Cold sores: how to treat (medicine and ointment)? See symptoms

It is believed that, in most people infected, it is still in childhood that the first contact with the cold sores virus occurs.

The interaction between children and adolescents, in addition to contact with adults already infected, makes the infectious agent spread quite easily and, therefore, the percentage of people infected is quite high.

According to the World Health Organization (WHO), two thirds of the world population under 50 years old was exposed to the herpes simplex virus, causing the infection to represent alarming numbers.

Herpes simplex infection does not always show symptoms, so a significant proportion of patients are unaware that they have the virus. On average, about 50% to 60% of patients develop the disease, that is, they manifest symptoms.


What is cold sores?

Cold sores are an infection usually caused by the Herpes simplex virus type 1, or HSV-1 . When the infection manifests, it is possible to characterize the disease by the lesions in the mouth region, which appear as painful blisters and have a great capacity for contagion and dissemination through contact with the infected person.

Although the lips are the most affected region, the disease can also cause sores on the gums, tongue, roof of the mouth, lining of the cheeks and even on the skin of the face and neck.

In general, when we talk about herpes, we deal with two types of virus in the family Herpesviridae: HSV-1 (type 1) and HSV-2 (type 2). Basically, they have similar structures, but different composition, causing the body to produce different antibodies when interacting with each virus.

The HSV-1 type usually causes lesions in the mouth region, and, popularly, herpes type 1 became known as cold sores. The HSV-2 virus, on the other hand, tends to be more prevalent in the genital region, being popularly called genital herpes .

Although HSV-1 generally causes milder symptoms and has a lower virulence (transmission capacity) compared to HSV-2, immunological factors interfere with the manifestation of the disease, so that in both infections, the body’s reaction can be very similar.

Until a while ago, about 80% of the wounds in the genital region were caused by the herpes virus 2 (HSV-2) and 80% of the lesions in the mouth were due to HSV-1. But nowadays, this scenario has changed, possibly due to cases of unprotected oral sex.

So, we can consider that there are 2 types of herpes with predominance in different parts of the body (mouth and genitals), but the manifestation of the disease is quite similar and can include both regions (including occurring simultaneously in the mouth and genitals).

The infection goes through a latency period, that is, it may be present in the body and not develop symptoms, causing the infection not to be recognized by the patient. This period can be a few months or may last a lifetime.

It may be that the symptoms are constant or that it takes years to manifest, but it is important to remember that the infection has no cure, causing the infected person to keep the virus in his body.

Thus, treatment aims to reduce injuries, pain and discomfort caused by the disease.

Cold sores, herpes in the mouth and cold sores: is there a difference?

No. Both cold sores, as well as herpes in the mouth or mouth are derivations of nomenclature. All of them refer to the same problem that affects the oral cavity, which may involve lips and mucous membranes.

Or what causes cold sores?

Cold sores are usually caused by the HSV-1 virus, but can also be caused by HSV-2. Contagion occurs through direct contact with infected people or their secretions. After infection, the lesions can be triggered by decreases in immunity, stress or ingestion of some foods.

Many people carry the virus, but they do not show symptoms. So it is possible that the infectious agent will be inactive in the body for a long time.

However, when a factor awakens the herpes simplex virus, the sores in the lips, mouth and even the throat area appear.

It is estimated that up to half of the children have already been exposed to the herpes virus, mainly through direct contact with infected adults.

The virus affects the person, crosses the skin layer and settles in the organism, remaining inactive or “asleep” until something favors its manifestation. Among the factors capable of arousing symptoms are stress, decreased immunity, intense exposure to sunlight or other infections.

In 2011, a study published in the Journal of the Society of Infectious Diseases of America indicated a possible reason for the disease to manifest itself in some infected people, but not in others.

According to the publication, the appearance of lesions may be associated with genetics. The analyzes showed that there are differences in a gene present on chromosome 21 between the people who manifest the symptoms.

What is the virus cycle in the body?

When we think of herpes, we often associate it immediately with unprotected sex. But it is worth noting that there is a large percentage of people worldwide infected with the type 1 virus, which is usually associated with cold sores.

The Herpes simplex virus is transmitted by droplets of saliva, kisses and direct contact with contaminated objects.

