Herpes Simplex (Cold Sores)

What is it? Herpes simplex is a common viral infection causing inflammation and blistering on a limited area of the skin. The first (primary) infection often occurs in childhood. Commonly a continuing infection reoccurs on and off over the years with swelling, redness and blistering (cold sores), usually seen on the lips and around the mouth.

The primary infection may not be noticed. Occasionally it can be more severe causing painful mouth ulcers and enlarged tender glands in the neck. In children with eczema, a herpes simplex infection on top of the eczema can cause widespread blistering and must be seen urgently by a doctor.

The more common reoccurring infection, or cold sores, may be brought on by fever, exposure to sunlight or wind, or occasionally stress. They start with tingling or burning, followed by inflammation (red through purple to brown), then blistering. This occurs over 24-48 hours and takes 4-5 days to clear. Secondary bacterial infection may occur in the cold sore.

How is it prevented?
As herpes is easily transmitted people with active cold sores should avoid direct skin contact with others, e.g. kissing.

Using sun protection, such as clothing, a hat and sunscreen, is important to prevent repeated attacks of cold sores on the face.

How is it treated?
Antiviral treatment is not normally used for the primary herpes simplex infection. Children should be given plenty of fluids and soft food if there is mouth ulceration. If the blisters or ulcers are painful or there is fever, mild painkillers such paracetamol is all that is necessary.

There are many creams and lotions available for old sores. However there is no cure for these continuing attacks. Fortunately, the attacks tend to happen less often and become milder over time.

A specific antiviral product from the chemist/pharmacist must be used within the first few hours to help ease an attack of cold sores. An antiseptic solution or cream should be started to prevent bacterial infection occurring in the cold sores.

Important Points

• Herpes simplex is a common viral infection with a primary infection phase and a secondary infection that occasionally reappears
• The primary infection may not be noticed, but can occur as painful mouth ulcers, tender glands in the neck and fever in children
• The secondary, or reoccuring infection is known as cold sores and frequently reoccurs in the same area with attacks lasting 2-5 days
• Medical advice should be sought urgently for children with eczema who develop a skin infection with herpes simplex
• Most primary herpes simplex infections do not require antiviral treatment
• Using sun protection is important to prevent repeated attacks of cold sores on the face
• Antiviral creams and lotions are available for cold sores, but must be started within the first few hours of the infection
• Secondary bacterial infection of cold sore is common and antiseptic creams and solutions should be used to prevent this
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