Talk:Cold sore

Weak evidence for effectiveness of Acyclovir cream
"It has been claimed that the evidence for the effectiveness of topically applied cream for recurrent labial outbreaks is weak." – The comment letter at the origin of that claim dates from 1996. However, in the meantime there have been other large double-blind trials which have demonstrated the effectiveness of local Acyclovir cream application with high statistical significance (e.g. http://www.ncbi.nlm.nih.gov/pubmed/12069980). Since this article is not the place to discuss clinical studies, and the source of the ineffectiveness claim is "only" a comment, rather than a study, I will remove the claim and its source (instead of adding this conclusive counter-argument to the article). If someone wants to re-instate the claim, please provide a clinical study as the source, not the (inaccessible) BMJ comment. --77.188.62.124 (talk) (talk) 21:21, 7 April 2010 (UTC)

I have several questions not covered by the articles
1-From reading the articles several of them, I understand that Herpes is permanent, and that it is very contagious and that many people have it. 2-What happens if one partner in a relationship has it in the lips and the other inside the mouth? Will each one contaminate the other,or will the worst of the two affect the other person? Or can it not be transmitted if a person already has it from a partner that also has it, are they simply already contaminated and cannot further be more infected? 3-How to emotionally deal with this issue? I met someone I like very much but she has Herpes of the lips, I am very scared now to "get close" and be infected???!! I feel now I must abandon the relationship and will I walk into another case???? since it is not so obvious!(latent)I am very saddened by all this. It is very sad to walk around with this disease in the lips! It is so obvious and spreadable to love ones such as children! 4-Where and how soon will I see the responses to these questions and remarks? 5-Yes many of the articles are too technical although I understand them. I had to read them 2-3 times to do so. I want to be educated not confused! 6-If anything, I am just contributing questions, not medical information. 7-Of all the things I liked the most was the comment that Aloe Vera is very helpful and that Herpes causes nausea, headaches and fever, my partner expeienced this now we know why, and also how it is contracted. 8-The articles seem to go around and around in circles not getting to the point and too many links, but it's ok. It helps, more information.

Sincerely, Thank you — Preceding unsigned comment added by 99.112.88.210 (talk) 13:12, 17 August 2011 (UTC)

Are we certain that "herpes labialis" is the only infection or condition that results in cold sores as symptoms?
Or rather it's not whether "we" are sure, it's whether recent medical literature is unanimous in saying so. That's a responsibility of those who put this article in its current form.76.218.104.120 (talk) 05:10, 2 July 2013 (UTC)
 * "Cold sore" is not a technical term but I think it is synonymous with a lesion caused by herpes simplex on the lips. If you mean, can other things cause sores on the lips, then yes of course (same as there are many things which could cause a sore on the skin) but less commonly, and I personally don't think these would be called cold sores. Lesion  ( talk ) 01:39, 17 July 2013 (UTC)
 * Cold sores are NORMAL, and NOT FROM HERPES. You people have HIJACKED the term from an unrelated condition that has nothing to do with sex, and that isn't a life-long ailment, and which is a common winter issue, like getting the flu, except it's mostly just embarrassing and a turn off instead of all that bothersome because it looks bad. What the actual cold sore one is called, though, I don't know. Did you actually think all the cold sore medicines of the past numerous decades were for herpes, even among virgins, and people who are loyal to their spouses, and even in kids, and while these products are just lip balm type products? Whatever the scientific names is, cold sores are not herpes. They are very temporary, and only reoccur if you get exposed to it again. Whatever it is goes around in winter. It's blister-things are VERY different from herpes ones. And, it can't be spread to have more blisters, it's almost ALWAYS just one blister-thing around the mouth, which is BY the lips, not ON them. And, it's not an STD. A cold sore is usually located around one of the corners of the lips, not touching the lips. You only ever have one, at most two. How they are gotten, I don't know, but it must be from something of a contagious sort, despite it rarely spreads in one person, let alone gets passed from one person to another, yet it does do so enough that it sticks around in a population. I think I remember stuff about cold sores years ago saying they're not really sure what it is either, but I'm not sure. It's been a long time since I've looked it up. And, you people have the internet getting spammed with this lie that cold sores are an STD herpes virus, trying to make it out as more normal, and more shameless than it is. --174.19.181.117 (talk) 03:17, 15 October 2014 (UTC)
 * Are you thinking of an apthous ulcer? Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:04, 15 October 2014 (UTC)


