores) facts

    • Herpes simplex virus (HSV) can cause infections that affect the mouth, face, genitals, skin, buttocks, and the anal area.
    • Of the two herpes simplex viruses (HSV 1 and HSV 2) that are associated with skin lesions, cold sores are most commonly caused by HSV-I.
    • HSV infection may not produce symptoms, but when it does, the hallmark symptom is a group of blisters on a red base. These blisters dry up rapidly and leave scabs that last anywhere from a few days to a few weeks.
    • The virus resides deep in the nerve roots and may reactivate at a later time, causing the same symptoms in the same location.
    • Cold sores can be treated with antiviral medications to reduce pain and shorten healing time.

    What are herpes simplex infections?

    Herpes simplex virus (HSV) can cause infections that affect the mouth, face, genitals, skin, buttocks, and the anal area. This article will concentrate on nongenital herpes. Many people acquire the virus and have no symptoms. For others, painful blisters appear near the area where the virus entered the body. Typically, the blisters heal completely but reappear at some point in the future when least expected (or desired). In between attacks, the virus resides deep in the roots of the nerves that supply the involved area. When herpes simplex lesions appear in their most common location, around the mouth and lips, people often refer to them as "cold sores" or "fever blisters."

    What causes cold sores?

    There are two types of HSV, type 1 and type 2. In general, HSV-1, also known as herpes labialis, causes infections above the waist, most commonly as oral "cold sores." HSV-2 infections occur mainly below the waist, leading to genital herpes. However, both types of HSV are capable of infecting the skin at any location on the body.

    Herpes infections, no matter where they occur first, have a tendency to recur in more or less the same place. Such recurrences may happen often (for example, several times per year) or only occasionally (for example, once or twice a year).

    What makes herpes (cold sores) recur?

    After infection, the virus enters the nerve cells and travels up the nerve until it comes to a place called a ganglion. There, it resides quietly in a stage that is referred to as "dormant" or "latent." At times, the virus can become active and start replicating again and travel down the nerve to the skin, causing sores and blisters. The exact mechanism behind this is not clear, but it is known that some conditions seem to be associated with recurrences, including

    • a fever, a cold, or the flu;
    • ultraviolet radiation (exposure to the sun);
    • stress;
    • changes in the immune system;
    • trauma to the involved area;
    • sometimes there is no apparent cause of the recurrence.

    How do cold sores spread?

    Infections caused by HSV are contagious. The virus is spread from person to person by kissing, by close contact with herpetic lesions, or even from contact with apparently normal skin that is shedding the virus. Infected saliva is a common means of virus transmission. The contagious period is highest when people have active blister-like sores. Once the blisters have dried and crusted over (within a few days), the risk of contagion is significantly lessened. However, a person infected with HSV can pass it on to another person regardless of the presence or absence of symptoms and visible sores or blisters. This is because the virus is sometimes shed in saliva even when sores are not present. HSV can also be spread through personal items that are contaminated with the virus, such as lipstick, utensils, and razors. Despite popular myth, it is almost impossible to catch herpes (cold sores) from surfaces, towels, or washcloths.

    Picture of cold sores on the lips (fever blisters, HSV 1, or herpes simplex infection type 1)

    What are the signs and symptoms of cold sores?

    The hallmark symptom of herpes is a group of blisters on a red base. These blisters dry up rapidly and leave scabs that last anywhere from a few days to a few weeks, depending on the severity of the infection. This pattern has important implications for the many people who fear they have herpes but don't: If something lasts for weeks, it is unlikely to be herpes.

    Herpes infections feel dry and crusty, and they sometimes itch. Some patients have a "prodrome," which is the occurrence of certain symptoms before the actual sores become fully evident. The prodrome to herpes infections typically involves a burning or tingling sensation that precedes the appearance of blisters by a few hours or a day or two.

    What is primary oral herpes?

    Primary herpes refers to the first episode of symptoms after infection, often presenting with painful sores on the lips, gums, and mouth.

