Cold sore living in adults

Overview

A cold sore is a small, painful blister that usually appears on or around the lips. It is caused by the herpes simplex virus (HSV). Once you have the virus, it stays in your body and can cause cold sores to come back from time to time.

Yes, cold sores are very common. Most people get the virus as a child, but not everyone gets symptoms.

Anyone can get cold sores, but they are most common in adults between 20 and 40 years old.

Symptoms

Common symptoms

• Tingling, itching, or burning feeling around the lips
• Small, fluid-filled blisters
• Blisters that burst and crust over
• Soreness or pain in the area

Symptoms in children

• First infection can cause fever, swollen gums, and mouth sores (gingivostomatitis)
• May have more blisters inside the mouth
• Irritability and trouble eating or drinking

Symptoms in older adults

• Outbreaks may last longer or be more painful
• Higher risk of complications if the immune system is weak
• May have larger or more widespread sores

Causes

Main causes

• Herpes simplex virus type 1 (HSV-1) – the most common cause of cold sores
• Herpes simplex virus type 2 (HSV-2) – usually causes genital herpes but can also cause cold sores
• Direct contact with an active cold sore or the fluid from a blister

Risk factors

• Stress or being tired
• Illness or fever (like a cold or flu)
• Too much exposure to sun or wind
• A weakened immune system (for example, from chemotherapy or an organ transplant)
• Hormonal changes, such as during menstruation

When to see a doctor

See a doctor urgently if:

• If the cold sore spreads to your eye – get same-day medical help
• If you have a high fever or feel very unwell with the outbreak

Book a routine appointment if:

• If outbreaks happen often or are very painful
• If you have a weakened immune system and get a cold sore
• To talk about antiviral treatment to reduce outbreaks

Diagnosis

A doctor or nurse can usually diagnose a cold sore just by looking at it. The tingling feeling before the blister appears also helps identify it.

Tests that may be done

• Sometimes a swab of the fluid from the blister is sent to a lab to confirm the virus

What to expect at your appointment

The diagnosis is quick and painless. Your doctor will ask about your symptoms, how often you get cold sores, and any triggers.

Treatment

Treatment can help heal cold sores faster and reduce symptoms. It may include self-care and, for some people, antiviral medicine.

Self-care at home

• Apply a cold, damp cloth to the sore to ease pain
• Use a lip balm with sunscreen to prevent sun-triggered outbreaks
• Avoid touching the sore to prevent spreading the virus
• Wash your hands often, especially after touching the area
• Do not kiss anyone or share cups, towels, or lip products while the sore is active

Medical treatments

Antiviral creams can be applied directly to the sore to speed healing. For severe or frequent outbreaks, a doctor may prescribe antiviral tablets. These work best if started as soon as you feel the tingling.

When is surgery considered?

Surgery is not used for cold sores.

Living with this condition

Cold sores can be uncomfortable and sometimes embarrassing, but they are manageable. Most people learn their triggers and can take steps to prevent or shorten outbreaks.

Lifestyle tips

• Avoid known triggers like stress or too much sun
• Get enough sleep to support your immune system
• Use separate towels and utensils when you have a sore

Diet and exercise

Eating a balanced diet and staying active can help keep your immune system strong. Some people find that foods high in lysine (like dairy, fish, and chicken) may help, but there is not strong evidence for this.

Mental health and emotional wellbeing

Cold sores can affect your confidence and make you feel self-conscious. This is normal. Remember that most people have the virus and outbreaks usually heal quickly. If you feel anxious or down, talk to your doctor or a counsellor.

Prevention

You cannot always prevent cold sores because the virus stays in your body. But you can reduce outbreaks by avoiding triggers and using sunscreen on your lips.

Vaccines

There is no vaccine for cold sores yet.

Screening programmes

There is no routine screening for the herpes simplex virus. Testing is only done if you have symptoms.

Complications

If left untreated

• Spread of the virus to the eyes (herpes keratitis) – can affect vision if not treated
• Widespread skin infection, especially in people with eczema (eczema herpeticum)
• Severe infection in people with weakened immune systems

Long-term outlook

For most people, cold sores are a minor annoyance. Outbreaks tend to become less frequent over time. With good self-care and treatment, you can manage the symptoms and reduce the impact on your daily life.

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