 * Apthous ulcers tend to occur inside the oral cavity rather than externally on the lips so I doubt it. I would think that the vast majority of people use the informal term "cold sores" to refer to herpes labialis, which by the way can be easily spread in other ways than sexual contact. Matthew Ferguson 57 (talk) 07:01, 2 November 2014 (UTC)

MEDRS sweep
Reflist sweeped per WP:MEDRS:


 * ^ Xu, Fujie; Fujie Xu, MD, PhD; Maya R. Sternberg, PhD; Benny J. Kottiri, PhD; Geraldine M. McQuillan, PhD; Francis K. Lee, PhD; Andre J. Nahmias, MD; Stuart M. Berman, MD, ScM; Lauri E. Markowitz, MD (2006-10-23). "Trends in Herpes Simplex Virus Type 1 and Type 2 Seroprevalence in the United States". JAMA (AMA) 296 (8): 964–73. primary source ✅
 * http://www.herpesguide.ca/articles/facts_cold_sores.html unreliable medical source -- unreferenced, advertising. Should be using sources published in peer review journals... ✅
 * http://www.pslgroup.com/ Just advertising? Linked to a page of videos ... unreliable medical source ✅
 * http://www.uhs.wisc.edu/display_story.jsp?id=674&cat_id=38 deadlink ✅
 * ^ Emmert, DH (2000 Mar 15). "Treatment of common cutaneous herpes simplex virus infections.". American family physician 61 (6): 1697–706, 1708. . MEDDATE- 13 year old source ❌
 * ^ Glick M.,Siegel M. A. (1999). "Viral and fungal infections of the oral cavity in immunocompetent patients". Infectious disease clinics of North America 13 (4): 817–831. . case report + MEDDATE ✅
 * ^ Raborn GW, Chan KS, Grace M (January 2004). "Treatment modalities and medication recommended by health care professionals for treating recurrent herpes labialis". J Am Dent Assoc 135 (1): 48–54. . primary source + borderline MEDDATE ✅
 * ^ Gilbert, S. C. (2007). "Management and prevention of recurrent herpes labialis in immunocompetent patients". Herpes : the journal of the IHMF 14 (3): 56–61. . Borderline MEDDATE ❌
 * http://harvardpartnersinternational.staywellsolutionsonline.com/HealthNewsLetters/69,W0307e Unsuitable medical source ✅ Lesion  ( talk ) 00:36, 2 September 2013 (UTC)

Latency
"... lies dormant in the facial nerve ... " I thought it was the trigeminal? Lesion ( talk ) 03:23, 2 September 2013 (UTC)

annually. The frequency and severity of outbreaks generally decreases over time.

Definitions
In medical contexts, "labia" is a general term for "lip"; "herpes labialis" does not refer to the labia of the genitals, though the etymology is the same. When the viral infection affects both face and mouth, the broader term "orofacial herpes" is used to describe the condition, whereas the term "herpetic stomatitis" is used to specifically describe infection of the mouth; "stomatitis" is derived from the Greek word stoma that means "mouth".

