Cold Sore Outbreaks
What exactly is a cold sore outbreak? What causes cold sore outbreaks? How does one deal with a cold sore first outbreak? Can cold sore outbreaks on the lips be prevented? Can cold sores be cured? How often do cold sore outbreaks occur? Are there really ways to get rid of cold sores ‘overnight’?
These are a few of the more common questions asked by those who experience cold sores, and especially by those who have recurring or frequent cold sore outbreaks – which is more than 80 million Americans! Many people also want to know if there is a way to know when a cold sore outbreak is about to erupt, and if there’s anything that can be done to prevent an outbreak of cold sores.
We understand. Cold sores are painful. They can be very embarrassing. They can disrupt one’s social life, family life and business life. No one wants to be seen with a mouth full of cold sore blisters, or a cold sore outbreak on the face, mouth or nose. We’ve heard people say that they think everyone is staring at them. And we’ve heard over and over that those who experience recurring cold sore outbreaks go to bed every night praying that they don’t wake up with yet another outbreak of cold sores. And we really get it.
We know that understanding what causes cold sores, and what can be done before, during and after a cold sore outbreak can help quite a lot. Understanding the real cause of cold sores is also important, as is knowing how cold sores are transmitted from person to person. And last, but not least, understanding what triggers cold sore outbreaks can help one avoid those triggers.
So let’s start with the basics:
What Are Cold Sores?
Often referred to by the more socially acceptable terms ‘cold sores’, or ‘fever blisters’, the eruptions that occur in and around the oral / facial area are the result of the action of the Herpes Simplex Virus Type 1 (HSV-1). As the HSV-1 virus is primarily transmitted through direct contact, kissing and sexual activity, for decades, “having herpes” was considered a sign of promiscuous sexual behavior, and more socially friendly terms, like ‘cold sores’, were coined.
But no matter what anyone may have heard, or read on the internet, there is no cure for cold sores. Once the HSV virus is in the body, it’s there for life. For about half of people with the HSV virus, the virus remains in a dormant, or inactive state and doesn’t cause frequent outbreaks. Others may experience recurring outbreaks with a frequency that can be weeks, months or several times a year. It depends on a lot of factors, but some of the main factors are diet, stress, and exposure to various triggers than can cause the herpes virus to start to reproduce in large numbers in the body.
But the cold facts are that ‘cold sores’ and ‘fever blisters’ are indeed outbreaks caused by the herpes virus. And it’s nothing to be ashamed of, and it doesn’t have to be a big deal, or disrupt daily life. In fact, the herpes virus is in reality primarily transmitted as much by ‘Viral Shedding’ (explained a little later), as it is by direct sexual contact. Almost half of people infected with the Herpes virus don’t even know it, as they may never have experienced a visible outbreak, or didn’t know that certain symptoms were those of Herpes. If someone has ever had a cold sore, they have the HSV-1 virus in their system. Now, the objective is to keep the virus from reproducing as much as possible.
While there is NO CURE for the herpes virus, and it stays in the system for, taking care to avoid outbreak triggers, and learning about the many viable options that may help to reduce the symptoms, frequency, severity and length of any outbreaks one may experience are important steps to maintaining better health.
Another variant of the herpes virus is Herpes Simplex Type 2 (HSV-2), which is also referred to as ‘genital herpes’, as it primarily affects the genital region of your body. HSV-2 is primarily transmitted through sexual contact and is highly contagious, both during outbreaks and when there are no visible symptoms. One does not need to have an active outbreak of cold sores or genital herpes to transmit it to others. This is very often misunderstood.
Other than the specific area of the body affected, both HSV-1 and HSV-2 function in very similar ways, result in very similar symptoms, are triggered by similar events, and may be reduced in frequency and severity by a number of prescription and non-prescription treatments and immune system supporting supplements. The frequency of cold sore outbreaks can vary widely from person to person; some can experience cold sore outbreaks all the time, and others can get cold sore outbreaks back to back. There is no standard cold sore outbreak frequency, and each affected individual can experience outbreaks at a completely different frequency and severity.
How Are Cold Sores Transmitted?
