cold sores: the social stigmata

There is a social stigma related to herpes simplex virus, and I think mostly because people don't really understand it, or want to talk about it! Firstly, more than 100 million Americans have been exposed to the HSV-1(herpes simplex virus 1)and most all of them were exposed as children, but only 5% as adults ever have outbreaks.  Approximately 40 million Americans have the HSV-2 (herpes simplex virus 2) virus and most of them were exposed as teenagers and adults.  HSV-1  is usually referred to as cold sores because historically HSV-1 is the type of herpes that hangs out, in its latent (inactive) form in the ganglion nerve near your jaw/ear so the outbreaks usually occur on your lips and lower face area. HSV-2 is the type of herpes that is located in its latent from in the base of the spine, therefore the active outbreaks occur in the groin/genital area.  So, now that I covered that, I will confuse you with the fact that now, due to the increased transmission rates (which I believe is due to people not understanding the disease or its transmission)you can have HSV-1 present in your groin and HSV-2 that will present in your face...awesome how viruses adapt to modern life, huh?  Mostly due to oral sex transmission is how this fun little adaptation occurred.  The good news is that HSV-1 in the groin has low rates of recurrent outbreaks, and same for HSV-2 present in the face.

HSV can have no signs or symptoms when latent, but still can be transmitted to another person (5% of people with HSV-1 can transmit through their saliva even in a latent phase.)  Although, it is most easily spread when there is an active outbreak.  HSV-1 is the most common of the two viruses, making it the most commonly spread of the two viruses.  The good news (kinda)?  If you have HSV-1, you have some immunity due to the creation of antibodies by your immune system, so you are at a lower risk for getting infected by HSV-2.

What can trigger HSV outbreaks?
UV light exposure (i.e. sunburns- so always wear SPF lip protection when in the sun if you are prone to cold sores)
Stress
Hormonal changes (PMS)
Cold, flu
Changes in the immune system
Trauma to the skin

How do I know an outbreak is coming?
Most people can tell a few hours before the outbreak occurs because they feel a tingling in the area that the virus is replicating, you can see redness, and feel some heat and pain in the area.  Within an hour or a couple of hours the sore occurs....they can be large vesicles that are fluid filled (appeared to be filled with pus) and are surrounded by a reddened area.  The first outbreak is usually the worst and all recurrent outbreaks are usually not as painful or large.

What can you do?  There are topical treatments that are over the counter, such as Abreva and Releev (benzalkonium chloride with echinacea).  Abreva claims to shorten cold sore duration by a few days, and Releev claims to relieve symptoms within 24 hours.  Prescription topical treatments are Acyclovir cream and Denavir cream, which claim to reduce cold sore times by only a half a day.  And a prescription oral pill is Valcyte which can be taken daily as a prevention for outbreaks, or can be taken at the first signs of outbreaks and can significantly decrease outbreak lengths.  BUT, all of these treatments need to be started before the vesicle (or sore) actually appears...so, at the first sign of tingling, you should have a treatment on hand (whichever your HCP suggests works best for you) and start treatment immediately.  And, as noted above, wear sunblock on areas prone to outbreaks, limit stress, and note when your outbreaks occur (are they PMS related?)

Also, people with decreased immune systems due to chemotherapy, HIV/AIDS, cancer, other illnesses, are at a much higher risk for outbreaks due to a decreased immune system, so if you are someone with a history of either HSV-1 or 2 and have any of these issues also, please discuss with your HCP and they will most likely give you a standing prescription for treatment.

If you are one of the MANY Americans affected by HSV, don't be embarrassed!  So many people are affected, and granted it is not the best week of your life walking around with a sore on your face, but that is why there are drugs to treat it, and noticing the early signs are important, so that you can talk to your HCP about an standing prescription maybe or how best to treat/prevent your outbreaks.  And, bring this up with your HCP, there may be a stigma in the general public, but within the medical field, we understand and want to make your comfort and health a priority.  Talk to your HCP and bring it up, drop the stigma!!!

Yours in Good Health
B