    In some people, the first attack (primary herpes) of herpes is associated with fever, swollen lymph nodes, and bleeding gums, together with painful sore(s) around the mouth (gingivostomatitis). These signs and symptoms may last several days. Difficulty in eating and drinking may lead to dehydration. The sores heal completely in two to six weeks, usually without scarring. Virus can be recovered from the saliva for days after the lesions heal. Primary herpes is usually contracted during childhood.

    Not everyone has a severe primary attack when they are first infected with herpes. In some people, the virus infects the body without causing any symptoms. The process generates an antibody response, causing the immune system to produce antibodies against the herpes virus. This antibody response helps reduce recurrences and keep them mild. Antibodies also make it hard for the virus to get a foothold anywhere else on the body. (If this weren't so, cold sores would spread to other parts of the body from routine actions, such as face washing, which doesn't happen.)

    What does recurrent herpes look like?

    By far the most common manifestation of herpes infections -- what people usually mean when they speak of "herpes" or "cold sores" -- is a recurrence of the virus when it is reactivated from its latent state in the nerves below the skin. What this looks like depends on where the virus has been hibernating. Although the mouth is the most common site of infection, other areas of the body may be involved:

    • Labial herpes: This is the familiar cold sore that appears on the lip margins (labial refers to the lip). When labial herpes reappears, it usually occurs at the same location each time or a few millimeters away.
    • Herpetic whitlow: Sometimes, the herpes virus shows up on the fingertip. This is especially common in dental and medical workers who have to put their fingers inside people's mouths, despite the use of gloves. In herpetic whitlow, the virus has entered the finger. Occasionally, the virus re-emerges and causes blister-like sores on the fingertip.
    • Wrestlers' herpes: This has the picturesque name "herpes gladiatorum." Gladiators, or nowadays just plain wrestlers, can contract herpes from an opponent who is shedding the virus. This form of herpes can appear anywhere over the body. The face, neck, and arms are common locations. Unlike most other types of infection, lesions may occur at multiple sites.

    How long do cold sores last?

    In recurrent herpes, sores start as inflamed red bumps that swell and become fluid-filled forming blisters. The blisters eventually collapse and form an ulcer. This will take two to three days. It often takes seven to 10 days before these ulcers completely disappear and the skin returns to normal.

    In primary herpes, the healing process usually takes two to three weeks, but skin pain can last for one to six weeks.

    What are the risk factors for herpes simplex infections?

    Exposure to someone with cold sores increases the risk of getting oral herpes. HSV is most contagious when the person has mouth sores or blisters on the lips. The virus can also shed from saliva when there are no visible lesions. Therefore, a person can be contagious without having an outbreak. Direct contact with the virus, from kissing or sharing personal items, will increase the chance of getting infected with HSV.

    Health-care workers, such as dentists, dental hygienists, and respiratory therapists, are at risk of developing herpetic whitlow because of contact with people's mouths.

    Medical conditions or treatments that weaken a person's immune system can increase the risk of severe complications from the virus. These include HIV, cancer, chemotherapy, and steroids.

    What are the possible complications of oral herpes (cold sores)?

    Herpes can be spread from one area to another on the same person, which is called "autoinoculation." For example, touching a cold sore on the lip can cause herpes of the finger (herpetic whitlow). Autoinoculation occurs most commonly at the time of primary infection, when viral shedding is high and the immune system is still gearing up to contain it. The antibodies that are made after primary infection are usually -- but not always -- successful in preventing autoinoculation during recurrent attacks.

    A more serious complication is ocular herpes (involvement of the eye), which is characterized by lesions and severe pain around the eye. Ocular herpes is also caused by autoinoculation. If not treated, ocular herpes can lead to serious damage or even blindness.

    Rarely, herpes simplex may infect the brain, causing encephalitis. This infection requires hospitalization and intravenous antiviral medications.

    In immunocompromised people, such as those receiving chemotherapy, severe outbreaks of herpes may occur. Colds sores may spread to large parts of the lower face or invade organs. Antiviral therapy is used to prevent or lessen such attacks.

    In a few people, outbreaks of herpes will be associated with erythema nodosum. Erythema nodosum is a nonspecific skin reaction characterized by red and painful skin lumps that usually appear on the front side of the legs. This condition can be caused by many inflammatory and infectious diseases, including herpes virus infections. Erythema nodosum can be self-limited and resolve on its own in three to six weeks. Treatment of the herpes episode usually hastens the resolution of erythema nodosum.