In reality, this question is a softer way of asking “how did I get cold sores?”. Some of these facts may be surprising, but the majority of people infected with the herpes virus were first exposed and infected before the age of 20 – most typically from a congenial kiss from a family member who has the herpes virus, but may not even know it. With more than 80% of the entire US population testing positive for the HSV-1 virus, it isn’t surprising that mom, dad, grandma, grandpa, aunts, uncles and even family friends could easily infect a young person whose immune system isn’t fully developed and ready to protect them against these kinds of viruses. In fact, research has shown that it can take only 1 or 2 herpes virus particles to confer an infection!
School-aged children are well known to play ‘kissing games’, and are more sexually curious at a younger age than ever before. This increases the risk of transmission at an early age as well.
It’s good advice for parents to be aware of anyone (including themselves) who show signs of cold sore outbreaks, and refrain, or ask family members and friends to refrain from direct contacts, and especially the friendly familial kiss.
The herpes virus is also transmitted by something called ‘viral shedding’, where skin cells (which contain herpes virus particles) are constantly being shed every day. These shed skin cells can be infectious, and more so in the days or weeks before a cold sore outbreak is visible.
What Happens During a Cold Sore Infection?
Most people in the U.S. who test positive for HSV-1 have been infected before the age of 20. After first becoming infected, a person may experience an outbreak of blisters within a period of approximately 1 to 3 weeks from the time of exposure or infection. Not everyone who is infected with HSV-1 gets outbreaks of cold sores, or experiences frequent or recurring outbreaks later, but as many as 25% of infected persons may.
Symptoms may vary from very mild to very severe – or anywhere in between, and an outbreak may last up to 3 weeks. Many people see that after a first outbreak the HSV-1 virus goes dormant, ‘hiding’ in specific nerve tissues in the facial area (or in the case of HSV-2 in the sacral nerves in the lower back, near the genital regions) until it is ‘re-awakened’ by a trigger event that re-awakens the cold sore virus and stimulates it to reproduce quickly. The virus may remain dormant for weeks, months or even years, although many people experience outbreaks much more frequently – sometimes monthly or several times a year.
The Real Cause of Cold Sore Outbreaks
Cold sore outbreaks, in the same way as genital herpes outbreaks, occur when the amount of virus particles in the system hit a critical level. For the most part, once the virus is in the body, it’s there for life, but hopefully remains dormant and resides in the nerve groups either in the trigeminal area (around the nose and mouth, in the case of HSV-1), or in the sacral ganglia nerve bundles in the lower back area (in the case of HSV-2). While the virus remains ‘dormant’ is doesn’t reproduce a lot. However when the virus is ‘re-awakened’ by a trigger event or trigger food, it starts to reproduce faster an in large numbers.
Because viruses cannot reproduce by themselves, they first must ATTACH to a human host cell. Once they have attached to a host cell, the penetrate the host cell membrane with spikes on the outside of the virus membrane. When this is done, the virus is able to insert its genetic material into the host cell and literally hijack the host cell’s reproductive mechanisms to reproduce new “baby” virus particles. When the level of newly reproduced virus particles is high, the newly reproduced viruses burst out of the host cell, and every one of them (in the millions) looks for a new host cell to attach to, infect, and reproduce inside of.
The holy grail in virology is to interfere with the ability of a virus to attach to a host cell in the first place. If a virus cannot attach, it cannot get inside the host cell to reproduce, and the immune system is better able to identify and eliminate these virus particles.
No virus attachment = no virus reproduction.
Here’s a simplified diagram of the virus life cycle – the way the cold sore and herpes viruses attach to a host cell, reproduce inside that host cell, and then exit the host cell in search of the next cell to infect. This cycle repeats over and over and over, and this is what results in cold sore outbreaks and herpes outbreaks.
Cold Sore Outbreak Symptoms
The symptoms of an HSV-1 outbreak may range widely from lesions or blisters in or around the mouth, on the gums, on and around the lips, in or around the nasal opening, as well as on the skin near the nose or mouth. One can experience cold sores on the mouth, cold sores on the lips, cold sores on the tongue, and even cold sore outbreaks on the chin, nose or other areas of the face. Symptoms may be mild or more severe, and this will vary from person to person. Cold sore outbreak symptoms can include burning, itching, nerve pain, tingling, and this may radiate from the point of the cold sore outbreak as well.