So, in the case of small children, putting things in their mouths is not always very safe – although this is a way for babies to know the world and test their senses.

Anyone who is a parent, mother or guardian of a small child knows that no matter how attentive they are, there is not always time to clean their hands properly or prevent objects from going into their mouths.

So the child is in the middle of his learning routine, groping the world and picking up an object contaminated by the virus, bringing it to his mouth. Or an infected adult uncle decides to pick him up and kiss his nephew. There, the virus was transmitted.

The microorganism invades the body and settles in some nerve endings, especially in the ganglia (glands that help the immune system). Possibly, there will be no symptom manifestation, as it is as if the virus was just asleep in the body.

It may take a few years (or many years), but if there is a weakening of immunity, such as a very stressful situation or another infection, the virus can wake up.

So, it may be that that person who was infected before 1 year of age will only manifest some symptom when he is, for example, in the vestibular period, when stress and anxiety are quite high.

As there is a triggering factor, the herpes virus leaves the ganglion or nerve end and migrates to the epidermis (surface of the skin), causing a wound.

The lesion, in general, lasts about 8 days, but it depends a lot on the patient’s immune condition. Thus, while the stressful situation is affecting the person, the injury tends to resist.

If the immunity reacts again, the body is able to gradually soften the wounds and the virus falls asleep again.

Transmission: how do you get herpes in your mouth?

Transmission of the herpes simplex virus occurs through direct contact with the infected person or with her saliva. Touching, kissing, having unprotected sex, sharing glasses and cutlery are ways of contracting the infectious agent.

The possibility of contagion is much greater when the patient has visible lesions, reaching an increase of 1000 times.

However, it is possible that even when the patient is not in crisis of the disease (showing apparent lesions), the virus can still be transmitted – although this possibility is minimal.

Among the most recurrent transmission situations are:

  • Unprotected sex (oral sex);
  • Kiss;
  • Contact with injured skin;
  • Sharing cutlery, toothbrushes or intimate goals;
  • Contact with saliva droplets.

Pregnant women can also transmit HSV-1 or HSV-2 during pregnancy or childbirth, if the child comes into contact with a wound.

Groups of risk

According to the Brazilian Society of Dermatology (SBD), it is estimated that 90% of the world population has already been exposed to the HSV-1 virus, although not all of them show symptoms.

Among the risk groups for contagion with the herpes simplex virus are:

  • Small children (they tend to put objects and their hands in their mouths frequently);
  • Professionals who deal with the public (there is greater contact with people, increasing the risks of transmission);
  • Health professionals (due to circulation among sick people);
  • People who have unprotected sex.

What are the symptoms of herpes in the mouth?

Wounds and blisters in the area of ​​the lips are the most characteristic symptoms of herpes simplex, receiving the name of herpetic gingivostomatitis .

On average, 20% of patients present with symptoms as soon as they are infected, and in these cases, the intensity of symptoms tends to be greater. That is, in the next clinical manifestations, the lesions are likely to be less painful and stinging or smaller.

Patients who show symptoms after infection may experience fever , malaise, reduced appetite, sore throat and enlarged lymph nodes (lingual) in the neck.

Herpes simplex wounds are characterized by papules that develop into blisters filled with a serous liquid (the result of the inflammatory process). When they are up to 3mm, the lesions are still considered vesicles, but above that they are called blisters.

They can still appear in different amounts, but usually the vesicles appear in a grouped and concentrated form. Wounds tend to hurt, burn, burn and itch, especially when the person speaks or eats.

It is usually in the first few days of the appearance of the blisters that the pain and itching are greatest. Swelling, slight bleeding and constant discomfort to move your mouth may occur due to sensitivity.

It is possible that the neck nodes become swollen and painful, and small grayish ulcers appear at the bottom of the throat (tonsils).

During outbreaks of the disease (manifestation of the injury), the patient may also experience tingling or tenderness in the gums, around the mouth, throat and face, in addition to difficulty swallowing.

In general, the bubbles burst and release the serous content, becoming ulcerations or exposed lesions. Crusts or thick layers are formed during healing and, in some days, the wound tends to regress and improve.

