Cold Sores (Nongenital Herpes Simplex Infections)

  • Medical Author: MaryAnn Tran, MD
  • 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 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.)

Medically Reviewed by a Doctor on 2/18/2015

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