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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
The best cold sore is one that never appears. Fortunately, antiviral medications can be very effective at suppressing the virus that causes cold sores and preventing outbreaks, though this entails taking them on a regular basis, as we’ll cover in a moment. But if you’re reading this, chances are good that one or more have erupted around your mouth, advertising that you have the cold sore-causing virus herpes simplex virus or HSV-1. The fact that most people have HSV-1 is neither here nor there. You want it gone, stat. So let’s get right to it.
How to get rid of cold sores fast
Cold sores generally clear up on their own, without any medical intervention, within two to four weeks.
But there are things you can do to speed the healing process. Several antiviral medications are available, which can shorten healing time. Antiviral drugs prescribed for cold sores include valacyclovir (brand name Valtrex; see Important Safety Information), acyclovir (brand names Xerese, Zovirax), famciclovir (brand name Famvir) and penciclovir (brand name Denavir).
If you get frequent, recurrent cold sore breakouts, your healthcare provider might recommend that you regularly take an antiviral drug, such as valacyclovir, to suppress them. (You also might want to do this to ensure a cold sore doesn’t accompany you to a special event like your vacation, wedding, school reunion, etc.)
Cold sore home remedies and treatments
Abreva (docosanol) is an over-the-counter ointment for cold sores that may shorten healing time. At the first sign of cold sore symptoms — such as tingling — apply it to the affected area as the package directions indicate.
To relieve cold sore pain and discomfort, you can also try these strategies:
- Apply lip balm or moisturizer. Use a lip balm, or moisturizer with sunscreen (such as zinc oxide), on your lips. Keeping wounds moist — no matter where they are on the body — is one of the best ways to speed healing. That’s especially important with cold sores — making sure your lips aren’t too dry will prevent you from reinjuring the area when you smile, eat or drink.
- Try pain-relieving creams. Over-the-counter creams or ointments that contain lidocaine or benzocaine may relieve the pain of cold sores. A popular brand is Orajel, although generic equivalents (and prescription-strength forms) are available.
- Use a cold compress. Applying a cool, damp cloth to the affected area can soothe irritation and help remove crusting.
- Take over-the-counter pain relievers like ibuprofen or acetaminophen to ease discomfort.
Cold sores and oral herpes: causes, symptoms and treatment
Alternative cold sore treatments
Alternative treatments for cold sores include:
- Reducing stress. If you find that your cold sores are triggered by stress and anxiety, relaxation techniques such as mindfulness, meditation, breathing exercises and physical activity might help.
- Aloe vera gel. In studies, aloe vera gel has been shown to have anti-inflammatory and antiviral effects. According to a 2016 study published in the Journal of Dentistry, aloe vera gel inhibited the growth of HSV-1 in test tubes and “could be a useful topical treatment for oral HSV-1 infections without any significant toxicity,” researchers found (Rezazadeh, 2016).
- Lysine. Lysine, an amino acid that’s available as an oral supplement and as a cream, has been recommended for cold sore treatment and prevention. In a 2017 review of studies published in the journal Integrative Medicine, researchers found that doses of more than 3g a day might help soothe cold sore symptoms and improve breakouts, but evidence is insufficient for doctors to recommend it, and that dose might be risky for people with cardiovascular or gallbladder disease (Mailoo, 2017).
- Propolis. Also known as synthetic beeswax, this ointment has been touted for shortening cold sore duration and reducing associated pain. But a 2017 meta-analysis of studies on propolis and cold sores published in the journal Evidence Based Complementary and Alternative Medicine found inconclusive evidence to support those claims and called for further studies (Sung, 2017).
- LED devices. Devices which utilize LED light have been touted online as being able to speed the healing time of cold sores and canker sores. Studies in scientific journals that support these claims are lacking.
Now that you know about some ways to reduce a cold sore, let’s get into what cold sores are, what they aren’t, how they spread, and why they happen in the first place.
What is a cold sore?
Cold sores, also known as fever blisters, are caused by the HSV-1 (herpes simplex virus 1, a.k.a. oral herpes) virus. HSV-2 (herpes simplex virus 2) is the form of the virus responsible for genital herpes, although you can contract either form of the virus on your mouth or genitals.
Cold sores generally take the form of blisters on or near the lips (known as the “vermillion border”). They tend to appear in three stages:
- Tingling, burning or itching: A cold sore may be preceded by itching, burning or tingling around the lips for about a day. Then a small, painful spot (or multiple spots) will appear, replaced by a blister (or a cluster of them).
- Blisters. The small, fluid-filled blisters usually appear where the lips meet the face. (Cold sores can also show up around the nose or on the cheeks.)
- Oozing and crusting. After a few days, the small blisters burst. Open sores ooze fluid, then crust over. That crusting can hang out on the face for a while (read on for a tip to reduce it).