EDIT REQUEST:SECTION Signs and symptoms
Please add this edit. . . . . . . . . . . . . . . . . . Recurrent oral infection is more common with HSV-1 infections than with HSV-2. Symptoms typically progress in a series of eight stages (see viral life cycle) :
 * 1) Latent (weeks to months incident-free): The remission period; After initial infection, the viruses move to sensory nerve ganglia (Trigeminal ganglion), where they reside as lifelong, latent viruses.  Asymptomatic shedding of contagious virus particles can occur during this stage.
 * 2) Prodromal Phase(day 0–1): Symptoms often precede a recurrence. Symptoms typically begin with tingling (itching) and reddening of the skin around the infected site.  This stage can last from a few days to a few hours preceding the physical manifestation of an infection and is the best time to start treatment.
 * 3) Macule Phase: Inflammation (day 1): Virus begins reproducing and infecting cells at the end of the nerve.  The healthy cells react to the invasion with swelling and redness displayed as symptoms of infection.
 * 4) Papule Phase: Pre-sore (day 2–3): This stage is defined by the appearance of tiny, hard, inflamed papules and vesicles that may itch and are painfully sensitive to touch. In time, these fluid-filled blisters form a cluster on the lip (labial) tissue, the area between the lip and skin (vermilion border), and can occur on the nose, chin, and cheeks.
 * 5) Vesicle Phase: Open lesion (day 4): This is the most painful and contagious of the stages. All the tiny vesicles break open and merge to create one big, open, weeping ulcer. Fluids are slowly discharged from blood vessels and inflamed tissue.  This watery discharge is teeming with active viral particles and is highly contagious. Depending on the severity, one may develop a fever and swollen lymph glands under the jaw.
 * 6) Postule Phase: Crusting (day 5–8): A honey/golden crust starts to form from the syrupy exudate. This yellowish or brown crust or scab is not made of active virus but from blood serum containing useful proteins such as immunoglobulins.  This appears as the healing process begins. The sore is still painful at this stage, but, more painful, however, is the constant cracking of the scab as one moves or stretches their lips, as in smiling or eating.  Virus-filled fluid will still ooze out of the sore through any cracks.
 * 7) Crust Phase: Healing (day 9–14): The area dries out and a reddish brown scab forms. New skin begins to form underneath the scab as the virus retreats into latency. A series of scabs will form over the sore (called Meier Complex), each one smaller than the last.  During this phase irritation, itching, and some pain are common.
 * 8) Scabbing Phase: Post-scab (12–14 days): A reddish area may linger at the site of viral infection as the destroyed cells are regenerated. Virus shedding can still occur during this stage. The scab falls off and pain disappears; there may be some residual swelling or dry flaking.

Thank You. 69.143.113.189 (talk) 18:15, 29 January 2014 (UTC)
 * This is not a suitable reference . Please read WP:MEDRS regarding sourcing requirements. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 02:29, 30 January 2014 (UTC)

Semi-protected edit request on 5 March 2014
Remove incomplete sentence.(100 million ...) The lifetime prevalence in the United States of America is estimated at 20-45% of the adult population. 100 million episodes Lifetime prevalence in France was reported by one study as 32.4% in males and 42.1% in females.

DougMartin.toronto (talk) 19:23, 5 March 2014 (UTC)
 * Yes check.svg Done — &#123;&#123;U&#124;Technical 13&#125;&#125; (t • e • c) 19:52, 5 March 2014 (UTC)

HSV-1 Rates in US/World
Article mentions lifetime prevalence of HSV-1 in the US is estimated to be 20-45% of adult population. However, the Epidemiology of herpes simplex article states: "HSV-1 affected 57.7% of Americans tested in a 1999–2004 study." I suggest going with the 57.7% figure. Further, this study appears to show world seropositive rate of HSV-1 in 15+ year olds to be 72.9%. 2605:A000:1107:8067:44B5:B425:AC7F:403D (talk) 08:57, 9 March 2014 (UTC)

Technical tag unwarranted?
I find the article reasonably understandable, while stumbling over the technical jargon and wading through the elaborate detail of section Signs and Symptoms, and I don't have any specific medical knowledge of the condition. I propose replacing the current tag with two: 'Overly Detailed' for the named section, and 'Jargon' for the article. There's already an edit request above on the talk page for section Signs and Symptoms, though it doesn't specify what the edit(s) are supposed to be. It obviously has attracted attention, and probably for the same reason as mine.Sbalfour (talk) 18:53, 12 November 2014 (UTC)

Semi-protected edit request on 12 May 2015
Cold sore treatment research has recently been testing new methods of eliminating cold sores using non-medicated options. Applications of heat or cold to a focused area have shown to have some results on the growth of a cold sore. Thermal therapy, which uses concentrated heat, is used to activate heat shock proteins that can make the bacteria self-destruct, without burning or scarring tissue. Applying an ice cube to an infected area has also proved to provide relief for some cold sore patients.

