Cold Sores (Nongenital Herpes Simplex Infections)

  • Medical Author:

    Sandra Gonzalez Gompf, MD, FACP is a U.S. board-certified Infectious Disease subspecialist. Dr. Gompf received a Bachelor of Science from the University of Miami, and a Medical Degree from the University of South Florida. Dr. Gompf completed residency training in Internal Medicine at the University of South Florida followed by subspecialty fellowship training there in Infectious Diseases under the directorship of Dr. John T. Sinnott, IV.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Cold Sores Slideshow

What causes cold sores?

There are two types of HSV, type 1 and type 2. In general, HSV-1, also known as herpes labialis or oral herpes, causes infections above the waist, most commonly as "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. Thus, the virus that usually causes oral herpes (HSV-1) can cause genital herpes as well as herpes on the hands and eye. The virus that causes genital herpes (HSV-2) can also cause oral herpes, although it almost exclusively infects the genital area.

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. You would know that you have herpes if you have an outbreak or if a doctor performs a blood test to tell if you have been infected with it. Most adults have been infected with oral or genital herpes and never know it.

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. This is called "asymptomatic shedding." 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. Abnormal areas of skin such as eczema may be especially prone to herpes infection.

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.

Medically Reviewed by a Doctor on 6/15/2016

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