Patients who suffer from herpes on a regular basis are often able to know when the lesions will occur, as some symptoms appear before the blisters appear.

With the drop in immunity, the area of ​​the lips that will be affected may itch, burn or become slightly sore, pointing to the possible injury.

What are the stages of the outbreak?

When an outbreak occurs, the manifestation can be separated into 4 phases, which are similar in herpes types 1 and 2:

  • Itching : it is the initial phase, in which the person can predict the appearance of the lesions. The region is burning and itching;
  • Blister : a small blister or bump appears on the skin, which can be isolated or grouped. There is pain and the wounds tend to swell gradually;
  • Secretion : it is usually the phase in which the wounds are more intense and form wounds with secretion that burst and release the contents;
  • Crust : the final stage of the lesions is marked by the drying of the wound that burst. A very sensitive crust forms, which, if broken, can bleed.
  • Healing : the crust (or cone) begins to improve and gradually fades. In a short time, the skin shows complete improvement.

It is worth mentioning that the symptoms of herpes 1 or 2 can be mild and go unnoticed and, normally, patients who have fever and pain show improvement of these symptoms before the wounds heal.

What are the stages of lip infection?

It is also possible to divide the symptoms according to the stage of the infection:

  • Primary infection : may present with fever, sores in the mouth, skin or genitals. But asymptomatic cases are common;
  • Latency : there are no symptoms, but the virus migrates to the region of the ganglia and settles in the body;
  • Recurrence : when there are situations that trigger or favor the onset of herpes, the lesions appear on the skin or mucous membranes. Stress, decreased immunity and prolonged exposure to the sun, for example, are among the causes.

What can trigger a crisis?

Any situation that causes a drop in immunity or changes in the body can be the triggering factor for recurrent injuries.

In general, the conditions most associated with the herpes crisis are:

  • Stress;
  • Menstruation;
  • Excessive exposure to the sun;
  • Infections (such as colds and flu);
  • Bad eating habits;
  • Use of medications, especially antibiotics.

Diagnosis of herpes in the mouth

The most suitable professionals for the diagnosis and treatment of herpes are the dermatologist, infectious disease, general practitioner and dentist .

The disease is diagnosed essentially by clinical evaluation, in which the professional will make a survey of the patient’s history, symptoms and periods of manifestation.

The professional will thoroughly evaluate the injuries, considering their manifestations and their frequency. In addition to the physical examination, tests may be ordered to confirm the diagnosis, but few cases are necessary.

Among the exams that can be ordered are:

  • Smear : a sample of the lesion is collected and sent for analysis, where techniques are used to identify if there is the presence of the infection;
  • Biopsy : it is usually requested when the lesions present atypical forms of manifestation;
  • Serology and the PCR (virus DNA detection) exam : done through blood collection, help to distinguish infections by the herpes simplex virus type 1 and type 2.

Is there a cure?

No . In patients who show symptoms or not, after being infected, the organisms are not able to get rid of the virus, despite treatment. Many will not even discover that they have the infection and, for those who develop herpes attacks, there are ways to treat the lesions and mitigate their occurrence.

What is the treatment?

The treatment for cold sores consists of easing the symptoms and improving the lesions more quickly through the use of oral medications and ointments.

In general, the lesions and ulcerations heal on their own within a few days, however, the treatment aims to accelerate recovery and reduce discomfort, pain and discomfort.

It is worth mentioning that treating a crisis does not prevent or prevent future crises, but helps to reduce pain, burning and the duration of injuries.

For this, antiviral drugs are used, in ointment or tablets, or just analgesics, to relieve pain.

Oral medicines, in general, have better effects when they are taken before the lesions appear, usually in that initial phase when the wounds are expected to appear.

For patients with frequent bouts of wounds (at least 4 per year), the doctor can assess the need or the efficiency of continued use of antiviral drugs.

In addition to the use of medications, which must be evaluated and prescribed by the doctor, treatment consists of alleviating the triggering factors of the injuries.

Read more: Herpes cases without treatment can lead to serious problems

Treatment options include:

Antiviral medications

They can be indicated for continuous use if the patient suffers from very recurrent symptoms. They are most effective when the virus is starting to manifest and can make herpes attacks last a few hours or days less.

