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 is the incubation period for cold sores?

The time between infection and symptoms of primary oral herpes is anywhere from two days to two weeks.

What is primary oral herpes?

Primary herpes refers to the initial outbreak of symptoms after infection, often presenting with painful sores on the lips, gums, and mouth.

In some people, primary herpes is associated with fever, swollen lymph nodes, and bleeding gums, together with painful ulcers around the mouth (gingivostomatitis) and sore throat. 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 usually occurs during childhood.

Not everyone has a severe primary attack when they are first infected with herpes. In most 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 harder for the virus to get a foothold somewhere else in the body. However, it is possible to transfer the herpes virus to other parts of the body (autoinoculation).

What does recurrent herpes look like?

Recurrent herpes occurs in the area where it first appeared, though most of the time, there are fewer blisters or a milder outbreak than the first time. Although the face is the most common site of infection, other areas of the body may be involved:

  • Labial herpes: This is the familiar cold sore that appears on the lip margins (labial refers to the lip). When labial herpes reappears, it usually occurs at the same location each time or a few millimeters away.
  • Herpetic whitlow: Sometimes, the herpes virus shows up on the fingers. This is especially common in dental and medical workers who have to put their fingers inside people's mouths, despite the use of gloves. In herpetic whitlow, the virus has entered the finger. Occasionally, the virus re-emerges and causes blister-like sores on the fingertip.
  • Wrestlers' herpes or herpes gladiatorum: Wrestlers or any athlete engaged in direct contact sports can contract herpes from an opponent who is shedding the virus. This form of herpes can appear anywhere over the body, but the face, neck, and arms are common locations. Unlike most other types of infection, lesions may occur at multiple sites.
  • Eczema herpeticum: This may occur in people (especially children) who have areas of eczema or atopic (allergic) dermatitis, which is very itchy. They may scratch and spread herpes to these areas if they have cold sores or other sources of active herpes infection (autoinoculation). The skin involved with eczema or allergic dermatitis is less able to fight viral infections, and herpes spread to this area may result in widespread sores.

In recurrent herpes, it often takes seven to 10 days before the ulcers completely disappear and the skin returns to normal.

Medically Reviewed by a Doctor on 6/15/2016

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