HERPES SIMPLEX (Cold sores; Fever Blisters)<

General Information

DEFINITION--A common, contagious virus (herpes simplex or HSV-1) infection. Cold sores are sometimes confused with impetigo.

BODY PARTS INVOLVED--Lip; gums and mouth; cornea (rare); genitals (occasionally).

SEX OR AGE MOST AFFECTED--Both sexes. Most persons have their first infection before age 5.

> Eruptions of very small, painful blisters--

usually around the mouth, but sometimes on the genitals. The blisters are grouped together and each surrounded by a red ring. They fill with fluid, then dry up and disappear.

• If the eye is infected: Eye pain and redness; feeling that something is in the eye; sensitivity to light; and tearing.

CAUSES--Infection with a herpes virus that invades the skin, often remaining for months or years before causing active inflammation. Most persons develop antibodies that control the virus unless risk factors develop. The virus is transmitted by person-to-person contact or by contact with saliva, stools, urine or discharge from an infected eye. The blisters and ulcers of herpes simplex are contagious until they heal, both in the first and in succeeding flare-ups.

RISK INCREASES WITH

• Newborns; children who have eczema.
• Physical or emotional stress.
• Illness that has lowered resistance, including a cold, minor gastrointestinal upset or fever.
• Excess sun exposure.
• Menstrual periods.
• Dental treatment that stretches the mouth.
• Use of immunosuppressive drugs.

HOW TO PREVENT

• Avoid physical contact with others who have active lesions.
• Wash your hands often during a flare-up.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Laboratory virus cultures (rare).

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment, especially if the eye is affected.

POSSIBLE COMPLICATIONS

• Permanent vision impairment, if herpes eye infections are untreated.
• Severe infection in patients with eczema.
• Meningitis or encephalitis (rare).

PROBABLE OUTCOME--Spontaneous recovery in a few days to a week, occasionally longer. Recurrence is common. The virus remains in the body for life, but it is usually dormant. Research continues in developing a vaccine.

How To Treat

GENERAL MEASURES--

• Drink cool liquids or suck frozen juice bars to reduce discomfort.
• Apply an ice cube for 1 hour during the first 24 hours after a lesion appears. This may make it heal more quickly.
• Don't rub or scratch an infected eye.
• To prevent flare-ups, use zinc oxide or sun-screen on your lips when outdoors.

MEDICATION--

• Use aspirin or ibuprofen to relieve minor pain and reduce inflammation. Don't use aspirin for children and adolescents under 18. The use of aspirin during some viral illnesses may lead to Reye's syndrome, a form of encephalitis.
• Use non-prescription cold sore remedies. They may help the discomfort, but don't prevent flare-ups or hasten healing.
• Don't try to treat an infected eye--especially with cortisone ointments or drops--without consulting your doctor. Cortisone promotes growth of the herpes virus in the cornea.
• Your doctor may prescribe: Antiviral topical or oral medication. Antibiotic ointment if lesions become infected with bacteria. Anticancer topical medication for eye infections.

ACTIVITY--

• No restrictions, except to avoid close contact--especially kissing or oral sex--until lesions heal.
• Avoid newborns or patients who are taking immunosuppressant drugs.

DIET--No special diet.

Call Your Doctor If

The following occurs with a cold sore:

• Signs of secondary bacterial infection, such as fever, pus instead of clear fluid in the lesions, headache and muscle aches.
• Eruption of lesions on the genitals similar to those around the mouth.
• New, unexplained symptoms.