Typically, people experience some warning signs during a short period before an actual outbreak – this is called the ‘Prodrome’ period, or simply ‘prodrome’. An cold sore initial outbreak is almost always accompanied by a period of prodrome, and after recurring outbreaks of cold sores most people get used to the prodrome effects and learn to recognize that a cold sore outbreak may be coming soon.
Prodrome – Before the Outbreak
During prodrome (a period of several days to several weeks prior to an outbreak), HSV-1 patients may experience such warning signs of an impending outbreak as:
- Itching of the lips or skin near the mouth or nose
- A burning sensation near the lips or around the mouth or nose
- Tingling near the lips or near the mouth or nasal areas
- Mild symptoms of a sore throat
- A mild fever
- Swollen glands
- Painful swallowing
- Muscle aches
- A slight malaise (just not feeling well)
A cold sore outbreak becomes visible when blisters or a rash appears. They may occur on the gums, lips, mouth, nasal passages or even in the throat or on the face. Blisters usually appear as a group of small ‘pustules’ (small capsules of liquid), and may form into red or dark blisters that can break open and leak infective fluid, typically yellowish in color.
Smaller blisters may merge together to form larger blisters as they fill with fluid. Blisters can last a few days up to several weeks, and eventually, if left alone they will heal; first they will turn yellowish and get crusty, then they will begin to scab over and shed off like dried skin, eventually revealing normal but lighter skin underneath.
Outbreaks of HSV-1 occur when the virus has reproduced so much that the host cells they have infected can no longer contain the newly reproduced viruses. The membrane of the host cells in which the virus has been reproducing breaks open, releasing the newly formed virus particles into the surrounding area. And each newly formed herpes virus particle seeks out a new host cell to infect and to reproduce inside of.
Remember, viruses can NOT reproduce by themselves. They must first attach to a human host cell, insert their virus DNA or RNA into that host cell, and hijack the host cell’s reproductive biology in order to reproduce.
Cold Sore Outbreak Triggers
There are many factors that can easily trigger a dormant cold sore virus to re-awaken and start to reproduce. Let’s look at what triggers cold sore outbreaks.
These include (but are not limited to):
- Exposure to the sun, extreme heat or overexposure to UV rays, such as from tanning
- Fever from another cause, such as fighting another disease
- Stress and fatigue – one of the most common triggers of outbreaks
- Menstruation or changes in hormone levels
- A weakened immune system, or an immune system occupied with fighting some other infection or disease
- Friction, rubbing or trauma to the infected area
- Sexual activity
- Exposure to cold or wind which could irritate an infected area of the skin
- Diets rich in specific trigger ingredients, specifically the amino acid L-arginine, which is a nutrient the cold sore virus needs to survive and reproduce
- Excessive consumption of alcohol, caffeine or tobacco which can weaken the immune system
All in all, the quick summary is that:
- Cold sores are caused by the herpes simplex virus
- Once the cold sore (HSV-1) virus is in the system, it’s there for life
- There is NO cure for cold sores and no cure for the herpes virus
- More than 80% of all people have the HSV virus in their system – this is more than 260 million Americans
- 30% to 40% of these people experience recurring and often frequent cold sore outbreaks – this is more than 80 million Americans
- The cold sore virus can be transmitted easily by direct contact even when there is no cold sore outbreak visible
- There are many triggers than can stimulate the herpes virus to come out of a dormant state, re-awaken and start to reproduce; avoiding these triggers as much as possible can help
- The cold sore (herpes HSV) virus can NOT reproduce by itself; it has to attach to a host cell and reproduce inside the host cell
- If the virus cannot attach to a host cell, it cannot insert its virus DNA into the host cell, and thus it cannot reproduce
As always, make sure to talk with a doctor or qualified health professional for any health concerns.
*These statements have not been evaluated by the Food & Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease. Always seek professional medical attention for any medical conditions or health issues you may be experiencing. The information on this website is not intended as medical advice or to replace the advice of a qualified medical professional.