Cold Sores (my latest "Ask Dr. Peg" column)

Dear Dr Peg:

I have read your Health Columns in the Daily Lobo and have found them to be very informative and helpful. I have been concerned about a health issue since school started and would like to submit this question.

Is there an unusually high number of people at UNM with cold sores/oral herpes? It seems that they are everywhere and I am afraid that I will come down with lip sores like that. I have never had one. Is there a way to prevent getting them? Why do you think so many people on campus have this problem? What is causing this?

Thank you very much.

-Curious About Cold Sores

Dear Curious,

Great questions! I’ll do my best to answer them, but first, a few basics for those who might need them. A cold sore, also commonly called a fever blister, is actually neither. I’m talking about those round, raw-looking sores that bloom on the vermilion border of the lip, which is the junction between lip and face. They aren’t caused by cold weather, a cold, or a fever. They’re actually caused by a virus, as you suggested. Herpes Simplex, to be precise. The medical term for “cold sore” is “Oral Herpes.” Like any virus, Herpes Simplex is contagious. Oral Herpes is usually passed by direct contact (kissing, oral sex) but can also be passed by sharing items like razors or towels.

I don’t think UNM students have more Oral Herpes than anyone else. I can’t give you statistics to prove this, however, because we rarely test for this condition. It’s pretty easy to diagnose just by looking at it, and the test is expensive, so students usually decline it. Having said that, I have to tell you that Oral Herpes is extremely common in this country in general. You say you have never had a cold sore, but you might be mistaken. The American Social Health Association asserts that “50-80% of the adult population in the United States has oral herpes, with as many as 90% having the virus by age 50.” Most of us get it as children, when some well-meaning but infected relative gives us a smooch and a squeeze. Nice, huh?

Now, to cut Aunt Blanche some slack, she probably didn’t have a nasty, oozing sore when she kissed you. The problem is, she could have passed it along to you even without an active sore, or outbreak. Herpes, once it gets under your skin, takes up residence deep in the root of a nerve. It can stay there forever without ever coming out, or it can venture up to the surface and wreak havoc. Unfortunately, before the havoc, i.e. the actual sore, you can shed viruses and be contagious. Some people can tell they’re about to have an outbreak because they feel tingling or pain at the site. Triggers for the virus to make a surface foray include sunburn, stress, illness, lack of sleep….yes, basically the college lifestyle. This might be why you see a lot of Oral Herpes. Students may have more outbreaks than other, less stressed adults, even if the infection rate is the same.

How can you keep from getting oral Herpes? Stay away from Aunt Blanche! Naw, but you shouldn’t be kissing anyone with a sore on their lip, or letting them kiss you. Anywhere. Herpes Simplex comes in two subspecies – type I and type II. Type I generally prefers lips, and Type II usually prefers genitals, but they’re adaptable. Either type can live in either place. And either type can be passed from one place to the other. I deliberately left Genital Herpes out of this discussion, due to space restraints and the fact that you asked about Oral Herpes, but I’d be happy to address that another time.

If you have a cold sore, avoid kissing and performing oral sex, don’t share eating utensils or cups, and wash your hands often.

If you develop a cold sore, know that it will clear up in about a week. In the meantime, you can ask your pharmacist for topical creams or ointments to soothe your discomfort, or you can come to the Student Health Center for a prescription for antiviral medication. These medications can decrease the severity of the symptoms and shorten the duration of the outbreak. Try to keep your hands off the sore. Take a pain reliever if needed, and apply ice or warm compresses, whichever feels better.The good news about Oral Herpes is that it causes a sore and that’s all. Yes, it takes up residence in your body for life, but it doesn’t damage your internal organs, cause cancer, or kill you. Ever since HIV has come on the scene, Herpes seems a lot less of a big deal.

The other good news is that many people “grow out of” cold sores. They may have outbreaks for several years after the Aunt Blanche episode, but stop having them by the time they’re adults. Adults who catch the virus may notice that their outbreaks diminish over time and eventually stop.

I hope this is helpful. If you or anyone else have more questions, email me at pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous in the Daily Lobo.