The Kiss You Can Never Forget

So let’s be honest: cold sores are gross and no one wants to actually talk about them. That, dear reader, is why you are looking at this article instead of talking to your friends and family about it. And of course, that is why we are here.

If you have not had a cold sore yet, chances are you will; roughly half of all adults will have been infected by around 25 years old, and by 70 years old, it reaches almost 90% of Americans. That’s a lot, and considering that this infection cannot be cured, it would be nice to know what to do when it happens to you.


Here are some facts to start with. Yes, it is true, cold sores are herpes. No, this is not quite the same thing as genital herpes, but it is very similar. The herpes virus is the bad guy, and it also causes chickenpox. None of these infections can be cured yet, and they often will come back. With cold sores and genital herpes, repeated infections look very similar to the original infection and usually happen in the same spot. When chickenpox comes back, it looks different from the original infection and is called Herpes Zoster, or “shingles.”

What all these infections have in common is that the virus that is the cause stays hidden in the nerve cells in your body, ready for something to let it come back out. Physical or emotional stress is often a trigger for the herpes virus to become active. In the case of cold sores, a common cold, stress, or chapped lips from cold weather can be the trigger. Hence the name, Cold Sores.

When the cold sore starts, it might be signaled by pain or tingling before any rash appears. Then, small blisters with clear fluid come up in a cluster, almost like flat grapes. All herpes infections are contagious when they first start, and cold sores are no exception. While the blisters are present and still look like bubbles, they are infectious and can be spread. This is how a cold sore can become the “kiss you can never forget.” Don’t let anyone fool you; if the blisters are not all crusted over, they are infectious, and even after they are crusted, you need to be careful. A good rule of thumb is to treat the area as infectious for 10 days after the first blister appears.

Preventing the spread of the cold sore is pretty simple.

1. Do not touch. If you don’t touch, it cannot spread.

2. If you do touch, wash with soap and water or an alcohol-based hand lotion. This means that if you have a cold sore and apply a cream or balm to the area, wash your hands right away. The virus is there on your fingers! You can actually spread this to your eyes or other very delicate areas of your body just by touching the cold sore, not washing, and then touching something else.

3. Let a hug be good enough. Chances are, someday you will be into someone who develops a cold sore, or someone else may be into you when you have one. Kissing is just out. Refer to rule #1. And no exceptions. Remember, this NEVER goes away, so preventing the infection for as long as possible is the goal.

Once you get a cold sore, you will want to do something for it because it hurts; it can even bleed, and, honestly, it is not very attractive. There are many products that are advertised to treat cold sores, and, unfortunately, most of them do not work. They can make the skin softer and feel better, which is nice, but nothing over the counter has scientific evidence to say that it actually makes the cold sore go away faster. (If you meet someone who swears by what they use, don’t argue, because it makes them feel better to use it, and that is worth something.)

The only proven means to make a cold sore go away faster are certain medications. Acyclovir was the first. It is a capsule that is taken 5 times a day for 10 days during the first outbreak, and 5 times a day for 5 days during future outbreaks.  Using this medication can reduce the risk of recurrent infection, and if the cold sores are frequent, your doctor might even have you take it once a day for several months to try to prevent the cold sores from coming back. There are other medications as well, called valacyclovir and famciclovir, and these work well also and are used fewer times a day, but they can be more expensive. They need to be started ASAP when the cold sore starts, and they do not help if started 72 hours or later after the onset of the cold sore. This means if you have had cold sores talk to your doctor, and think about having a prescription on hand to use as soon as a cold sore is apparent.

That’s pretty much it. They are herpes, but not the kind you are thinking of. They are contagious, but there are ways to try to prevent getting infected. And if you, like almost everyone else in America, gets cold sores, talk to your doctor since there are things to do that can make it go away quicker. And remember: Be careful. Remember a kiss because of how you felt, not because of what it left behind.


Dr. James Meade went to medical school at the University of Wisconsin, Madison, and did his Residency and Fellowship training in Harrisburg, Pennsylvania.  He is a family doctor and sports medicine doctor.  He has been in practice since 1991, and had the privilege of working with Penn State Hershey Medical Center, and, in a minor role, with Penn State Athletics, until he moved home to Wisconsin, where he entered into private practice with his twin brother, a pediatrician. 


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