Cold sores (self-care)

Question 1

Causative organism of cold sores?

Answer 1

Herpes Simplex Virus (HSV)

Question 2

Modes of transmission of cold sores?

Answer 2

Close contact via inoculation of virus into susceptible mucous membrane

(Oropharynx, cervix, conjunctiva)

Question 3

Risk factors for cold sores?

Answer 3

1. Age: between 6mo - 3y
2. Immunocompromised patients
3. Pregnancy
4. Behavioural factors (close contact)

Question 4

Typical symptoms of cold sores

Answer 4

• Painful blisters or ulcer on the lips
• Swollen red gums
• White coating on tongue
• Swollen neck glands
• Fever
• Muscle aches

Question 5

Exclusion criteria from self-treatment of cold sores?

Answer 5

1. Lesions > 14d
2. Excessively red, swollen or purulent lesions
3. Lesions occur > 6x in a year
4. Signs of systemic illness
5. Immunocompromised
6. < 12y age

(4 and 5 are sort of exclusion criteria for nearly everything in self-care? ><)

Question 6

The topical preparation used to treat cold sores. State its dosing regimen, treatment duration, forensic classification and maximum supply if applicable

Answer 6

Acyclovir 5% cream five times a day for 5-10d, spacing each application at least 4h apart
- Only apply to lips and face
- Forensic classification: POM with exemption
- Maximum supply: as a preparation of ≤5% cream, less than 2g

Question 7

State the names and the dosing regimens of the oral antiviral agents for cold sores

Answer 7

1. Acyclovir 200 mg 5x a day for 7-10d
2. Valacyclovir 2g BD for 1d, started at earliest onset of symptoms

Question 8

Counselling points for acyclovir cream?

Answer 8

• Wash hands thoroughly before and after applying cream
• Use glove/finger cot when applying to prevent spread of infection. Dab cream instead of rubbing
• Do not occlude cold sores after applications
• Not for genital herpes
• See doctor if lesions get worse, or did not improve despite self-care

Question 9

Non-pharmacological advice for management of cold sores?

Answer 9

• Don’t pick/touch cold sores
• Use sunscreen lip balm SPF≥15 when in bright sunlight to prevent cold sores
• Avoid sharing personal equipments with others
• Maintain strong immune system (e.g. vitamin C, regular exercise)
• If using contact lens, handle with care to prevent contamination of contact lens and hence spread of cold sores

Question 10

Options to manage pain in cold sores?

Answer 10

Paracetamol and NSAIDs