Overview
Herpes simplex is a common viral infection caused by the herpes simplex virus (HSV). There are two types of HSV: HSV-1 and HSV-2. HSV-1 is primarily responsible for oral and facial infections, including cold sores, while HSV-2 is commonly associated with genital infections. Both types can spread to various body parts, including the mouth and genitals, through close contact such as kissing or oral sex.
What are Cold Sores?
Cold sores, also known as fever blisters, are small, fluid-filled blisters that typically form on or around the lips. They are caused by the HSV-1 virus and are highly contagious. These blisters often appear in clusters and can cause significant discomfort. After the blisters break, they crust over and usually heal within two to three weeks without leaving scars.
Causes of Cold Sores in Children
Children can contract HSV-1 through close contact with an infected person. Common ways the virus spreads include:
- Kissing
- Sharing cups or utensils
- Sharing washcloths or towels
- Touching the cold sore before it heals
Once a child is infected, the virus remains dormant in the body and can reactivate, causing cold sores. Triggers for reactivation include exposure to hot sun, cold wind, illness, and a weakened immune system.
Symptoms of Cold Sores
Cold sores go through several stages:
- Tingling and Itching: Initial symptoms include itching, burning, or tingling around the lips before a small, hard, painful spot appears.
- Blisters: Small, fluid-filled blisters form, often along the border of the lips.
- Oozing and Crusting: Blisters may merge and burst, leaving shallow open sores that crust over.
First-time outbreaks can include additional symptoms such as fever, painful gums, sore throat, headache, muscle aches, and swollen lymph nodes. Recurrences are generally less severe and more localized.
Cold sores are caused by certain strains of the herpes simplex virus (HSV). HSV-1 usually causes cold sores, while HSV-2 often causes genital herpes. However, either type can spread to the face or genitals through close contact, such as kissing or oral sex. Shared eating utensils, razors, and towels can also spread HSV-1. Cold sores are most likely to spread when blisters are present and oozing, but the virus can be transmitted even when no blisters are visible.
Risk Factors and Complications
Most adults carry the HSV-1 virus, even if they have never shown symptoms. Factors that increase the risk of complications include:
- Weak immune system due to HIV/AIDS, chemotherapy, or immunosuppressive drugs.
- Atopic dermatitis (eczema).
- Severe infections in other body parts, such as the eyes or fingertips (herpes whitlow).
In some cases, the HSV can cause more severe health issues, such as:
- Herpes Whitlow: An infection of the fingers.
- Ocular Herpes: Eye infections that can lead to scarring and vision loss.
- Eczema Herpeticum: A severe condition in people with eczema, causing widespread blisters.
- Encephalitis: Inflammation of the brain, which is a serious and potentially life-threatening condition.
Prevention of Cold Sores
Preventing the spread of cold sores involves:
- Avoiding kissing and skin contact during an outbreak.
- Not sharing personal items like utensils, towels, and lip balm.
- Washing hands frequently and thoroughly.
If sunlight seems to trigger your condition, apply sunblock to the spot where the cold sore tends to form. Or talk with your healthcare provider about using an oral antiviral medicine before engaging in activities that tend to cause cold sores to return. Additionally, using sunscreens can help if sun exposure is a trigger.
Managing Cold Sores
While there is no cure for HSV, treatment can help manage symptoms and speed up healing:
- Antiviral Medications: Prescription antiviral drugs like famciclovir (Famvir) or valacyclovir (Valtrex) can shorten healing time. These are most effective when taken at the first sign of a cold sore, such as a burning or tingling sensation.
- Topical Treatments: Antiviral creams can be applied to the affected area to reduce pain and accelerate healing.
- Pain Relief: Over-the-counter pain relievers like ibuprofen or paracetamol can help manage discomfort.
Home Care Tips
To ease symptoms and promote healing:
- Avoid touching the cold sore, and wash hands thoroughly if you do.
- Apply a sunblock lip balm (SPF 15 or higher) if exposed to sunlight.
- Stay hydrated and avoid acidic or salty foods that can irritate the sore.
- Use cold sore patches to protect the skin while it heals.
