As a pregnant person, your primary concern is keeping you and your baby healthy. This means it’s natural to have questions and concerns when faced with a cold sore during pregnancy.
This article contains answers to the queries you might have about managing cold sores during pregnancy.
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Cold sores, also known as fever blisters, are small, painful blisters that typically appear on or around the lips (where the colored portion of the lips meets the skin). They can also occur inside the cheeks.
Cold sores are caused by the herpes simplex viruses (HSV) — primarily, the herpes simplex virus type 1 (HSV-1).¹ This common virus spreads easily and causes cold sores when it reactivates.
The World Health Organization (WHO) estimated that close to 70% of people globally will get HSV-1 by the age of five.² However, recent data in the US demonstrates a decline in the prevalence of HSV-1. From 1988 to 1994, the prevalence was 62%. It was much lower between 2015 and 2016 at 47.5%.³
Cold sores are highly contagious. The virus can spread through direct skin contact or the use of shared items such as towels and bedding.
An HSV-1 infection starts with an acute phase. During this time, you won’t develop a cold sore. After the acute phase, the virus becomes dormant. It may cause cold sores upon reactivation.
Cold sores are most contagious when they are actively blistering or oozing fluid. They continue to be contagious until they disappear. However, it’s still possible for the virus to spread if you don’t have symptoms.⁴
If you suspect you have a cold sore, consult your doctor to get a proper diagnosis. They may examine the affected area and conduct tests such as a viral culture or polymerase chain reaction (PCR).
You might develop a cold sore because the HSV-1 in your body has reactivated. Stress, fatigue, and immunosuppression can trigger cold sore outbreaks in people who already have the virus.⁵ It can also be contracted through direct skin contact with an infected person.⁶
If you have never had a cold sore, you can still get the virus from an infected partner or anyone else you come into close contact with who has an active infection.
If you have the herpes simplex virus, you can take proactive measures to prevent a cold sore outbreak during pregnancy and reduce the risk of transmission.
Consider the following strategies:
Maintain a healthy lifestyle with proper nutrition, exercise, and sufficient rest.
Minimize stress and practice relaxation techniques.
Avoid triggers that may cause outbreaks, such as excessive sun exposure and stress.
Practice good hand hygiene and wash your hands frequently.
Use a lip balm with sunscreen to protect your lips from sun damage.
Inform your doctor about your herpes status for appropriate monitoring and guidance.
Managing cold sores during pregnancy involves a combination of self-care practices and medical guidance.
Your doctor may prescribe a course of antiviral medication, but its safety is not clearly established during the first trimester. Your doctor will decide on the best treatment for you.
You can try over-the-counter (OTC) treatments during an outbreak (such as creams and patches) if you have previously treated cold sores with these methods. However, be sure to speak to your doctor first.
Here are some additional tips to help manage cold sores effectively:
Keep the affected area clean and dry.
Apply OTC topical creams or ointments to relieve symptoms.
Avoid touching or picking at the cold sore to prevent further infection.
Wash your hands frequently to minimize the risk of spreading the virus.
Apply cold compresses to reduce pain and inflammation.
Consult with your doctor for guidance on antiviral medications.
If you have already been infected with HSV-1, the virus is dormant in your nervous tissues. In this case, your immune system and antibodies can keep it in check.
However, if the primary infection occurs during late pregnancy, there is typically not enough time to develop antibodies that stop the virus from replicating before you give birth. This increases the risk of vertical transmission (transmitting the virus to your baby). The risk is higher if you have associated genital lesions as well as cold sores.⁷
If your baby contracts the herpes simplex virus, it can lead to serious complications. Neonatal herpes, while rare, can cause central nervous system infections, respiratory issues, organ failure, and even death.⁸ However, it’s important to note that the risk of transmission predominantly affects people with genital lesions.⁹
The risk can be significantly reduced with proper management and medical support.
Symptoms of neonatal herpes may include the following:
The risks associated with neonatal herpes can be severe, leading to long-term health consequences and even death. Prompt medical attention is crucial if you suspect your baby may have been exposed to the herpes simplex virus.
To protect your newborn from getting HSV, follow these essential steps:
Inform your medical team of your herpes status during pregnancy and labor.
If you have an active genital outbreak during labor, your doctor may recommend a cesarean section (C-section) to reduce the risk of transmission.
Encourage family members and visitors to wash their hands thoroughly before touching the baby.
Avoid close contact between the baby and individuals with active cold sores or visible symptoms of infection.
Take precautions to avoid transmitting the virus to your baby if you have a cold sore outbreak while breastfeeding.
HSV is not transmitted through breast milk, but it can be transmitted through direct contact with a cold sore or herpes lesion.
You can continue breastfeeding as normal if you have HSV but don’t have active lesions on or near your breasts.¹⁰ If you have an active outbreak on the skin around your breast, stop breastfeeding until it clears.
Managing cold sores during pregnancy requires proactive measures, proper medical guidance, and vigilant hygiene practices.
By following recommended precautions, seeking timely medical care, and promoting awareness among family members and caregivers, you can reduce the risk of transmission and keep your baby safe.
Remember, your doctor is your best resource for personalized advice and support during pregnancy. Stay informed, stay proactive, and prioritize the health of you and your baby.
Herpes—Fast facts | American Sexual Health Association
Herpes simplex virus | World Health Organization
Herpes simplex virus | World Health Organization
Herpes Simplex Virus (HSV) Infections (2022) | MSD Manuals
Genital herpes in pregnancy (2018)
Herpes Simplex Virus (HSV) | Centers for Disease Control and Prevention