Antiviral Ointments

Ointments, for topical (external) use, are especially indicated to speed recovery from injuries. They are more indicated in mild cases, with lesions that do not compromise the patient’s activities and that are not frequent.

Antiseptic compresses

If medically recommended, compresses can help to ease pain and improve healing. They can be done 2 or more times a day, as needed.


Recently, studies published in Revista Gaúcha de Odontologia have pointed out the benefits of lysine to reduce or alleviate the attacks of type 1 herpes. The substance is an amino acid naturally present in several foods, such as milk, meat, fruits and vegetables.

Due to the ability of lysine to reduce the multiplication of the virus, causing the risk of injury to be reduced, it can be a therapeutic resource.

Although there is a recommendation to reinforce the diet with foods rich in the amino acid, new treatments are being conducted with the use of supplements or remedies based on lysine, which can promote the increase of up to 20 times more lysine in the body.

In short, lysine enters the body and inhibits the action of arginine, which is another amino acid. Although lysine and arginine are amino acids obtained in food, in contact with HSV-1 they have very different actions.

While arginine stimulates the reproduction and multiplication of herpes, lysine inhibits the action of arginine. That is, when taking the supplement, there is no stimulus for the virus to manifest.

A study published in Revista Gaúcha de Odontologia, in 2007, followed patients who started to ingest 500mg of lysine per day, for 1 year. At the end of the research, there was a 63% reduction in the incidence of injuries in the period, pointing out that supplementation can bring benefits in the control of symptoms.

Medicines: what is the best medicine for cold sores?

The use of antiviral ointments helps to speed healing and reduce the pain and discomfort of injuries. The medication should be applied directly to the wound area, according to the doctor’s recommendations, respecting the frequency and quantity indicated until the lesions improve.


Among the oral ingestion options (tablets) for the treatment of cold sores are:

  • Valacyclovir : like Valtrex and Herpstal ;
  • Acyclovir : like Herpesil ;
  • Fanciclovir : like Penvir and Flancomax .

There are also lysine hydrochloride tablets , such as Gaballon and Resist .

Ointment and solutions

Among the ointments commonly used for cold sores are those that contain Acyclovir as an active ingredient, such as Zovirax . As anesthetic options, used only to relieve pain, there are ointments based on lidocaine and benzocaine .


NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living with the cold sore virus

Living with cold sores can be very simple or very laborious, depending on each organism. There are people infected with the virus who will never manifest symptoms and, therefore, there is no impact on the routine.

But for patients who develop lesions, living with the disease requires care and, often, changes in daily life to alleviate symptoms.

As the treatment is not able to eliminate future occurrences of the virus, patients need to observe aspects that can trigger the symptoms and eliminate them – or at least reduce them.

Read more: Who has herpes (simple or zoster) can donate blood?

Here are some tips to reduce the appearance of injuries and improve the quality of life:

Protect yourself from the sun

When the herpes sufferer is exposed to the sun for long periods or under a very strong solar incidence, there are great chances of the lesions to manifest. This is because ultraviolet A radiation reduces or inhibits immunity cells, which favors the development of infections.

As it is not possible to constantly avoid the sun, the most important thing is to protect yourself with the frequent use of sunscreen, which must be applied to the entire skin every 2 hours. If possible, the ideal is to avoid being exposed to UVA radiation in the most intense periods, between 11 am and 2 pm.

Take care of the food

Food is directly related to immunity, as it provides necessary nutrients for the body to maintain its active defense system.

Therefore, it is worth investing in those tips for good health in general: a balanced, nutritious and diversified diet, giving preference to natural and healthy foods.

Nutritional monitoring is important and can assist in the preparation of a balanced menu.

Avoid arginine

Arginine is an amino acid that can stimulate the development of herpes symptoms and prolong the duration of attacks. Among the foods richest in the amino acid are chocolate, alcoholic drinks, kiwi , pineapple and nuts.

Consume lysine

Lysine is an amino acid that acts by reducing the replication of the virus and, therefore, helps to reduce symptomatic episodes. Among the foods with lysine are lean meat, cheese, chicken, soy, fish, shrimp, shellfish, nuts, seeds, eggs, beans .

