Primary Cold Sore Infection

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What is a primary cold sore infection?

Cold sores are caused by the herpes simplex virus. The first time you are infected with this virus is called the primary infection. The mouth is the area commonly affected. This is because normal skin is resistant to the virus, but the moist inner skin of the mouth is not. The first infection is usually in childhood. It is often caught by kisses from a family member who has a cold sore.

What are the symptoms of a primary cold sore infection?

Symptoms of the first infection are often different to recurring cold sores.

• You may have no symptoms, or only trivial ones. For example, you may not realise that a tiny spot on the tongue is a first cold sore. However, you may then develop typical cold sores from time to time in the future.
• You may have a more severe infection in and around the mouth.
  • Small blisters or ulcers (sores) may develop on the mouth, tongue, gums, lips, or throat. There may be only a few blisters, but sometimes there are many.
  • The blisters and ulcers are painful. Swallowing or eating may become quite painful. The pain may cause you to pool saliva in the mouth, and children may drool.
  • The glands in your neck may swell.
  • You may develop a fever (high temperature), and general aches and pains.
  • The infection gradually subsides and goes within 1-3 weeks.

What are the treatments for a primary cold sore infection?

• Painkillers such as paracetamol or ibuprofen can ease the pain.
• Have plenty to drink. It may be painful to drink, but it is important to drink to prevent dehydration.
• If it is painful to clean your teeth, chlorhexidene mouthwash may help adults or children old enough to use it to keep the mouth and teeth clean.
• Sloppy foods such as yoghurts and soups are easier to eat when your mouth is painful.
• An antiviral medicine is sometimes prescribed if the symptoms are severe. It does not clear the virus, but prevents the virus from multiplying. It may not have much effect once the blisters and ulcers are well developed. However, if taken early in the infection it may reduce the duration of the pain, and speed recovery a little.

Children
Young children may be distressed with the pain and refuse to take medicine or drinks. Tips to help include:

• Try using a syringe (which you can buy at pharmacies) to slowly squirt medicine into the side of the mouth. Do not squirt into the back of the mouth as this may cause choking.
• Keep offering cool drinks. You can also use a syringe to give some drinks. Again, slowly squirt into the side of the mouth, not towards the back of the mouth.
• Sucking ice pops or ice cubes may help to ease the pain, and are also a way of giving fluids.

Occasionally, a child stops drinking because of the pain in their mouth. They are then in danger of becoming dehydrated. See a doctor if you are concerned that your child is not drinking enough, or if you think that they are dehydrated (low in body fluid). Some children who are at risk of dehydration are admitted to hospital for a short while until the infection settles, and they are drinking normally again.

Recurrent cold sores

After a primary infection has cleared, the virus remains dormant (inactive) in a nerve sheath. For most of the time it causes no problems. In some people the virus 'activates' from time to time to cause cold sores around the mouth and nose. Recurrent cold sores may be unpleasant, but do not cause severe mouth infections like some primary (first) infections. About 1 in 5 people in the UK have recurrent cold sores.

Contact with others

When you have a cold sore you should not kiss anyone or allow anyone to come into skin contact with the sore. In particular, avoid kissing newborn babies and anyone who has a poor immune system such as people on chemotherapy or with AIDS. People who have a poor immune system can become quite ill if they are infected with the cold sore virus.

However, when you have no symptoms (when the virus is dormant), you are not usually infectious. Also, healthy people who already have cold sores cannot be re-infected.

© EMIS and PIP 2006   Updated: June 2006   PRODIGY Validated

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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