Cold Sores in Children
Children are more vulnerable to cold sores if they live with someone infected with HSV. In some cases, the initial infection can cause severe flu-like symptoms and mouth ulcers. Recurrences are usually milder.
Diagnosis and Treatment in Children
A healthcare provider can diagnose cold sores by examining the sores and may conduct tests such as skin scrapings or blood tests. Treatment options include antiviral medications to reduce the severity and duration of symptoms.
Preventing Cold Sores in Children
To prevent cold sores in children:
- Avoid exposing them to individuals with active cold sores.
- Teach them not to share utensils, towels, or personal items with someone who has a cold sore.
- Encourage them not to touch their cold sore to prevent spreading the virus to other parts of their body.
When to Seek Medical Attention for Children
Parents should contact a healthcare provider if:
- The cold sore does not begin to heal within 10 days.
- The child experiences severe pain or large sores.
- The child has a weakened immune system or other underlying health conditions.
Understanding Herpes Simplex in Detail
Primary Herpes Simplex Infection
Primary infection with HSV can be mild or subclinical, but symptomatic infection tends to be more severe than recurrences. Type 2 HSV is more often symptomatic than Type 1 HSV.
Primary Type 1 HSV most often presents as gingivostomatitis in children between 1 and 5 years of age. Symptoms include fever, which may be high, restlessness, and excessive drooling. Drinking and eating are painful, and the breath is foul. The gums are swollen, red, and bleed easily. Whitish vesicles evolve into yellowish ulcers on the tongue, throat, palate, and inside the cheeks. Local lymph glands are enlarged and tender. The fever subsides after 3–5 days, and recovery is usually complete within two weeks.
Primary Type 2 HSV usually presents as genital herpes after the onset of sexual activity. Painful vesicles, ulcers, redness, and swelling last for 2 to 3 weeks if untreated, and are often accompanied by fever and tender inguinal lymphadenopathy. In males, herpes most often affects the glans, foreskin, and shaft of the penis. Anal herpes is more common in males who have sex with men than with heterosexual partners. In females, herpes most often arises on the vulva and in the vagina, making it painful or difficult to pass urine.
Recurrent Herpes Simplex Infection
After the initial infection, whether symptomatic or not, there may be no further clinical manifestations throughout life. However, recurrences are common, particularly with Type 2 genital herpes. Triggers for recurrences include minor trauma, surgery, upper respiratory tract infections, sun exposure, hormonal changes, and emotional stress. The vesicles tend to be smaller and more closely grouped in recurrent herpes, usually returning to the same site as the primary infection. They heal in 7–10 days without scarring, although white patches or scars may occur at the site of recurrent attacks, especially in individuals with darker skin.
Diagnosis and Complications of Herpes Simplex
If there is clinical doubt, HSV can be confirmed by culture or PCR of a viral swab taken from fresh vesicles. Complications of herpes simplex include:
- Eye Infection: HSV can cause swollen eyelids and conjunctivitis, leading to superficial ulceration of the cornea.
- Throat Infection: HSV may cause painful throat infections, interfering with swallowing.
- Eczema Herpeticum: Severe and widespread infection in patients with atopic dermatitis, characterized by numerous blisters on the face or body, swollen lymph glands, and fever.
- Erythema Multiforme: An uncommon reaction to HSV, presenting as symmetrical plaques on hands, forearms, feet, and lower legs, characterized by target lesions with central blisters.
References
Mayo Clinic. (2023). Cold sores (oral herpes). Retrieved from https://www.mayoclinic.org/diseases-conditions/cold-sore
National Health Service (NHS). (2023). Cold sores. Retrieved from https://www.nhs.uk/conditions/cold-sores/
Harvard Health Publishing. (2023). Cold sores: Prevention and treatment. Retrieved from https://www.health.harvard.edu/a_to_z/cold-sores
Stanford Health. (2023). Herpes Simplex Virus. Retrieved from https://stanfordhealthcare.org/medical-conditions/skin-and-hair/herpes-simplex-virus.html
DermNet New Zealand. (2023). Herpes simplex. Retrieved from https://dermnetnz.org/topics/herpes-simplex