    What is the prognosis for oral herpes (cold sores)?

    Cold sores usually resolve on their own within one to two weeks. However, the virus may become reactivated, causing a recurrence of symptoms in the same location.

    Herpes infection may be severe in people with a weakened immune system. It is also dangerous if it infects the eye or the brain.

    What other conditions can look like oral herpes (cold sores)?

    There are many conditions that can be confused with herpes, including abrasions, razor burns, pimples, impetigo, angular stomatitis, and canker sores (aphthous ulcers).

    What is angular stomatitis?

    Angular stomatitis refers to inflammation, cracking, or irritation at the corners of the mouth. In contrast, herpes infections usually appear on the upper or lower lip margins, not in the corners. Angular stomatitis may be an initial sign of anemia or vitamin deficiency. It can also occur in people who wear dentures, whose saliva can accumulate and lead to the overgrowth of yeast.

    What are canker sores?

    Canker sores, or aphthous ulcers, are ulcerations that occur inside the mouth along the mucosa. They are found on the inner cheeks and lower lip as well as on the tongue, palate, and the covering of the gums. Canker sores are small, round, and painful. They are gray in color with a distinct edge. They are not contagious and are caused by stress or trauma to the area.

    How is oral herpes diagnosed?

    The diagnosis of herpes (cold sores) is usually based solely on the appearance of the lesions. Less commonly, viral culture or polymerase chain reaction (PCR) tests are used to help in the diagnosis of herpes infection.

    Swabbing the blister in an attempt to culture the virus in the lab is only productive in the first 48 hours and before the blister has crusted over. If lesions resolve, then cultures are of no help, because there's nothing left to culture. Culture results take a minimum of three to five days.

    PCR testing detects herpes DNA, but it is not as readily available as culture. PCR is done on clinical specimens obtained from swabs of active lesions as described above.

    Blood tests are often irrelevant, since finding antibodies to herpes just means that the body has been exposed to this virus at some point in the past. It does not determine if the current lesion is due to herpes.

    If the diagnosis is in doubt, the best approach is to encourage the person to see a doctor at the first sign of a sore. That will allow the clinician to see active lesions that can be tested by culture or PCR.

    What is the treatment for cold sores, are there any home remedies, and what medications are used?

    Currently, there are no cures or vaccines for the herpes simplex virus. Avoiding precipitating factors, such as sunburn and stress, can help prevent additional outbreaks. Cold sores will usually heal within two weeks even without treatment. However, there are established treatments available to help decrease healing time, reduce pain associated with the lesion, and in specific cases, suppress the recurrence of the virus.

    • Nondrug therapy: Applying cool, moist compresses to the lesion may decrease pain and keep the lesion from drying and cracking.
    • Over-the-counter (OTC) treatments: Most topical OTC products provide symptomatic relief only; they do not decrease healing time. Using topical anesthetics that contain benzocaine (5%-20%), lidocaine (0.5%-4%), tetracaine (2%), or dibucaine (0.25%-1%) will help relieve burning, itching, and pain. The most commonly recommended products are Lipactin gel and Zilactin. It is important to keep in mind that these topical anesthetics have a short duration of action, usually only lasting 20-30 minutes. Skin protectants, such as allantoin, petrolatum, and dimethicone-containing products help keep the lesion moist and prevent cracking of the lesion. Sunscreen-containing lip balms may also help prevent additional outbreaks if the sun is a precipitating factor. For additional pain relief, using aspirin, ibuprofen (Advil), or acetaminophen (Tylenol) may be beneficial. These products should be used according to package instructions.

