Cold sore (herpes simplex virus) - Treatment 

Treating cold sores 

Cold sores usually clear up without treatment within 7 to 10 days. Antiviral tablets or cream can be used to ease your symptoms and speed up the healing time.

Antiviral creams and tablets

Antiviral creams such as aciclovir or penciclovir (also known as Fenistil) may speed up the healing time of a recurrent cold sore infection if used correctly.

Cold sore creams are widely available over the counter from pharmacies without a prescription. They are only effective if you apply them as soon as the first signs of a cold sore appear, when the herpes simplex virus is spreading and replicating. Using an antiviral cream after this initial period is unlikely to have much effect.

If you have frequently recurring bouts of cold sores, use antiviral medication as soon as you feel the tingling sensation that indicates that a cold sore is about to develop. You will need to apply the cream up to five times a day for four to five days.

Antiviral creams can only help to heal a current outbreak of cold sores. They do not get rid of the herpes simplex virus or prevent future outbreaks of cold sores occurring.

Antiviral tablets are generally more effective than creams at treating cold sores, but are usually only prescribed for more severe cases.

Cold sore patches

Cold sore patches that contain a special gel called hydrocolloid are also available. They are an effective treatment for skin wounds and are placed over the cold sore to hide the sore area while it heals.

Non-antiviral treatments

Several non-antiviral creams are also available over the counter without a prescription from pharmacies.

These creams are not specifically designed to treat cold sores and will not help them heal faster, but they may help ease any pain or irritation. Ask your pharmacist to recommend a suitable treatment for you.

Pain can also be treated with painkillers such as ibuprofen or paracetamol (both are available in liquid form for young children).

However, don't take ibuprofen if you have asthma or stomach ulcers, or you have had them in the past.

Children under the age of 16 should not take aspirin.

Speak to your GP if you have cold sores and you are pregnant.

Treating complications

If your cold sores are particularly severe or your immune system is damaged (for example, if you have HIV or you are having chemotherapy treatment), you may be at risk of developing serious complications.

For example, your risk of developing encephalitis (brain tissue inflammation) or the infection spreading to other parts of your body, such as your eyes, is increased.

Visit your GP if you are at risk. They may prescribe antiviral tablets and refer you for specialist treatment. The type of treatment recommended will depend on the severity of your cold sore symptoms and the complication that is causing problems.

For example, if you develop herpetic keratoconjunctivitis (a secondary eye infection), you may need to see an ophthalmologist (a specialist eye doctor).

Read more about the complications of cold sores.

Gingivostomatitis

Also visit your GP if you or your child develops gingivostomatitis (swollen, painful gums) as a result of the primary herpes simplex infection. They will be able to suggest treatments to help ease your symptoms.

If the infection is painful, your GP may suggest using a preparation that contains benzydamine (available as an oral rinse or oral spray) to help relieve any pain in your mouth or throat.

Brushing your teeth may also be painful because of the inflammation (swelling) of your gums. Your GP may suggest using an antiseptic mouthwash. This will help prevent secondary infections and will also control a build-up of plaque if you cannot brush your teeth effectively.

As with the treatment of cold sores, any pain or fever can be treated using ibuprofen or paracetamol. Again, do not take ibuprofen if you have asthma or if you have stomach problems, such as stomach ulcers. Children under the age of 16 should not take aspirin.

In rare cases of gingivostomatitis, it is possible for your lips to become stuck together in places. Using a lip barrier cream, available from your local pharmacist, will help prevent this happening.

If you or your child has gingivostomatitis, it is important to drink plenty of fluids to avoid becoming dehydrated. Young children are particularly at risk as they may refuse to eat or drink because of the pain in their mouth.

It is important to watch out for signs of dehydration, such as:

  • headaches
  • tiredness
  • irritability
  • lightheadedness
  • low urine output

Most cases of gingivostomatitis will get better in 7 to 14 days, although it may take up to three weeks for the sores to heal completely.

Specialist treatment

If you or your child still has symptoms of gingivostomatitis after two weeks or the infection is severe, go back to your GP, who may refer you for specialist treatment.

Specialist referral may also be needed for gingivostomatitis if you are pregnant or have a weakened immune system.

Also visit your GP if you have a newborn baby who develops gingivostomatitis. They may also need to be referred for specialist treatment.

Page last reviewed: 10/04/2014

Next review due: 10/04/2016

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Comments

The 8 comments posted are personal views. Any information they give has not been checked and may not be accurate.

rw24 said on 29 October 2014

I find that the best thing to prevent coldsores is keeping your lips and skin moisturised. I always carry a lip balm with me as if your lips get dry and cracked, that's when the virus can cause a sore.
Although do not use lip balms if you already have a coldsore as it can make the virus spread across the rest of your lips. Also, if you get a coldsore make sure you throw your lipbalms and toothbrush away.
Unfortunately I still get coldsores occasionally, but only when I haven't used my lip balm and my lips have become dry.

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Esther23 said on 24 March 2014

I never had cold sores until after receiving chemotherapy -another possible side effect of chemo. I had facial shingles while on chemo. I've survived cancer 13 years now but with multiple health issues. The cold sores don't seem to have any particular trigger save maybe tiredness or stress. I've never bothered with the doctor. I just use neat tea tree oil. It has to be a good quality oil.

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GemL81 said on 22 September 2013

Having suffered from cold sores every month for years i've finally found what works for me. I take a lysine supplement every morning and evening and have looked at my diet - eating foods rich in lysine and low in arginine. I can't eat chocolate, nuts, oats anymore. I've not had one for 6 months now.

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LulaP said on 28 May 2012

I suffer from cold sores without fail every month, normally the week before I am due on my period. Sometimes the cold sore will only last a few days (if I've slept a lot, not stressed and been very healthy) but more than often two or three will come up, large and persistent. A few years ago I spoke to my doctor and tried a few different runs of tablets... he was only experimenting really... but that knocked it back for about 3 months, quite a relief and gave my mouth sometime to recover. Compeed patches are the best remedy I have found, no messy creams and not a chance of touching the sore, generally less pain and less scarring. Its affecting my relationship quite a lot as my boyfriend doesn't suffer from them - Should I take it back up with my doctor, or is there not a place for cold sores on the NHS research budget?

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Cold sore remedies said on 27 November 2011

Was my comment posted?

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ocr95y said on 13 September 2011

I have just recovered from a nasty bout of six or seven cold sores over my lips & the area between my nose & upper lip. Regarding treatmnets, I do seem to have better results with the compeed-type patches than I do with creams. I've just purchased a battery operated gadget which i've heard good reviews about, mine was from Boots but there are other brands available, it's some sort of UV light treatment. It's not cheap (about £35) but it will be worth it if it works!

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a28de754 said on 21 July 2011

My partner has her entire lips and corners of mouth swollen and painful with the virus. It lasts 3 months then comes back again a month later. She is extremely depressed about this. Any advice?

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EH7 said on 19 July 2011

So are there other treatments for cold sores, or are the 'over the counter' creams it...? What if they bearly help and the cold sore comes out anyway...?

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Cold sore advice

  • drink plenty of fluids to avoid dehydration
  • avoid acidic or salty foods and eat cool, soft foods
  • if brushing your teeth is painful, use an antiseptic mouthwash
  • dab creams onto sores rather than rubbing it in
  • wash your hands using soap and water before and after applying cold sore creams
  • avoid touching your cold sores, other than to apply cream, and don't share your cold sore cream with others

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