As conspicuous as a cold sore might make you feel, you’re far from alone: According to the World Health Organization, 67% of people worldwide are infected with HSV-1. Most people contract the virus as children, often from relatives — a quick peck on the face can be enough to transmit it. But the majority of people who have HSV-1 don’t show symptoms. Only about 30% of people with HSV-1 will get cold sores, usually once or twice a year.
There is no cure for HSV-1. After infection, it remains in the body forever. Usually, the first outbreak of cold sores is the worst in terms of symptoms. But after a cold sore outbreak fades, the virus remains in the body’s nerve endings, waiting to be triggered and resurface.
How long does a herpes outbreak last?
Why do cold sores happen?
Several factors can contribute to cold sore outbreaks, including:
- Stress or anxiety
- Illness, especially flu or fever
- Sunlight, wind or cold exposure
- Immune system weakness or changes
- Injury to the skin, such as a scratch, wound or bite
- Hormonal changes, including those associated with menstruation, pregnancy or menopause
How do cold sores spread?
HSV-1 (oral herpes) spreads through exposure to saliva or infected skin — via kissing, oral sex or sharing cups, straws or utensils.
Although cold sores are most contagious when oozing blisters are visible, you can spread HSV-1 even when no blisters are present, and it can be transmitted either to the mouth or the genitals. Oral sex can spread HSV-1 to the genitals and HSV-2 to the mouth or lips.
Cold sores vs. canker sores
It’s important to know that cold sores are not the same as canker sores.
- Canker sores are greyish ulcers that only form on the inside of the mouth, on the tongue or on the soft palate. Cold sores appear outside the mouth, taking the form of blisters on the lips or nearby.
- Canker sores are not caused by a virus or bacteria. Experts aren’t sure why canker sores erupt, although they tend to surface during times of stress or lowered immunity, or after you’ve injured your tongue or the inside of your mouth (e.g. by biting them while eating or perhaps during a family argument).
- Canker sores are not contagious — they can’t be transmitted to another person’s lips, mouth or genitals. But cold sores are very contagious.
- Unlike cold sores, canker sores don’t respond to prescription medication. You can relieve pain with some over-the-counter treatments, but as with romantic trauma, the only thing that will heal you is time.
If you’re unsure whether you have a cold sore or canker sore, see a health-care provider. They’ll be able to tell you on sight, and they can advise you on strategies to speed healing time, ease discomfort and prevent transmission to others (if applicable).
Do not try to pop a cold sore!
As discussed, cold sores are not canker sores. Something else they’re not? Pimples. While popping a pimple can be a quick, effective, and profoundly satisfying way to reduce the unsightliness of a pimple, trying to squeeze a cold sore is likely to blow up in your face—and other places besides.
See, pimples form when sebum clogs a pore in your skin. Cold sores, on the other hand, are the result of an infectious virus (HSV-1). Get that infectious viral fluid on your fingers, and you’re risking spreading cold sores to other parts of your body or the body of someone else. So relax, don’t do it.
Cold sores and oral sex: what you need to know
Cold sores, kissing, and sex
If you get cold sores, that doesn’t mean you should totally avoid intimacy, whether that’s dating, kissing or sex. But the American Sexual Health Association advises that you should wait until a cold sore heals and the area looks normal again before performing oral sex or kissing someone directly on the mouth (ASHA, n.d.).
“Because most adults have oral herpes, we do not advise that a person stop giving or receiving affection altogether between outbreaks (when there are no signs or symptoms) simply because they have oral herpes,” the ASHA says. “However, using a barrier (such as a dental dam) or condom when performing oral sex (even though there are no symptoms present around the mouth) can reduce the risk of contracting genital herpes.”
- American Sexual Health Association (ASHA). (n.d.). Oral Herpes. Retrieved from http://www.ashasexualhealth.org/stdsstis/herpes/oral-herpes/
- Mailoo, V. J., & Rampes, S. (2017). Lysine for Herpes Simplex Prophylaxis: A Review of the Evidence. Integrative Medicine (Encinitas, Calif.), 16(3), 42–46. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419779/
- Rezazadeh, F., Moshaverinia, M., Motamedifar, M., & Alyaseri, M. (2016). Assessment of Anti HSV-1 Activity of Aloe Vera Gel Extract: an In Vitro Study. Journal of Dentistry – Shiraz University of Medical Sciences, 17(1), 49–54. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26966709
- Sung, S. H., Choi, G. H., Lee, N. W., & Shin, B. C. (2017). External Use of Propolis for Oral, Skin, and Genital Diseases: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2017, 8025752. doi: 10.1155/2017/8025752. Retrieved from https://www.hindawi.com/journals/ecam/2017/8025752/
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.