      Docosanol 10% cream (Abreva) is the only OTC topical product that is known to decrease healing time when applied at the first sign of recurrence (for example, the prodrome or tingling sensation). Docosanol is applied five times per day until the lesion is healed. Common side effects include rash and itching at the site of application.
    • Prescription-strength topical medications: Treatment with topical acyclovir (Zovirax 5% cream) or penciclovir (Denavir 1% cream) will reduce healing time by approximately half a day and decrease pain associated with the lesion. Topical treatment is limited in its effectiveness because it has poor penetration to the site of replication of the virus, and therefore is restricted in its healing ability. Acyclovir cream should be applied five times per day for four days, and penciclovir cream should be applied every two hours while awake for four days. In August 2009, the FDA approved a cream containing acyclovir and a topical steroid, called Xerese, which reduces healing time by approximately one day.
    • Oral prescription-strength medications: The current FDA-approved oral antiviral medications used in the treatment of herpes simplex virus in adults are acyclovir, valacyclovir (Valtrex), and famciclovir (Famvir). These oral medications have been shown to decrease the duration of the outbreak, especially when started during the prodrome (symptom onset before the actual condition becomes fully evident). The medications are generally well tolerated with few side effects. Most common side effects include headache, nausea, and diarrhea. Treatment is only for one day with valacyclovir and famciclovir. Valacyclovir is given as 2 grams orally every 12 hours for one day, and famciclovir is given as 1,500 milligrams orally for one dose. Acyclovir is given as 400 mg orally five times per day for five days. Acyclovir, valacyclovir, and famciclovir are considered relatively safe and effective when used in pregnancy, although topical treatment would be preferred when appropriate. Acyclovir and valacyclovir have been used while breastfeeding. However, pregnant women and nursing mothers should contact their physician or pharmacist prior to using any medication.

      People who have more than two outbreaks in four months, which significantly affect their daily lives, should consider chronic suppressive therapy. The FDA has approved the use of oral valacyclovir daily to prevent recurrence of the herpes simplex virus in people with normal immune systems and famciclovir in people with suppressed immune systems.
    • Other treatment options: Lysine supplements, citrus bioflavonoids, lactobacillus acidophilus and bulgaricus, vitamin C, vitamin E oil, and vitamin B12 have also been identified in the potential treatment of herpes simplex virus. However, there is no good clinical evidence to support these treatments, and they are not recommended.
    • Treatment for children is similar to that in adults, including OTC and prescription medications. However, famciclovir has not been tested in children with cold sores.

    Learn more about: Tylenol | Zovirax | Denavir | Valtrex | Famvir | B12

    What makes herpes (cold sores) recur?

    After infection, the virus enters the nerve cells and travels up the nerve until it comes to a place called a ganglion. There, it resides quietly in a stage that is referred to as "dormant" or "latent." At times, the virus can become active and start replicating again and travel down the nerve to the skin, causing sores and blisters. The exact mechanism behind this is not clear, but it is known that some conditions seem to be associated with recurrences, including

    • a fever, a cold, or the flu;
    • ultraviolet radiation (exposure to the sun);
    • stress;
    • changes in the immune system;
    • trauma to the involved area;
    • sometimes there is no apparent cause of the recurrence.

    How do cold sores spread?

    Infections caused by HSV are contagious. The virus is spread from person to person by kissing, by close contact with herpetic lesions, or even from contact with apparently normal skin that is shedding the virus. Infected saliva is a common means of virus transmission. The contagious period is highest when people have active blister-like sores. Once the blisters have dried and crusted over (within a few days), the risk of contagion is significantly lessened. However, a person infected with HSV can pass it on to another person regardless of the presence or absence of symptoms and visible sores or blisters. This is because the virus is sometimes shed in saliva even when sores are not present. HSV can also be spread through personal items that are contaminated with the virus, such as lipstick, utensils, and razors. Despite popular myth, it is almost impossible to catch herpes (cold sores) from surfaces, towels, or washcloths.

    Picture of cold sores on the lips (fever blisters, HSV 1, or herpes simplex infection type 1)

    What are the signs and symptoms of cold sores?

    The hallmark symptom of herpes is a group of blisters on a red base. These blisters dry up rapidly and leave scabs that last anywhere from a few days to a few weeks, depending on the severity of the infection. This pattern has important implications for the many people who fear they have herpes but don't: If something lasts for weeks, it is unlikely to be herpes.

