John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442

Herpes Simplex Infections (Cold Sores and Fever Blisters)

Patient Information Sheet

Fever blisters and cold sores are manifested by a sudden appearance of clusters of small water blisters on the skin, lips, genitals, or other areas. They may become very sore and ooze watery or pusy material. Generally they will heal up on their own without treatment in ten to fourteen days. The healing time varies with the size and severity of the fever blister. It also varies from person to person. A virus that infects the skin causes fever blisters. It is called Herpes Simplex virus. There is no known cure for herpes simplex virus infections. Fortunately, there are some medicines like Valtrex that have helped patients with this problem. It should be possible to control it.

There is considerable controversy in the medical community about herpes simplex virus infections. Some doctors suspect that herpes simplex virus infections make people more prone to getting skin cancer in the infected areas. The major areas of risk are the lips and the cervix. However, because of these suspicions, some doctors feel herpes simplex infections should be treated aggressively. Some doctors do not agree with that. The herpes simplex virus is one of a classification group of viruses, some of which have been shown to be cancer associated.

Type 1 herpes is traditionally though of as above the waist, meaning lips. Type 2 is associated with below the waist, meaning genital herpes. Actually, either type can occur in either location. This is probably due to changes in sexual practice.

There has been an increase of herpes simplex infections in the genital area. We do not know how many cases there are, but the Communicable Disease Center in Atlanta, Georgia estimates that there were 25 million cases in 1981 in the USA. By 1995, 26% of Americans were infected with herpes.

When herpes simplex infection occurs on the penis or vulva, it is called Herpes Progenitalis. Herpes progenitalis is a painful embarrassing problem. It is not serious in the sense of venereal diseases such as syphilis and gonorrhea, but it is a problem. Personally, I think too much is made of herpes by the various news media. If you listen to TV reporters enough, you would think herpes is worse than leprosy. That simply is not true. I have treated hundreds of cases of herpes progenitalis. Of those, only two people have had a lot of trouble with frequent recurrences, and now they are much better. I do not think people should develop an emotional complex about herpes. Instead, they should get it treated. Herpes simplex is not a hopeless condition. There is a lot that can be done for it.

The sores of herpes cause breaks in the skin through which other germs like HIV, AID, and syphilis can enter. While the herpes itself is not dangerous, it makes people vulnerable to diseases that are potentially life threatening.

There is one situation in which herpes progenitalis can be dangerous. If a woman has active herpes simplex lesions of the vagina or vulva at the time of delivering her baby, the baby may get infected and have some very serious problems. Several articles report a high incidence of brain damage and death in newborns acquiring herpes. That may be true, but I have not had that experience in the few cases of newborn babies with herpes I have seen. Nevertheless, a woman with herpes or a past history of herpes must tell her doctor prior to the time of delivery. If herpes lesions are present, it may be necessary to deliver by cesarian section. I favor taking Valtrex at delivery for this situation.

There is a special situation that some doctors are no aware of. I usually see this as a cluster of vesicles on one side of the buttocks with pain radiating down the back of the leg. Sometimes the pain occurs without the vesicles. That makes it hard to diagnose. This is herpes simplex neuralgia. Valtrex works well. It is more common in women and sometimes is related to the menstrual cycle. That is, it recurs with menses.

Factors That May Induce the Appearance of Herpes Simplex Blisters

The virus seems to remain hidden in the skin between attacks. It may be attached to skin cell chromosomes. Various physical factors may cause it to separate from the host chromosomes and to start replicating and produce blisters on the skin. These blisters usually recur in the same spot. The fluid inside the tiny blisters contains thousands of virus particles which can spread to other areas or other people. Factors that can precipitate an attack are excessive exposure to sunlight and sunburns especially when water skiing, hiking, and snow skiing, and minor and severe skin injuries from abrasions and bruises. One of the most useful things you can do to prevent recurrences of herpes is to use a sunscreen such as Neutrogena Dry Touch SPF 1000. Some women have recurrences with their menstrual periods. Finally, emotional stress and exhaustion from working too hard seem to precipitate attacks in some people.

Infectivity

Herpes is contagious. You got it from someone else, and you can give it to someone else. More importantly, you can spread it to other parts of your own body. Do not rub your cold sore with your finger and then scratch your eye. Herpes is contagious during the blister stage and during the time the ulcers are healing. Sometimes virus can be recovered from the area even after the skin has healed and looks normal. No one has shown that you can catch herpes from the area after it has healed even though it may shed a small amount of virus. I believe the reason for this is that the amount of virus shed from the healed area is less than the minimal infectious dose. Many doctors think the herpes is contagious even when the skin is not broken out. I am skeptical of that.

Treatment

There is no cure. Zovirax, Valtrex, and Famvir are pills marketed for herpes. The best is Valtrex. The adult dose is one gram twice a day for 5 days. This stops the infection. Most of the time, it works well. Topical Zovirax ointment has helped some of my patients tremendously.

Because herpes simplex virus destroys cells in the superficial layer of skin, it leaves an opening for bacteria to invade. Generally, the herpes attack does not leave a scar. However, if secondary bacterial infection occurs, it can result in a scar. Bacterial infection, impetigo, can be recognized by pus or "honey crust." This is especially important on the face. Scars can usually be avoided in this situation by using antibiotics. If these conditions occur, it may be desirable to have Dr. Tkach treat you with antibiotic pills.

Conventional Non-Prescription Treatments

Conventional over-the-counter medicines are aimed mostly at drying up the lesions. Some useful things include:

  1. Apply a drop of calamine lotion to the herpes lesions every hour while you are awake. This may help the areas to dry up after four or five days.
  2. Tea bags may be applied by soaking in water (not hot) and placing between the lips of the vulva for herpes simplex of the vulva. This provides pain relief. The tea bag should be left in place about 30 minutes and applied 3 or 4 times a day for 2 days.

Conventional Prescription Medicine

Acyclovir (Zovirax) can be purchased in any drug store by prescription from Dr. Tkach. Virus infected cells produce a viral enzyme (viral thymidine kinase) that converts acyclovir into an active triphosphate form. Activated acyclovir (acyclovir triphosphate) blocks or inactivates viral DNA polymerase and stops reproduction of the virus. It tends to leave normal cells alone.

Acyclovir ointment should be applied to new herpes blisters as soon as you notice them. The first day you rub it in every hour while you are awake. The second and third days, you rub it in 4 or 6 times. Some doctors feel this drug should not be used except for emergencies involving severe life-threatening attacks because the virus may become resistant to the drug. I have looked into this and corresponded with the medical director of the drug company. I think the risk of this is very low, and I favor using the medicine. My experience with acyclovir is that it is helpful. In my experience, there is a better treatment.

The information provided in these patient information sheets is offered for general informational and educational purposes only; it is not offered as and does not constitute medical advice. In no way are any of the materials presented meant to be a substitute for professional medical care or attention by a qualified practitioner, nor should they be construed as such.

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