The amino acid can also be consumed in the form of a manipulated supplement or medication, as long as it is prescribed by the doctor.

Reduce stress

One of the triggering factors for herpes is the patient’s emotional state. Stressful situations, stressful periods or routines, mental fatigue or anxiety disorders can promote the onset of symptoms or prolong episodes.

The ideal is to look for alternatives to deal with everyday situations. One of the aggravating factors of herpes caused by stressful factors is that many patients are uncomfortable or embarrassed by the lesions, starting a cycle that worsens the situation.

In other words, an episode of stress arises that triggers the injury. The wound becomes a nuisance and worsens the patient’s emotional state. Thus, he becomes more anxious or more irritated by the symptoms, causing the wound to continue even further due to the intensification of the emotional state.

Although it is not simple, it is important that the patient learns to deal with the lesions and symptoms of the disease, so that they become less limiting when they occur.

Take care while injuries manifest

During crises, it is important that the patient has extra care with the disease. As injuries greatly increase the possibility of contagion, it is important to avoid direct contact with other people, as well as the sharing of intimate objects.

It is important to separate utensils, such as cutlery, towels and glasses and to intensify care with hand hygiene.

In addition, it is essential to avoid aggravating the lesions by scratching, rubbing or puncturing (bursting) the blisters, as this can cause bleeding, prolong the recovery time and increase the sensation of pain.

It is also recommended not to touch the wounds and then to touch other parts of the body, especially the eyes and mouth.

Encourage healing

Always follow your doctor’s recommendations to prevent the lesions from getting worse or the virus from being transmitted. This includes avoiding intimate or close contact with other people, separating utensils and underwear, in addition to using the medications and measures prescribed by the professional.

Being careful when applying the ointments is also essential. Avoid rubbing or scratching the lesions by applying appropriate layers of the medication without causing friction on the skin. As the region is injured, any friction can aggravate the wound.


For patients who manifest herpes symptoms, even so, the prognosis tends to be good. When the lesions appear, in general, they last between 10 and 14 days, gradually improving.

Some patients are able to identify specific triggering factors, such as a drop in immunity due to other diseases, but there are patients who are more frequently affected. Even so, the symptoms tend not to present severe or debilitating conditions.

In general, there are greater concerns when the lesions appear in the region close to the eyes or when the patient has immunodeficiency, causing the lesions to be more severe.

Complications: what can herpes in the mouth cause?

Patients undergoing chemotherapy, with HIV , with cancer , as well as children and the elderly are more susceptible to complications due to low immunity.

Read more: Herpes virus may be one of the causes of Alzheimer’s

The most frequent are:


There is greater concern when the lesion appears close to the eyes, as the region is sensitive and can suffer severe damage. Inflammation in the layers of the eyes can impair vision and lead to blindness.

Spread of herpes (herpetic eczema)

Lesions can manifest throughout the body, leaving the patient highly debilitated. Generally, herpetic eczemas occur in overlap with other dermatitis, causing plaques, rashes and crusts to form much more aggravated.

Secondary skin infections

The lesions can promote the entry and infection of other bacteria, worsening the patient’s health status.

Transmission to baby

Pregnant women with herpes can transmit the virus to the baby, causing changes in the development of the fetus. The brain, eyes and skin can be affected. Therefore, it is necessary that the pregnancy be monitored through prenatal care. In addition, measures aimed at reducing the risks of transmission must be adopted.

Is cold sores more common in the cold?

In general, no. The incidence of cold sores in cold is very similar to that of heat. Often, what happens is that in cold times, the lips are dry and chapped due to the climate, which favors the manifestation of the condition.

How to prevent or cold sores?

The herpes simplex virus is considered to be one of the most transmissible and most circulating. As it is transmitted by droplets of saliva, avoiding contagion is not always simple, even in young children.

The ideal is always to maintain care with hand and surface hygiene, avoiding scratching your eyes or putting your hand to your mouth.

Due to the great difficulty in controlling the spread of the virus, it is important to avoid worsening the infection and spreading it to other regions of the body.

In this sense, it is essential that every sexual relationship is protected with male or female condoms, including oral sex.

Care should also be taken when people close to you are experiencing crises or wounds are present.

