Cold sores (oral), are blisters that are caused by the herpes simplex virus (HSV-1). While this virus is related to the strain of Herpes that causes genital sores, it is not the same at all. HSV-1 is one of the most common viruses, and is easily passed during an outbreak. Some of the most common ways to pass the virus are sharing cups, kissing, sharing a toothbrush, or any other exchange of bodily fluids. In some cases the virus can be passed by a person whose skin looks normal, yet their skin is shedding the virus.

After the first 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 called a "dormant" or the "latent" period. At times, the virus can start multiplying again and travel down the nerve to the skin, causing new cold sores. The very first time someone gets a cold sore (known as the "primary" attack), the symptoms can be severe. In some people, the first attack of herpes is associated with fever, swollen glands, bleeding gums, and many painful sore(s) around the mouth. These signs and symptoms may last several days. The sores tend to heal completely in two to six weeks, usually without scarring.

Many adults are surprised when they get an outbreak, especially those who can not remember ever having an out break before. This is because primary herpes usually happens during childhood, and often is forgotten or goes unnoticed. If the attack is severe, then a doctor should be contacted and there are medicines that can help minimize the pain, as well as future outbreaks.

Cold sores generally develop in stages

1) The "prodome", is stage one, a stage in which the person feels a general uncomfortable feeling. Some describe it as a prickling, itching or burning sensation, but there is no breakout on the surface of the skin. At his stage, if a person takes medication, or natural remedies, sometimes the breakout can be avoided altogether.

2) The skin will start to swell and become red around the area where the out break will occur.

3) The first sign of a blister or outbreak will develop. There can be one blister or several in the same area where the outbreak occurs.

4) The next stage is generally the worst and most painful. The blisters begin to crust and many people spread it unintentionally to other parts of their lips etc... by itching the sores in a futile attempt to ease the pain.

5) When the crust turns from soft to hard, this is stage five and the beginning of the healing, which lasts about 4-5 days.

6) This is the final stage which is around the 10th day, and the blisters are mostly gone and the area is red and swollen until it finally heals.

What Can be Done/ Natural Remedies?

There are several medications to reduce the duration or symptoms of cold sores. Some are available without a prescription (over the counter), and others require a prescription from a doctor. Some are taken in pill form. Docosanol 10% cream (Abreva) is the only over-the-counter product that is known to decrease healing time when applied at the first sign of recurrence (for example, tingling sensation). Docosanol is applied five times per day until the lesion is healed. Possible side effects include rash and itching at the site of application.

Prescription-strength topical medications: Treatment with topical acyclovir (Zovirax 5% cream) or penciclovir (Denavir 1% cream) will reduce healing time by approximately half a day and decrease the pain associated with the lesion. Topical treatment is limited in its effectiveness because it has poor penetration to the site of replication of the virus and therefore is restricted in its healing ability. Acyclovir cream should be applied five times per day for four days, and penciclovir cream should be applied every two hours while awake for four days.

The current FDA-approved medications used in the treatment of herpes simplex virus are acyclovir (Zovirax) and valacyclovir (Valtrex). Famciclovir (Famvir) can also be used, but it's currently is not approved for this indication. These oral medications have been shown to decrease the duration of the outbreak, especially when started during the "prodrome" (symptom onset before the actual condition becomes fully evident). The medications are generally well tolerated with few side effects. Headache, nausea, and diarrhea may occur in some people. For simple, recurrent cold sores, valacyclovir is given as 2 grams orally every 12 hours for one day, and famciclovir is given as 1,500 milligrams orally for one dose. Acyclovir is given as 400 mg orally five times per day for five days. Pregnant women and nursing mothers should contact their physicians or pharmacists prior to using any medication.

Many long time cold sore sufferers swear by a combination of the Abreva and L-Lysine pills or cream. L-Lysine is an amino acid that is proven to fight the herpes virus however you should not take the Lysine pills for longer than 6 months, nor should you take them if you are pregnant or breastfeeding. Some sufferers also swear by over the counter remedies such as Herpacin, or even simply putting ice on the sore while it is still in stages 1-2.

Another natural remedy that many cold sore sufferers swear by, is called Trilex. Trilex comes in pill form and it not only helps speed recovery from cold sores, it helps to strengthen your immune system. Trilex has some major advantages over prescribed Antiviral drugs; Trilex works faster, it is cheaper and it does not have the uncomfortable side effects such as nausea, vomiting and diarrhea.

However, any cold sore sufferer should be aware that they can spread the virus to other parts of their bodies by simply applying the medicine with their fingertips as opposed to using a cotton swab. In several cases people have spread the virus to their fingertips, eyes and even their genitals by forgetting to wash their hands after applying medication or by accidentally scratching the sore. Both ocular herpes, and genital herpes have serious side effects. Always remember to never directly touch the sores and to wash your hands thoroughly whenever you touch your face. 

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