Elephant

If you follow me on twitter, you might have seen my comment a few weeks ago, about me feeling like the biker in the Zovirax advert.

I had a cold sore; I wanted to put a crash helmet on, and hide in it until the thing had gone.

Cover that cold sore!

It was the first time I’ve had a proper outbreak, and I hated it. Previously, I’d had tingles, and then they’d gone away after a few hours, but this felt like it was a monstrous carbuncle.

Feeling rubbish

Cold sores make you feel like you have a huge abscess on your lip; and you feel run down and lethargic.

I smothered my lip in Zovirax (aciclovir) cream, then bought Compeed patches from Boots; and I also spoke to my doctor and got some aciclovir tablets, which, he told me, are more effective than the creams.

A few weeks later, as part of my voluntary work for THT, we had a talk from a nice lady from the Herpes Viruses Association (HVA). Cold sores are the result of the herpes simplex virus, which is a virus that the majority of people carry – many without ever being affected by symptoms.

What she told us

70% of people in the UK have facial herpes (cold sores) and 10% have genital herpes. These figures are even higher in other countries including the USA and the developing world. Of those:

• ¼ of them will have no symptoms at all;
• ½ of them will have only mild symptoms and are unlikely to ever want to treat it or have it diagnosed;
• And only ¼ of them will have more noticeable symptoms and will actually be diagnosed.

Hide and seek

The virus actually lives, mostly quietly, in the nearest nerve ganglia to where it is caught, and not in the skin where you get the cold sore. For the face, there are trigeminal ganglia near each ear. For the rest of the body, the ganglia sit beside the spine. The lowest one – the sacral ganglion – is at the base of the spine, and this is where dormant genital infections go.

But it can’t travel up or down between nerve ganglia; It can only access the area of skin that is covered by that particular ganglion, known as a dermatome. This chart shows the areas of skin covered by each dermatome.

As you can see, the face is one dermatome; a lot of the buttocks is the same dermatome as the genitalia. So if the virus lives in the dermatome that covers the face, then it could appear anywhere on the face – but usually prefers to return to the same spot each time, rather than moving around much. Similarly, although they appear to be a long way from each other, if you get a cold sore on your genitalia, you could get one on your buttocks – but again, it usually won’t bother with the travel.

Mythbusters

• It’s difficult to give to someone else: since the majority of people have it already, you can’t give it to them again;
• You can’t give a cold sore to someone who’s ever had one before, even if you’re in the middle of an outbreak: because they already carry the virus, they can’t be reinfected, even on a different part of their body;
• It’s not spread by towels, cups or any other inanimate object: it dies very quickly once outside the body, so sharing objects shouldn’t cause concern;
• Aciclovir creams aren’t much good: tests (published in the Drugs & Therapeutics Bulletin) have shown that they’re no better than a placebo. (Aciclovir used to be spelled acyclovir.)
• It can’t be spread around the body: because your body has produced antibodies to the first attack, once you’re infected in one place, you can’t reinfect yourself somewhere else;
• You can’t spread it from your lip to your eye: it lives in your spine and come out every so often, but tends to pick the same spot each time; and the whole of your face is covered by the same bit of spine.

Two for the price of one

There are two herpes simplex viruses – HSV-1 and HSV-2. Most facial infections and about half of genital ones are HSV-1. Half of genital and a few facial infections are HSV-2. If you have either one, you are unlikely to get symptoms if you catch the other type – or symptoms will be pretty mild.

In the days when most children caught HSV-1 on the face before puberty, rates of diagnosed genital herpes were probably much lower – though we can’t be sure because no one bothered to keep any stats in those days.

Treatment

Tests have shown that it’s best to try to keep the cold sore from drying out and cracking – you can use a regular lip balm or Vaseline; or pharmacists sell cold sore patches, a circle of something resembling plastic, which covers the sore and helps to stop the tingling. Don’t buy the own brand ones – buy Compeed, because they’re thinner, and feel less like you’re sticking OHP sheet to your face.

You can also buy lidocaine in a tube, which is a local anaesthetic you can rub on the sore to numb it and prevent it tingling.

Finally, the Herpes Viruses Association recommends Lomabrit, a cream or lip salve which contains Melissa officinalis (lemon balm) and they say is very good at halting the progression of an outbreak. It helps to prevent herpes simplex virus from causing a sore because melissa contains molecules that block the receptor sites on skin cells and this stops the virus from getting in.

You can buy it direct from them.

Try a tablet

You might be able to get some aciclovir tablets from your doctor (they’re only available on prescription), which will reduce the length of an outbreak, but won’t stop it in its tracks like the HVA claims Lomabrit will.

Above all else, don’t worry about it. It won’t last much longer than a week; and just because it’s obvious to you, doesn’t mean it’s obvious to everyone else. If you keep getting cold sores, you can ask your doctor for a suppressant supply of aciclovir – which you need to take every day to keep them at bay.

Find out more

For more information, you could contact the Herpes Viruses Association. Because they were so helpful when I was writing this post, I’ve made a donation on their website. They have a helpline which is open 5 days a week on 0845 123 2305; and you can also get information from the NHS website.