ControlExpert51 (talk) 15:53, 12 May 2015 (UTC)
 * Red question icon with gradient background.svg Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format. --I am  k6ka  Talk to me!   See what I have done  16:59, 12 May 2015 (UTC)
 * Also please note that sources used to build such content need to meet WP:MEDRS, I.e. review articles, or systematic reviews/meta analyses or textbooks. Thanks. Matthew Ferguson (talk) 17:11, 12 May 2015 (UTC)

Lysine effectiveness.
I just added a review of multiple studies that indicated that Lysine is effective for reducing frequency of outbreaks. User:Doc James |replaced it straight away with another review study claiming no effect. However, the study that I referenced reviewed 7 trials, and Doc James' study only reviewed one study related to Lysine (and a study with noted low evidence at that). On the other hand, my reference was a lot older, and I'm not familiar with either of the journals. Another thing to note is that Doc James' reference has one conflict of interest noted: "Oliver Chosidow, who refereed this protocol, has acted as a consultant for BioAlliance Pharma, a company developing a long-acting aciclovir formulation in the management of episodic therapy of cold sores." I think the best way to deal with this would be to leave in both references, but I'm not sure. --naught101 (talk) 22:03, 26 January 2016 (UTC)
 * The 2001 review is a little old. The 2015 review of course is much newer. Both journals are good. Per WP:MEDDATE we should go with sources from the last 3 to 5 years (sometimes we use older source but only if newer ones are not available). Doc James  (talk · contribs · email) 02:52, 27 January 2016 (UTC)
 * Ok, but the point remains that the older study actually addresses a lot more evidence related to Lysine - in the newer study Lysine appears to be a tangential consideration. --naught101 (talk) 03:17, 1 February 2016 (UTC)
 * The reviews used different cutoffs for what was sufficiently reliable to include. Basically the better quality evidence does not show benefit. Doc James  (talk · contribs · email) 09:56, 1 February 2016 (UTC)


 * Huh.. Reading through that "Characteristics of included studies" table in Chi et al (2015) seem pretty damning of one paper or the other. Either Tomblin and Lucas (2001, TL01) wilfully ignored some serious problems with the studies they included; or Chi et al. are overstating those problems (also odd that they included the only study with negative results listed in TL15, even though they list the quality of evidence as "Very low"). Interesting that the largest study in TL15 (Griffith et al. "Success of L-lysine therapy in frequently recurrent herpes simplex infection." Dermatology 175.4 (1987): 183-190.), which showed strong positive results, was not included in Chi et al, nor explicitly excluded. Something seems off to me, but like I said, it's not my area, so I will leave it up to others to decide. naught101 (talk) 06:55, 25 February 2016 (UTC)

Edit request
The link psychological stress needs a closing bracket (]]). 221.205.230.87 (talk) 08:20, 4 June 2017 (UTC)
 * Thanks Doc James  (talk · contribs · email) 03:13, 5 June 2017 (UTC)

Facial nerve --> trigeminal ganglion
In the first section it says: "The rash usually heals within 10 days, but the virus remains dormant in the facial nerve.[1]" It's in the trigeminal ganglion. — Preceding unsigned comment added by Bgodo (talk • contribs) 20:47, 15 December 2018 (UTC)
 * ✅ — Preceding unsigned comment added by Morgan Ginsberg (talk • contribs) 04:48, 18 December 2018 (UTC)

Semi-protected edit request on 17 December 2019
I would suggest to change some of the language used, as it is not neutral/medical, but rather opinionated.

