Everything you need to know about cold sores

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everything about cold sores

Anyone who has had a cold sore will agree that they are not pleasant. Not only are they visually unappealing, but the stigma surrounding cold sores can affect you from your dating to your professional life.

How do cold sores develop?

Cold sores are painful blisters that form around your mouth and lips caused by the herpes simplex virus (HSV-1). The HSV-1 virus is contagious and can be transmitted from direct contact with someone who carries the virus. It can be transmitted orally though kissing, or sharing objects such as toothbrushes, towels or utensils. Even if cold sores aren’t present, the HSV-1 virus can still be transferred.

Cold sores usually develop after something has triggered the virus, for example:

  • Stress or anxiety
  • Weak immune system
  • Illness e.g. flu
  • Hormonal changes
  • Infectious disease
  • Exposure to cold weather


Cold sores develop in different stages:

Tingling and itching: A day or two before the blisters start to form, many people start to feel itching and a tingling sensation around the lips.

Blisters: The small blisters will begin to develop and form around the outside edge of the lip.

Weeping: This is the most painful and contagious stage as the blister will fill up with fluid and burst.

Scabbing: A scab will form over the blister which is often itchy and may crack open.

Healing: Flaking and residual swelling may be noticed around the lip and the skin may look slightly pink and red as the scab starts to come off.

The signs and symptoms will vary depending on whether it is the first outbreak or a recurrence. Once you have had your first outbreak, the virus will remain dormant in your nerve cells until something triggers it. Another cold sore will then appear in the same place as the previous outbreak. The first outbreak is usually the worst whilst recurrences tend to be less severe.

Treating cold sores

The most effective way to treat cold sores is to use antiviral medications. The most popular treatments are Valaciclovir and Aciclovir. Both medications do not cure cold sores but they both work to reduce the severity and frequency of the outbreak whilst decreasing the risk of transmitting the virus to other people.


Valaciclovir is classified as a pro-drug, which means it converts into another drug when it enters the body. After consuming valaciclovir, it turns into aciclovir which then blocks the herpes virus and controls the symptoms of the outbreak.

When taken twice daily, Valaciclovir has shown to have similar effects in treating cold sores as Aciclovir. It has also proven to be effective in treating cold sores and other HSV infections of the skin. Valaciclovir starts working almost immediately after you start taking it and is effective in reducing the healing time and reducing the risk transmitted to other people.


As well as treating herpes, Aciclovir can be used as a treatment for chicken pox or shingles. The effects of valaciclovir and aciclovir are the same – quicker recovery during a cold sore outbreak and reduces the risk of transmitting the virus to others.

When it comes to choosing valaciclovir or aciclovir, both treatments are safe and equally effective at treatments for the HSV virus. Aciclovir is more cost effective, but has to be taken more frequently than Valaciclovir making the latter more convenient to fit into a patient’s daily lifestyle.

How to minimise the spread of the virus

Cold sores are contagious until they are completely healed. You can minimise the risk of spreading the virus by:

  • Always washing your hands before and applying cold sore creams.
  • Do not share your medication with another person.
  • Do not share any items which could come into contact with the affected area for example lip products, cutlery or towels.
  • Avoid kissing and oral sex until the cold sore has healed and disappeared.

It is best to use medication as soon as you start to notice the symptoms of a cold sore. Not all of them can be prevented, but knowing what triggers them is key to managing them. The earlier you begin treating your treatment, the better chance you have of containing the outbreak.

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