    Herpes infections feel dry and crusty, and they sometimes itch. Some patients have a "prodrome," which is the occurrence of certain symptoms before the actual sores become fully evident. The prodrome to herpes infections typically involves a burning or tingling sensation that precedes the appearance of blisters by a few hours or a day or two.

    What is primary oral herpes?

    Primary herpes refers to the first episode of symptoms after infection, often presenting with painful sores on the lips, gums, and mouth.

    In some people, the first attack (primary herpes) of herpes is associated with fever, swollen lymph nodes, and bleeding gums, together with painful sore(s) around the mouth (gingivostomatitis). These signs and symptoms may last several days. Difficulty in eating and drinking may lead to dehydration. The sores heal completely in two to six weeks, usually without scarring. Virus can be recovered from the saliva for days after the lesions heal. Primary herpes is usually contracted during childhood.

    Not everyone has a severe primary attack when they are first infected with herpes. In some people, the virus infects the body without causing any symptoms. The process generates an antibody response, causing the immune system to produce antibodies against the herpes virus. This antibody response helps reduce recurrences and keep them mild. Antibodies also make it hard for the virus to get a foothold anywhere else on the body. (If this weren't so, cold sores would spread to other parts of the body from routine actions, such as face washing, which doesn't happen.)

    What does recurrent herpes look like?

    By far the most common manifestation of herpes infections -- what people usually mean when they speak of "herpes" or "cold sores" -- is a recurrence of the virus when it is reactivated from its latent state in the nerves below the skin. What this looks like depends on where the virus has been hibernating. Although the mouth is the most common site of infection, other areas of the body may be involved:

    • Labial herpes: This is the familiar cold sore that appears on the lip margins (labial refers to the lip). When labial herpes reappears, it usually occurs at the same location each time or a few millimeters away.
    • Herpetic whitlow: Sometimes, the herpes virus shows up on the fingertip. This is especially common in dental and medical workers who have to put their fingers inside people's mouths, despite the use of gloves. In herpetic whitlow, the virus has entered the finger. Occasionally, the virus re-emerges and causes blister-like sores on the fingertip.
    • Wrestlers' herpes: This has the picturesque name "herpes gladiatorum." Gladiators, or nowadays just plain wrestlers, can contract herpes from an opponent who is shedding the virus. This form of herpes can appear anywhere over the body. The face, neck, and arms are common locations. Unlike most other types of infection, lesions may occur at multiple sites.

    How long do cold sores last?

    In recurrent herpes, sores start as inflamed red bumps that swell and become fluid-filled forming blisters. The blisters eventually collapse and form an ulcer. This will take two to three days. It often takes seven to 10 days before these ulcers completely disappear and the skin returns to normal.

    In primary herpes, the healing process usually takes two to three weeks, but skin pain can last for one to six weeks.

    What are the risk factors for herpes simplex infections?

    Exposure to someone with cold sores increases the risk of getting oral herpes. HSV is most contagious when the person has mouth sores or blisters on the lips. The virus can also shed from saliva when there are no visible lesions. Therefore, a person can be contagious without having an outbreak. Direct contact with the virus, from kissing or sharing personal items, will increase the chance of getting infected with HSV.

    Health-care workers, such as dentists, dental hygienists, and respiratory therapists, are at risk of developing herpetic whitlow because of contact with people's mouths.

    Medical conditions or treatments that weaken a person's immune system can increase the risk of severe complications from the virus. These include HIV, cancer, chemotherapy, and steroids.

    What are the possible complications of oral herpes (cold sores)?

    Herpes can be spread from one area to another on the same person, which is called "autoinoculation." For example, touching a cold sore on the lip can cause herpes of the finger (herpetic whitlow). Autoinoculation occurs most commonly at the time of primary infection, when viral shedding is high and the immune system is still gearing up to contain it. The antibodies that are made after primary infection are usually -- but not always -- successful in preventing autoinoculation during recurrent attacks.

    A more serious complication is ocular herpes (involvement of the eye), which is characterized by lesions and severe pain around the eye. Ocular herpes is also caused by autoinoculation. If not treated, ocular herpes can lead to serious damage or even blindness.

    Rarely, herpes simplex may infect the brain, causing encephalitis. This infection requires hospitalization and intravenous antiviral medications.

