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Medical Author:

Mohamad El Mortada, MD

Medical Author:

MaryAnn Tran, MD

Medical Author:

Corrine Young, PharmD

Medical Author:

Mary Nettleman, MD, MS, MACP

Mary Nettleman, MD, MS, MACP

Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The very first time someone gets a cold sore (known as the "primary" attack), the symptoms can be severe. In some people, the first attack of herpes is associated with fever, swollen glands, bleeding gums, and many painful sore(s) around the mouth (gingivostomatitis) and nose. These signs and symptoms may last several days. The sores heal completely in two to six weeks, usually without scarring. Virus can be recovered from the saliva for days after the lesions heal. Because many people acquire the virus early in life, primary herpes usually happens during childhood. If the attack is severe, a doctor should be contacted. The doctor may prescribe medications that can shorten the attack. These medications are most effective if taken early in the attack. Difficulty in eating and drinking may lead to dehydration, which may also require medical attention.

Recurrent cold sores usually do not require medical care. A few people may have cold sores that come so frequently that a doctor will prescribe a daily medication to reduce the number of attacks. It is not possible to predict for how long the treatment should continue, because the virus continues to live in the ganglion. Thus, stopping suppressive treatment is largely a trial and error procedure.

People who have very weak immune systems from chemotherapy or other causes may have very severe outbreaks of cold sores. These look like the primary attacks described above. Medical care should be sought promptly to avoid complications.

Rarely, herpes simplex may infect the brain. People with this condition usually have fever and confusion. This infection requires hospitalization and intravenous antiviral medications.

In a few people, cold sores will be associated with painful skin lumps on the front of the legs known as "erythema nodosum." Erythema nodosum can be self-limited and usually goes away on its own in three to six weeks. If this happens, the person should be seen by a doctor to find out if prescription medications might make the condition go away faster.

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