Cold Sore that seems to keep bothering me

[Gerry2416]

Doctor,

I have posted about this but haven't gotten a straight answer and even my doctor hasn't been able to give me a knowledgeable answer. I had my first cold sore outbreak on my lip about 1.5 months ago. I took Valtrex the day I had the outbreak and it immediately provided relief and eventually the sore crusted over and healed in about 7 days but left a small scar on my lip. Two weeks later, my lip started to pulsate in the general area, not really tingle but a definite inflamed feeling. So, preemptively, I took the Valtrex. The next day the feeling had subsided and nothing ever developed but since then, I noticed white bumps (which I have had on my bottom lip for some time) had developed on my top lip right under my scar. These turned out to be bothering me and sending tingling and a weird feeling all around my lip and my scar. This has persisted for the last few weeks. I have been using various lip balms and abreva including Blistex medicated which helped very much but as soon as I start to bother my lip, it starts to bother me and I need to apply something to it to stop. Oddly enough today I had a visit with my doctor and he stated that it could very well all be related to the HSV 1 virus. My scar also has started to give me sensation today as I was exposed to sun all day off and on. I used the blistex and and abreva later and it has calmed down. My questions are: Is this going to be an ongoing issue for me? Will I always need to apply abreva or blistex? And do I need to avoid the sun going forward? Can the virus constantly exist on the surface of my lip as it feels like this isn't going away. Even today, when I run my tongue under my top lip, I can feel the scar bother me. Any insight?

[Terri Warren, RN, Adult Nurse Practitioner]

Yes, cold sores ARE caused by HSV 1.  Sun is a known trigger for cold sores, the only one trigger actually proven to be a defined trigger for outbreaks.  It is unusual however, for a cold sore to leave a scar.  The white dots you see have likely always been there but you are looking far more closely than you have in the past.  Ask someone you know if you can look at the inside of their upper lip and when you roll up the lip, you will see white dots on the inner upper lip surface.  They could be something called Fordyce spots, a dermatologist could answer the question about your specific dots, however.  

When someone has new oral herpes infection, sometimes the virus is very active for several months until the immune system has a chance to start to get a better handle on keeping the virus quieter.  You may wish to talk to your doctor about taking Valtrex daily for a while, perhaps six months.  I would also suggest that you use a lip balm with sunscreen daily to avoid the effects of the sun on your lips.  

Is that helpful?

Terri

[Terri Warren, RN, Adult Nurse Practitioner]

The chances of transmitting this to your 5 year old is very close to zero if you do not have a cold sore.  The way that you would kiss a child is not the same way you would kiss a partner, for example.  Though people can give off virus when they have no symptoms, they do that through thin skin, like genital skin or more on the inside of the mouth or lips.  Honestly, I don't think you need to worry about that.  

I disagree with your doctor.  He is talking about resistance, which we have not seen with the herpes medicines.  The normal daily dose is 500 mg once a day.  I personally never use Abreva.  The benefits in clinical trials (and we did them) is not substantial enough for me to recommend this product.  

I would say it is normal to have symptoms for a while with first infection.

Terri

[Gerry2416]

Thanks for your response Terri. I know I had HSV 1  from a test a few months ago but the numbers were very low and I had no symptoms. Its not clear how long I had exposure but my wife had gotten them for years.. But this was my first occurrence. Does this still count as a NEW infection? If in fact the virus is still active, which I can assume it is since the sensation is right on the spot, am I contagious. I have a 5 year old who likes to climb all over me and I am deathly afraid of infecting them. I asked my doctor about taking the Valtrex again and he was against it as it should only be used when I have the intense tingling sensation, otherwise the virus will learn to fight it. This is why I am here as I don't know he is right about this one. What is the usual dosage of daily Valtrex? I am currently applying abreva and it stops the sensations but after a few hours, I can feel slight tingling again. can I just keep applying the abreva? Is it typical for the first occurrence to linger this long. Everyone keeps telling me this shouldn' be the case, including my doctor! Frustrated.