John Tiong Jeh Lung
MPharm, PhD, RPh
Cold sores are contagious fluid-filled painful blisters caused by either herpes simplex virus (HSV) type 1 or type 2, with the formal being the more common cause of this infection. HSV type 2, on the other hand, is known to be the cause of the disease, genital herpes.
Cold sores usually appear around your lips, although it can be found on other parts of the body including on the gums, nose, cheeks, and hands. Once infected, an individual generally carries the virus for life. The virus will stay dormant in the body and some individuals will experience recurrent infections throughout their lifetime.
Interestingly, cold sores tend to appear on the same spot where the virus infects the nerves underneath the skin resulting in itching, a tingling sensation and/or pain. Some individuals may also experience fever during the course of infection. Cold sores generally persist for 1 to 2 weeks.
The infection is spread through skin contact and cold sores are usually most contagious when the blisters rupture. Nonetheless, it is important to note that an individual with no visible blisters can still transmit the infection to others. Of greater concern is the fact that, these individuals could be any family members or friends who could be kissing your newborn as a sign of affection. After all, it is sometimes difficult to contain their excitement at the sight of the cute little bundle of joy. They probably do not know that their sincere intimate contact could cause potentially detrimental health consequences to the newborn.
This seemingly harmless but bothersome infection in healthy adults can cause serious complications to neonates (infants of less than four weeks old) whose immune systems are still under-developed. These may range from lesions on the eyes, mouth and other skin areas to life-threatening conditions where the virus spreads to lungs, liver, adrenal glands, skin, eyes, and the brain resulting in organ damage, long-term developmental disabilities and even death.
Although the prevalence of such incidents varies from country to country, such cases have been properly documented in medical research and of late, are frequently reported by the media. The introduction of useful antiviral drugs has successfully improved the management of such disease in neonates, although awareness must still be raised among parents.
The following would be some useful advice for parents:
- You should not kiss your newborn if you have cold sores.
- Practise proper hygiene by washing your hands (particularly if you have touched your own cold sores) and cover up any cold sores before touching your newborn such as during breast-feeding.
- Respectfully decline the intimate gesture by others on your newborn if you are uncertain of the health status of the individual.
Immediately bring your newborn to see a doctor if you suspect any potential contact with the virus. An infected newborn may show the following symptoms:
- High fever
- Lack of energy and always sleepy
- Stop feeding
- High-pitched cry
- Breathing rapidly or with difficulties or with short, deep, hoarse sounds during exhalation
- Skin rash
- Blue tongue and skin
Cold sores are generally self-limiting in adults although it can be managed using oral anti-viral agents such as acyclovir, valacyclovir and famciclovir. Acyclovir and penciclovir creams can also be used. Docosanol cream, on the other hand, can shorten the duration of symptoms, while anaesthetic creams such as lidocaine and tetracaine are useful to soothe the pain and itch caused by cold sores.
It is worth noting that, these medications do not have any effect on the latent virus and there is generally no cure for cold sores. They also do not prevent transmission of cold sores, hence proper precautions are still required when you are near newborns.
Kimberlin, DW. (2004). Neonatal Herpes Simplex Infection. Clin Microbiol Rev 17(1): 1-13.
Thompson, C. & Whitley, R. (2011). Neonatal Herpes Simplex Virus Infections: Where Are We Now? Adv Exp Med Biol 697: 221-230.