Cold sores/Herpes simplex virus
Small, irritating and painful blisters often found around a person’s lips, eyes, nose or even hands are commonly referred to as a cold sore but are less known as HSV-1, meaning the herpes virus. They can also appear anywhere around the body and generally genital herpes (HSV-2) a different strand of the virus is often caused by sexual contact and symptoms are waist down.
HSV-1 is very common and highly contagious. Although some people may not have a visual symptom such as a blister, lump, scabbing, pus they may feel tingling and burning. Most will have it in their system and likely picked up from direct contact of someone having had one themselves. When someone is touched, kissed or has shared an item such as lip balm, cups etc the HSV-1 works its way through the skin and to the nerve cells. In some people it could be dormant but for others they may experience the unpleasant symptoms when they become run down, hormone changes, pregnancy, infections, stress, cold weather… Nobody actually knows exactly to why they react or flare up but it stays within the body and there is no permanent cure.
The virus can spread easily so its advised not to touch, squeeze or pick at it and if you have an active cold sore do not touch other parts of your own body either. They generally last 7- 10 days and heal by themselves. Good hand hygiene can help and there are over the counter products like antiviral creams or little films to cover the problematic area which can treat and protect from contamination. For those who suffer frequently they may be given oral suspension of antiviral medication daily to suppress it. You can also try to avoid triggers: firstly, take paracetamol/ibuprofen when it becomes painful, drink plenty of fluids, and use ice packs to try control the symptoms. Remember to dispose contaminated waste straight away and wash your hands often. Seek a GP or health visitor if the cold sore is not showing signs of healing. They can be extremely dangerous to infants, those with low immune systems, patients with cancer or HIV, people with skin complaints like eczema and pregnant women. They have caused severe eye damage in some people and have been known to be life threatening. In recent years the media have reported infant deaths caused by HSV-1.
Neonatal & Paediatric Herpes Simplex Virus (HSV1-2)
Some neonatal HSV infections occur if the mother passes on the infection during the vaginal birth. It can also be passed on by those with a cold sore and have contact with a baby or if the mother breast feeds her baby with the herpes cold sores on her breast. The cold sore is at its worse contagiously when they rupture. Herpes simplex can be extremely dangerous for a baby whose immune system is still undeveloped as they are unable to fight the virus in the first six weeks.
Sometimes neonatal herpes will generally affect the babies eyes, mouth and/or skin. Most babies dealt with efficiently by medical staff will recover well with admission for antiviral medicine but the condition can be very serious if it spreads to vital organs. Treated or untreated it can still lead to death.
Clinical features to raise concern:
- A Fever
- Abrupt onset of illness
- Inability to eat or drink/ stop feeding
- Gingivitis (bleeding and swollen gums)
- Increased drooling
- Being floppy
- Lacking energy
- High pitched cry
- Difficulty in breathing or grunting
- Rapid breathing
- Have a rash/blisters
- Have a blue tongue and skin
A newborn’s health can deteriorate very quickly if the virus spreads to their brain or other parts of their body. This can also develop into seizures.
If you are pregnant and have a history of HSV1 or HSV2 tell your midwife or doctor so they can advise you. They may advise you to take medication during pregnancy to prevent an outbreak of blisters before a vaginal birth or may decide on a caesarean section.
Do remember to advise anyone visiting you and baby to wash their hands before contact, not to kiss your baby, cover any cold sores and avoid touching your own cold sore especially if you are to breast feed.
Jasmine’s HSV1 story
My daughter was born in October 2014 via planned c section due to my previous multiples of abdominal surgery from having Ulcerative colitis. Jas was due to have her 6 week check within a few days and had developed what looked like severe conjunctivitis in her eye. Due to her age I took her to the GP who prescribed her some eye drops to help her fight the infection as she was still building up her immune system. The day she was to have her 6 week check with the health visitor and the GP she had developed a small spot under her eye. Her eye was red, still oozing and with this red dot now present we was eager to get her seen. The health visitor said to mention it to the GP but had no real concern. On taking her to the routine screening the doctor felt the need to send us to the local A&E. Within hours we was told that this was the cause of a cold sore and Jas had developed another couple of spots within hours. As the night went on she deteriorated very quickly. Bloods were taken and showed infection, she was immediately placed on IV fluids. We were sent to a London hospital due to a bed crisis in Essex and that night she was started on IV pain relief, IV antivirals, steroid drops, as well as topical eye creams to prevent further damage. I picked up a newspaper on the ward only to read that a ten-day old baby had died from HSV1, the very thing our daughter had just been diagnosed with. I was petrified. Our little soldier spent a week in hospital being treated and we prepared ourselves with as much knowledge as possible. We were told by the doctor in charge of her care that damage had occurred to the eye and we would need to use creams and drops for a long period of time to prevent further reoccurrence or more damage. Unfortunately, with her being so young we couldn’t tell if she was able to see properly as she was still developing but was told it had ‘practically eaten the outer layer of her eye’ causing pain, outer layer damage to the lens and some visual problems for her.
Jas improved, the spots crusted into blisters and we went home with weekly then monthly check ups. Only for it to return on her 1st birthday after a horrendous cold. Jas was admitted to hospital and once again we started the antivirals, creams and drops. Straight away the eye was red, watering, inflamed and with the blisters back. This time we had follow up eye appointments and was told to continue the eye treatment longer and daily.
Jasmine is now three and half years old and we have since had more admissions for her flare ups, we have been referred to a specialist eye hospital for eye treatment, eye patching and glasses. I take her twice annually for paediatric care in London for dermatology reviews and she is on lifelong twice daily anti-viral medication. Our daughter has lost vision in her eye and I can only describe it as blurred or cloudy vision. She wears glasses for her ‘good’ eye as she has over strained it. Jasmine copes very well with her condition and we have learnt her triggers such as when she catches a cold or becomes stressed. These are the things that can set her ‘nerves off‘ triggering a flare of cold sores around the mouth or eye again. Some of her symptoms can also be itching, tiredness, irritation, mood change and loss of appetite.
Since having our second daughter I have had cold sores myself (probably picked up from handling Jasmine) and managed to pass the protection to our daughter Pippa during pregnancy. She has had no symptoms luckily. The obstetrics team at hospital believe I may have not of had the HSV1 in my system before giving birth to Jasmine therefore meaning I couldn’t pass the protection on to our first born.
Written by Justine Gibbs