Herpes Simplex Infections
(Cold Sores, Non-Genital)

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Medical Authors: Mohamad El Mortada, MD, MaryAnn Tran, MD, Corrine Young, PharmD, and Mary Nettleman, MD, MS
Medical Editor: Melissa Conrad Stöppler, MD

• What are herpes simplex infections?
• What causes cold sores?
• What makes herpes (cold sores) recur?
• How is oral herpes spread?
• What are the signs and symptoms?
• What is primary oral herpes?
• What does recurrent herpes look like?
• How long do cold sores last?
• What are the possible complications?
• What other conditions can look like oral herpes (cold sores)?
• What is angular stomatitis?
• What are canker sores?
• How is oral herpes diagnosed?
• How is herpes (cold sores) treated, and what medications are used?
• Herpes Simplex Infections (Non-Genital Cold Sores) At A Glance
• Patient Discussions: Herpes Simplex Infections (Cold Sores, Non-Genital) - Describe Your Experience

Featured patient discussions on cold sores "I would suffer from cold sores for years, always one week before my period, every month. I would also break out if I was under more stress than usual. I would get all the usual symptoms of burning, itching, and throbbing pain. Also, I would feel like I was coming down with the flu...I'd be very tired and have achy joints. Sometimes my lymph nodes in my armpits and under my chin would hurt as well. My doctor put me on Valtrex which worked perfectly for me, stopping the progression of the cold sores in their track, saving me from the blistering and unsightly scabbing. Since I entered menopause, I don't suffer from cold sores or the accompanying symptoms anymore!" Read all cold sore comments » Top Searched Cold Sore Terms: treatment, symptoms, medication, signs, lysine, fever blister, diagnosis Patient Discussions are not a substitute for professional medical advice, or treatment. See the disclaimer at the bottom of the comments page.

What are herpes simplex infections?

Herpes simplex virus (HSV) can cause infections that affect the mouth, the face, the genitals, the skin, the buttocks, and the anal area. This article will concentrate on non-genital 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" and "fever blisters."

What causes cold sores?

There are two types of HSV, type I and type II. In general, type I, also known as herpes labialis, causes infections above the waist, most commonly as oral "cold sores." Type II infections occur mainly below the waist, leading to genital herpes. However, both types of HSVs 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, once a month) 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 lays 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 is oral herpes 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 transmitting the virus. People are most contagious when they 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. This is because the virus is sometimes shed in saliva even when sores are not present. Despite popular myth, it is almost impossible to catch herpes (cold sores) from surfaces, towels, or washcloths.

Herpes Simplex Infections (Cold Sores, Non-Genital) - Describe Your Experience

The MedicineNet physician editors ask:

Please describe your experience with herpes simplex infections (cold sores, non-genital).

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