Everything a Woman Needs to Know About Cold Sores!

By: Holly L. Thacker, MD • Posted on May 13, 2021

Uggh! You feel that weird tingling on your buccal lips and before you know it you have an outbreak of “cold sores.” These cold sores are known as herpes simplex vesicles on your lips. This common condition affects almost 90% of people. If you have a cold sore or the symptoms of one starting, be sure to avoid kissing and any oral contact with another person.

Triggers of cold sores include:

Stress
UV light
Colds
Reduced immunity from a poor diet and not enough sleep
Increased intake of the amino acid Arginine (as in milk and chocolate)

Herpes Treatment Options

It is optimal to first prevent primary infection, but this can be obviously difficult when 90% of us are infected with the condition. Cold sores are present in saliva and folks may secrete the virus in the prodromal shedding (when symptoms are in the early stages: itching, burning or tingling in the mouth).

Most oral herpes simplex is type I and most genital herpes are type II. However, either type can be present in any location on the skin, and someone who is not even sexually active can accidentally infect themselves genitally.

Genital Herpes Treatment

Genital herpes are more serious, painful and can affect urination. They usually require oral anti-viral agents with acyclovir (Zovirax®) or valacyclovir (Valtrex®). Genital herpes that occurs or recurs during labor and delivery may actually necessitate a Cesarean surgical birth to avoid the baby being delivered through the infected vaginal birth canal.

Cold Sores Treatment

I caution my patients with annoying, but usually not serious oral cold sores to avoid systemic anti-viral therapy and save that for more serious viral infections that involve eye, brain, lung or genitals. Certainly oral herpes that spreads or gets close to the eyes or happens in an immunocompromised person may require systemic therapy but for most of us that is over-kill.

Over the Counter Treatment

Take oral L-Lysine 500 to 600mg daily at first hint of tell-tale lip tingling.
Prevent cold sores by using lip balm with UV light protection sunscreen when out in the sun and/or at high altitudes.
Once blisters occur, use a soothing skin balm like Cicalfate, which is a zinc protective paste.
Abreva® is n-docosanol cream that is over the counter and may help some. It should be applied every 2 hours during wake time and started as soon as the telltale prodromal symptom starts. This agent should not be used if pregnant or breastfeeding.
Cold compresses may give some temporary relief.
Topical numbing agents may occasionally be needed.
Kanuka Honey has been reported as effective as an anti-viral medication in treating cold sores.

Prescription Options

Pencyclovir (Denovir®) is a prescription cream and is FDA approved to treat cold sores.
Acyclovir (Zovirax®) is a prescription that is available in an oral form and cream. Oral Acyclovir is also used to treat more serious conditions like Shingles, chicken pox (Varicella), and genital herpes.

As annoying and sometimes unsightly cold sores can be, usually they are a passing annoyance and a reminder to take better care of yourself! Don’t overreact and don't over-treat, and discuss the over the counter options available with your physician, advanced nurse practitioner or physician assistant.

Be Strong, Be Healthy, Be in Charge!

-Holly L Thacker MD

Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Dr. Thacker is also the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause. Her special interests and areas of research including menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health.

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