    In immunocompromised people, such as those receiving chemotherapy, severe outbreaks of herpes may occur. Colds sores may spread to large parts of the lower face or invade organs. Antiviral therapy is used to prevent or lessen such attacks.

    In a few people, outbreaks of herpes will be associated with erythema nodosum. Erythema nodosum is a nonspecific skin reaction characterized by red and painful skin lumps that usually appear on the front side of the legs. This condition can be caused by many inflammatory and infectious diseases, including herpes virus infections. Erythema nodosum can be self-limited and resolve on its own in three to six weeks. Treatment of the herpes episode usually hastens the resolution of erythema nodosum.

    What is the prognosis for oral herpes (cold sores)?

    Cold sores usually resolve on their own within one to two weeks. However, the virus may become reactivated, causing a recurrence of symptoms in the same location.

    Herpes infection may be severe in people with a weakened immune system. It is also dangerous if it infects the eye or the brain.

    What other conditions can look like oral herpes (cold sores)?

    There are many conditions that can be confused with herpes, including abrasions, razor burns, pimples, impetigo, angular stomatitis, and canker sores (aphthous ulcers).

    What is angular stomatitis?

    Angular stomatitis refers to inflammation, cracking, or irritation at the corners of the mouth. In contrast, herpes infections usually appear on the upper or lower lip margins, not in the corners. Angular stomatitis may be an initial sign of anemia or vitamin deficiency. It can also occur in people who wear dentures, whose saliva can accumulate and lead to the overgrowth of yeast.

    What are canker sores?

    Canker sores, or aphthous ulcers, are ulcerations that occur inside the mouth along the mucosa. They are found on the inner cheeks and lower lip as well as on the tongue, palate, and the covering of the gums. Canker sores are small, round, and painful. They are gray in color with a distinct edge. They are not contagious and are caused by stress or trauma to the area.

    How is oral herpes diagnosed?

    The diagnosis of herpes (cold sores) is usually based solely on the appearance of the lesions. Less commonly, viral culture or polymerase chain reaction (PCR) tests are used to help in the diagnosis of herpes infection.

    Swabbing the blister in an attempt to culture the virus in the lab is only productive in the first 48 hours and before the blister has crusted over. If lesions resolve, then cultures are of no help, because there's nothing left to culture. Culture results take a minimum of three to five days.

    PCR testing detects herpes DNA, but it is not as readily available as culture. PCR is done on clinical specimens obtained from swabs of active lesions as described above.

    Blood tests are often irrelevant, since finding antibodies to herpes just means that the body has been exposed to this virus at some point in the past. It does not determine if the current lesion is due to herpes.

    If the diagnosis is in doubt, the best approach is to encourage the person to see a doctor at the first sign of a sore. That will allow the clinician to see active lesions that can be tested by culture or PCR.

    What is the treatment for cold sores, are there any home remedies, and what medications are used?

    Currently, there are no cures or vaccines for the herpes simplex virus. Avoiding precipitating factors, such as sunburn and stress, can help prevent additional outbreaks. Cold sores will usually heal within two weeks even without treatment. However, there are established treatments available to help decrease healing time, reduce pain associated with the lesion, and in specific cases, suppress the recurrence of the virus.

    • Nondrug therapy: Applying cool, moist compresses to the lesion may decrease pain and keep the lesion from drying and cracking.
    • Over-the-counter (OTC) treatments: Most topical OTC products provide symptomatic relief only; they do not decrease healing time. Using topical anesthetics that contain benzocaine (5%-20%), lidocaine (0.5%-4%), tetracaine (2%), or dibucaine (0.25%-1%) will help relieve burning, itching, and pain. The most commonly recommended products are Lipactin gel and Zilactin. It is important to keep in mind that these topical anesthetics have a short duration of action, usually only lasting 20-30 minutes. Skin protectants, such as allantoin, petrolatum, and dimethicone-containing products help keep the lesion moist and prevent cracking of the lesion. Sunscreen-containing lip balms may also help prevent additional outbreaks if the sun is a precipitating factor. For additional pain relief, using aspirin, ibuprofen (Advil), or acetaminophen (Tylenol) may be beneficial. These products should be used according to package instructions.

