Dr Phil Kieran: What can my teenage son do about his cold sore?

"The cold-sore virus is far more common than you might think - somewhere between 70 and 80% of the population have it."

Wed, 28 Dec, 2022 - 07:40

Dr Phil Kieran

GENERAL PRACTITIONER

My teenage son has developed his first cold sore. It’s on his top lip and painful. What treatment would you recommend, and what steps can he take to ensure it does not return?

The appearance of a cold sore can be stressful and raise embarrassment as to who it was contracted from and whether it will spread to others. I remember when I was a child seeing people refuse to sit beside someone with a cold sore in case they caught it.

Cold sores are caused by a herpes virus (specifically herpes simplex 1 or HSV1). Some people confuse herpes simplex with genital herpes (more commonly caused by HSV2), a very different type of herpes virus.

The cold-sore virus is far more common than you might think. Somewhere between 70 and 80% of the population have it. You may well say, ‘I never get cold sores’, but this unfortunately may not be the case. Only half of the people with the cold sore virus will get the distinctive lesion. The remaining are more than capable of spreading the virus without ever knowing it.

Most of us inherit the cold sore virus from our family, either by sharing cups or bottles or by a kiss goodnight on the way to bed.

The good news for your son is that half of all people who get the virus will have one breakout when the initial infection happens and never again. The bad news is that the first infection can be pretty severe.

Primary herpes (what we call the initial infection) can spread to the lips, gums and even palate. This can be extremely painful and make eating or drinking difficult. Thankfully, the virus is usually short-lived and will resolve within five to 10 days.

If you are an adult prone to recurrent cold sores, protecting your lips is vital to reduce the risk. Sun damage can trigger a flare of the virus so using a UV-protective lip balm is a good habit to form.

A healthy immune system is also key to reducing the likelihood of a breakout. To this end, eat enough vegetables and fruit to ensure sufficient fibre and vitamins. If you smoke or vape, stop. Cut back on alcohol if you drink excessively. And the most effective treatment for preserving health is exercising regularly.

If your son can recognise the tingle or change in sensation that precedes a recurrent cold sore using a topical ointment can help, although the research suggests the effect is not particularly strong.

If you are an adult who suffers from repeated cold sores (more than three per year), talk to your GP about going on a course of suppressive treatment, which can stop the recurrences completely.