Change:
 * 1) Open lesion (day 4): This is the most painful and contagious of the stages. All the tiny vesicles break open and merge to create one big, open, weeping ulcer. Fluids are slowly discharged from blood vessels and inflamed tissue. This watery discharge is teeming with active viral particles and is highly contagious. Depending on the severity, one may develop a fever and swollen lymph glands under the jaw.[13]
 * 2) Crusting (day 5–8): A honey/golden crust starts to form from the syrupy exudate. This yellowish or brown crust or scab is not made of active virus but from blood serum containing useful proteins such as immunoglobulins. This appears as the healing process begins. The sore is still painful at this stage, but, more painful, however, is the constant cracking of the scab as one moves or stretches their lips, as in smiling or eating. Virus-filled fluid will still ooze out of the sore through any cracks.
 * 3) Healing (day 9–14): New skin begins to form underneath the scab as the virus retreats into latency. A series of scabs will form over the sore (called Meier Complex), each one smaller than the last. During this phase irritation, itching, and some pain are common.
 * 4) Post-scab (12–14 days): A reddish area may linger at the site of viral infection as the destroyed cells are regenerated. Virus shedding can still occur during this stage.

Into:
 * 1) Open lesion (day 4): This is the most painful and contagious of the stages. All the tiny vesicles break open and an ulcer forms. Fluids are discharged from blood vessels and inflamed tissue. This watery discharge contains active viral particles and is highly contagious. Depending on the severity, one may develop a fever and swollen lymph glands under the jaw.[13]
 * 2) Crusting (day 5–8): A honey/golden crust starts to form on the ulcer. This yellowish crust or scab is not made of active virus but from blood serum containing useful proteins such as immunoglobulins. This appears as the healing process begins. The sore is still painful at this stage. More painful, however, is the cracking of the scab as one moves or stretches their lips. Fluid from the sore will still be contagious.
 * 3) Healing (day 9–14): New skin begins to form underneath the scab as the virus retreats into latency. A series of scabs will form over the sore (called Meier Complex), each one smaller than the last. During this phase irritation, itching, and some pain are common.
 * 4) Post-scab (12–14 days): A reddish area may linger at the site of viral infection as the destroyed cells are regenerated. Virus shedding can still occur during this stage. Siemmsiem (talk) 23:22, 17 December 2019 (UTC)
 * Red information icon with gradient background.svg Not done for now: please establish a consensus for this alteration before using the template. Eggishorn (talk) (contrib) 21:55, 30 December 2019 (UTC)

Spirulina-based treatments
Might be worth it to mention studies that show that spirulina extract is effective against HSV-1, and its effect may be stronger than that of acyclovir: e.g. 1, 2. At least in Germany, there's a number of spirulina-based topical solutions currently available over-the-counter as an alternative to antivirals. — Preceding unsigned comment added by 2A02:8108:45BF:C000:55DE:4508:F018:200A (talk) 17:04, 5 November 2021 (UTC)

Wiki Education assignment: UCSF SOM Inquiry In Action-- Wikipedia Editing 2022
— Assignment last updated by Sfmedstudent (talk) 21:00, 16 September 2022 (UTC)


 * Great job so far JMOclaman. In the section Supplements and Nutrition, I would personally stay away from using direct quotations because that can sometimes make sentences harder to read through. However, that is more of a personal style preference. In the same section, I would also note there are two sequential sentences that both begin with "Further." I would change one of the sentences to better the flow of the section. With the section Treatment, I would change the phrasing of "a human body's immune system" to either "a human's immune system" or "the human body's immune system." Sfmedstudent (talk) 23:10, 16 September 2022 (UTC)

Requested move 16 March 2023

 * The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: moved. (closed by non-admin page mover)  The Night Watch     (talk)   01:54, 23 March 2023 (UTC)

Herpes labialis → Cold sore – Per WP:COMMONNAME, this is the much more common term for this topic according to the Google Ngrams. Same situation as having the article title be Shingles and not "Herpes zoster". Rreagan007 (talk) 01:36, 16 March 2023 (UTC) The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.
 * Support per nom. 〜 Festucalex • talk • contribs 05:51, 16 March 2023 (UTC)
 * Support as the WP:COMMONNAME. ModernDayTrilobite (talk • contribs) 16:32, 17 March 2023 (UTC)
 * Support per WP:COMMONNAME. ᴢxᴄᴠʙɴᴍ (ᴛ) 04:47, 22 March 2023 (UTC)
 * Support per nom. -- Necrothesp (talk) 14:17, 22 March 2023 (UTC)