      Docosanol 10% cream (Abreva) is the only OTC topical product that is known to decrease healing time when applied at the first sign of recurrence (for example, the prodrome or tingling sensation). Docosanol is applied five times per day until the lesion is healed. Common side effects include rash and itching at the site of application.
    • Prescription-strength topical medications: Treatment with topical acyclovir (Zovirax 5% cream) or penciclovir (Denavir 1% cream) will reduce healing time by approximately half a day and decrease pain associated with the lesion. Topical treatment is limited in its effectiveness because it has poor penetration to the site of replication of the virus, and therefore is restricted in its healing ability. Acyclovir cream should be applied five times per day for four days, and penciclovir cream should be applied every two hours while awake for four days. In August 2009, the FDA approved a cream containing acyclovir and a topical steroid, called Xerese, which reduces healing time by approximately one day.
    • Oral prescription-strength medications: The current FDA-approved oral antiviral medications used in the treatment of herpes simplex virus in adults are acyclovir, valacyclovir (Valtrex), and famciclovir (Famvir). These oral medications have been shown to decrease the duration of the outbreak, especially when started during the prodrome (symptom onset before the actual condition becomes fully evident). The medications are generally well tolerated with few side effects. Most common side effects include headache, nausea, and diarrhea. Treatment is only for one day with valacyclovir and famciclovir. Valacyclovir is given as 2 grams orally every 12 hours for one day, and famciclovir is given as 1,500 milligrams orally for one dose. Acyclovir is given as 400 mg orally five times per day for five days. Acyclovir, valacyclovir, and famciclovir are considered relatively safe and effective when used in pregnancy, although topical treatment would be preferred when appropriate. Acyclovir and valacyclovir have been used while breastfeeding. However, pregnant women and nursing mothers should contact their physician or pharmacist prior to using any medication.

      People who have more than two outbreaks in four months, which significantly affect their daily lives, should consider chronic suppressive therapy. The FDA has approved the use of oral valacyclovir daily to prevent recurrence of the herpes simplex virus in people with normal immune systems and famciclovir in people with suppressed immune systems.
    • Other treatment options: Lysine supplements, citrus bioflavonoids, lactobacillus acidophilus and bulgaricus, vitamin C, vitamin E oil, and vitamin B12 have also been identified in the potential treatment of herpes simplex virus. However, there is no good clinical evidence to support these treatments, and they are not recommended.
    • Treatment for children is similar to that in adults, including OTC and prescription medications. However, famciclovir has not been tested in children with cold sores.

    Learn more about: Tylenol | Zovirax | Denavir | Valtrex | Famvir | B12

    Source: http://www.rxlist.com

    Herpes can be spread from one area to another on the same person, which is called "autoinoculation." For example, touching a cold sore on the lip can cause herpes of the finger (herpetic whitlow). Autoinoculation occurs most commonly at the time of primary infection, when viral shedding is high and the immune system is still gearing up to contain it. The antibodies that are made after primary infection are usually -- but not always -- successful in preventing autoinoculation during recurrent attacks.

    A more serious complication is ocular herpes (involvement of the eye), which is characterized by lesions and severe pain around the eye. Ocular herpes is also caused by autoinoculation. If not treated, ocular herpes can lead to serious damage or even blindness.

    Rarely, herpes simplex may infect the brain, causing encephalitis. This infection requires hospitalization and intravenous antiviral medications.

    In immunocompromised people, such as those receiving chemotherapy, severe outbreaks of herpes may occur. Colds sores may spread to large parts of the lower face or invade organs. Antiviral therapy is used to prevent or lessen such attacks.

    In a few people, outbreaks of herpes will be associated with erythema nodosum. Erythema nodosum is a nonspecific skin reaction characterized by red and painful skin lumps that usually appear on the front side of the legs. This condition can be caused by many inflammatory and infectious diseases, including herpes virus infections. Erythema nodosum can be self-limited and resolve on its own in three to six weeks. Treatment of the herpes episode usually hastens the resolution of erythema nodosum.

    Source: http://www.rxlist.com

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