COLD SORE!!!

Cold sores are small, painful, fluid-filled blisters or sores that appear on the lips,mouth, or nose that are caused by a virus. The sores can be painful and usually last a few days. Unlike most viral infections, the cold sore virus is not completely eliminated by the body defenses. For this reason, cold sores often recur.

The virus that causes cold sores is known as the herpes simplex virus (HSV). There are two types of HSV, type I and type II. Cold sores are usually caused by type I.Herpes simplex is caused by a contagious oral virus. The virus is spread from person to person by kissing or other close contact with sores or even from contact with apparently normal skin that is shedding the virus. Infected saliva is also a means of spreading the virus. The most contagious period is when a person has active blister-like sores. Once the blisters have dried and crusted over , the risk of contagion is significantly lessened. However, a person infected with HSV can pass it on to another person even when a cold sore is not present. 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 cold sores from contaminated surfaces, towels, or washcloths.

After the first infection, the virus enters the nerve cells and travels up the nerve until it comes to a place called a ganglion, which is a collection of nerve cells. There, it resides quietly in a stage that is called a "dormant" or "latent" period. In more active stages, the virus starts multiplying again and travels down the nerve to the skin, causing blisters on the lips known as cold sores. The exact way this happens is not clear, but it is known that some conditions seem to be associated with recurrences,

Colds sores have a tendency to recur in more or less the same place each time. Such recurrences may happen often (for example, once a month) or only occasionally (for example, once or twice a year).

The diagnosis of cold sores is usually based on the appearance of the lesions. Usually, no laboratory test is needed because most sores that look like cold sores are cold sores. Occasionally, mouth sores known as canker sores may be mistaken for cold sores. However, canker sores occur inside the mouth whereas recurrent cold sores usually occur on the lips. If there is a question about the diagnosis, a variety of tests are available, including viral culture and polymerase chain reaction (PCR). To do these tests, a swab is rubbed over an active blister. Swabbing the blister in an attempt to culture the virus in the lab works best in the first 24-48 hours before the blister has crusted over. There is also a way to test for herpes DNA in a swab that has been rubbed on the sore.

If the diagnosis is in doubt, the best approach is to encourage the person to see a doctor at the first sign of a sore. That will allow the clinician to see active lesions that can be tested by culture or PCR. If a delay is anticipated in being seen, a mobile phone or camera can be used to take pictures of the lesion to show to the physician.

Cold sores usually go away on their own and do not require follow-up. Unusual symptoms such as fever, confusion, or eye involvement should prompt a visit to a doctor.

It is not always possible to prevent an outbreak of cold sores. In people who have attacks triggered by sunburn, using sunscreen or avoiding heavy sun exposure may reduce the number of attacks. Taking daily prescription antiviral medications can significantly reduce the frequency of cold sores. However, the vast majority of people do not have enough attacks to justify taking a daily medicine.

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