Q: How is the Cold Sore Virus transmitted?

The cold sore virus is typically transferred through direct or indirect physical contact. Examples of direct contact include viral transmission during kissing or other intimate behaviors. Indirect contact can occur when live virus is transferred between children putting commonly shared objects into their mouths, use of someone elses face cloth, drinking from a common cup or glass and sharing of cosmetics, such a lipstick. Often, transmission is between family members due to normal contact. A kiss from a friend or relative when he or she has a lesion can introduce the virus to a person who may not have been previously exposed.

The virus can remain active as long as it remains wet. One typically does not get infection from casual contact or contact with hard surfaces. It is now well known that transmission is possible, without the presence of an active lesion. Some people shed the virus in saliva without any other symptoms about 5% of the time.

There are two distinct periods in life when people are likely to be exposed to HSV-1. The first is early childhood (age 3 - 7) and a second period occurs in adolescence (age 12 - 21). Transmission is via close or intimate physical contact.

Q: What are the signs and symptoms of a cold sore?

When a clinical infection occurs for the first time in an individual, it is called a primary infection. Primary HSV-1 infection is often sub-clinical (no recognizable symptoms) and thus goes unnoticed, or it may be severe and may cause gingivostomatitis that ranges from mild to severe, the latter of which may be accompanied by enlarged and tender lymph nodes (lymphadenopathy) in the neck and under the jaw, swelling of the throat, fever and malaise.  There may be satellite sores on other parts of the body.  People who get cold sores after their primary exposure are said to have recurrent cold sores.  Primary infection can have lesions and symptoms that persist for 3 - 6 weeks.

Prior to a clinical outbreak of a recurrent cold sore episode, many people experience a prodromal phase, which includes an itchy, tingling sensation on the soon-to-be-affected skin. Often there is a warm or burning sensation with tenderness to touch soon thereafter. As the disease progresses, the area becomes red and raised. Tiny fluid filled bumps called vesicles form and join together. As the disease progresses, these blisters rupture leaving tender, fragile ulcers that release clear fluid-filled liquid containing the herpes viruses. Sometimes they bleed. The release of clear fluid is called weeping. When weeping is taking place, the infection is very contagious. As the ulcer heals, a scab forms and eventually falls off when healing is complete.

Some people experience secondary events when a new viral load travels out of the infected nerves and infects adjacent skin areas. When people begin to feel better and then appear to get worse, or get a new cold sore on top of or near the older one, this is usually due to secondary events. Experiencing a secondary event, especially after a lesion has been present for a couple of days, can extend the time the cold sore is active and painful.

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