So it is necessary to avoid sharing intimate objects, such as clothes or razors, taking care of the hygiene and sterilization of the environment, in addition to avoiding intimate contact (such as kissing and sexual intercourse).

As the virus can take years to manifest itself, many people discover, after a long relationship, that their partners are carriers of the herpes virus. In such cases, it is important to reinforce care with the separation of intimate objects during periods of crisis.

Even if there are no visible wounds or knowledge of the infection, the use of condoms in all types of sexual intercourse is essential to prevent types of herpes and other STIs.

Common questions

Do I need to get a herpes test?

A report by the US Prevention Service (USPSTF) recommends that patients without symptoms do not need to go for herpes tests, even given the great possibility that they have already been exposed to the virus.

This is because knowing that you are a carrier is not going to bring about major changes in your life, unless symptoms manifest.

How long does the cold sore cycle last?

On average, the cold sore cycle lasts between 7 and 10 days. Some people may experience some discomfort before the wound appears, such as burning and itching in the region.

How long does it take to get cold sores?

When lesions and ulcers appear, in the mouth or genitals, most patients need approximately 7 to 12 days for complete healing.

But the time can be quite variable depending on the patient’s immune system – the injuries can last for more than 20 days.

It is worth remembering that the recovery from one injury does not mean that others cannot arise in the future.

How long does it take for the herpes virus to manifest?

After contact with HSV 1 or 2, some infected people have no symptoms or manifestations. Among the symptomatic cases, the majority of patients present symptoms in 5 or 6 days, but it is possible that there are manifestations, usually mild, between the 2nd and the 26th day.

Why does herpes have no cure?

The treatment aims to control and alleviate the symptoms, accelerating the patient’s recovery, so that the lesions and ulcers disappear. Despite this, the virus cannot be eliminated from the body, causing the crisis to be treated, but the infection cannot.

Can blisters on the lips be herpes?

Yes. Herpes causes blisters that, after a while, burst and dry, forming crusts under the skin.

However, it is worth remembering that not every blister is a symptom of herpes and medical research is always necessary.

What is the best ointment to treat cold sores?

There are some medications that are very effective in quickly improving cold sores. Acyclovir and Penciclovir are among the substances most used for the topical treatment of the condition. They prevent the viral agent from multiplying and continue to attack the dermis.

How to cure cold sores or mouth sores?

Using the medicine with medical guidance and adopting precautionary measures, it is possible to eliminate, control and prevent the manifestation of symptoms, such as blisters and skin lesions. However, cold sores cannot be definitively cured or eliminated from the body.

Therefore, treatment must be continuous.

Why does herpes in the mouth occur more in the summer?

Prolonged or excessive exposure to the sun can lower the body’s immunity and, for patients who have the virus, cause symptoms to manifest.

It is worth remembering that when the patient is in crisis, that is, he has ulcerations, transmission is favored. Therefore, during the summer there may be a greater spread of the virus.

In addition, it is possible to consider that during the summer, especially on the beaches and swimming pools, there may be carelessness with the shared use of towels and underwear, for example.

Can I transmit the virus even if I have not had a seizure for a long time?

-Yeah . Even people in an asymptomatic state, who have been without crises for a long time, can transmit the virus, although the probability is much less compared to the periods when there are injuries.

It is also worth remembering that, sometimes, wounds are present in places that are difficult to identify (for example, inside the mouth), causing the person to be in crisis, but do not know it.

Is herpes on the lip less severe than genital herpes?

No . The two types of herpes are quite similar and cause similar symptoms.

The main difference, in addition to a predominance in the mouth and another in the genitals, is the social stigma, as we generally associate only genital herpes with STDs, making it appear that type 1 (labial) is less severe.

Since type 1 is easily transmitted by kissing and the infection can occur even in childhood, many people believe that the HSV-1 virus is less aggressive.

Who has cold sores has genital herpes too?

Not necessarily . These are two different conditions, but it is possible that the patient has both infections, caused by different types of the virus.

The herpes virus is a highly contagious agent and despite the enormous incidence, not all people show symptoms. For this reason, many spend their entire lives without knowing that they have been contaminated.

Care with the disease is mainly focused on minimizing crises and offering a better quality of life to patients who suffer from injuries.

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