7 Questions About Cold Sores, Answered

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We at Bustle love giving you tips for how to tap into your sexual potential and troubleshoot when things aren’t going your way in the bedroom. But what about finding solutions to those stressful sexual health situations that inevitably crop up when you’re getting down? Emma Kaywin, a Brooklyn-based sexual health writer and activist, is here to calm your nerves and answer your questions. No gender, sexual orientation, or question is off limits, and all questions will remain anonymous. This week’s topic: how contagious oral herpes is and how to manage it .

Q: I have oral herpes — not genital. I haven't gotten a cold sore in a while because whenever I feel a tingle I take Valtrex, the medicine that fights herpes. I'm just concerned because it feels like every time I drink even a little or don't sleep a ton, I feel a tingle in the same spot. I take Valtrex and it goes away. Does this mean I'm allergic to alcohol or my immune system is weak? Should I be taking Valtrex every day? Is it possible for me to pass oral herpes to other people if the virus is dormant and I don't have an actual sore, just the tingle? Is there any risk to taking Valtrex every day/could I build a tolerance to it?

A: Oral herpes, also called cold sores, is pretty much a fact of life. Seriously, you may think you’re the only one dealing with the sores caused by the Herpes Simplex Virus (HSV), but actually nearly everyone will have HSV by the end of their lives. That's because it's very easy to transmit by skin contact or saliva.

But how do we live with this incurable virus? It’s actually pretty easy, medically speaking. The key is to pay attention to your body so you can keep both yourself and others healthy.

Can You Pass HSV To Someone Else Even If You Don’t Have A Cold Sore?

There’s a common misconception that you can only get herpes from someone if you have contact with them when they have a herpes blister. Recent research has actually found that the virus can be transmitted between blisterings, which makes sense for how people who never experience symptoms can be passing it along. So yes, you can transmit cold sores to someone else if you don’t have an active cold sore, even if you haven’t felt a tingle. Unfortunately, it is a risk.

Can You Get Genital Herpes From Oral Herpes?

You can also get genital herpes if you have oral herpes while there's a strain of the virus that is most likely to show up around your mouth (HSV-1), 40 percent of genital herpes cases are this strain (and not the classic genital strain, which is HSV-2). This is important for two reasons: First off, it means that if your sexual partner also has herpes (let's say they have it orally also) and they go down on you, you can get it genitally even though you already have it orally. It also means you can give it to yourself genitally if, for instance, you lick your fingers and then masturbate. This is called autoinoculation, and it's pretty rare but it does happen usually during your first outbreak, which is the most intense. You can read more about that here.

Why Do You Get A Tingle In The Same Spot Every Time?

You mentioned feeling “a tingle,” and that’s really the first way to know if you’re about to get a herpes outbreak. The reason the tingly feeling is showing up in the same place every time is because you get sores in the site where the virus entered your system when you got it.

What Can You Take To Make The Sores Go Away Or Prevent Them In The First Place?

If you’re living with oral herpes and you get symptoms (not everyone does), you’ll start to recognize the tingly feeling you get before an outbreak. When that happens, there are lots of things you can take to shorten the length of an outbreak. This includes over-the-counter medicine, alternative medicine options, certain foods, and prescription suppression medications like Valtrex and Acyclovir.

Is It Bad To Take A Suppression Medication Every Day?

While oral herpes isn’t curable, if you take suppression medications daily, it can suppress your HSV. That means that it's very likely you won't get any more sores, or at least not nearly as many or as often. Second, suppression medication can also help prevent the spread of your herpes to your partners. Research has found that if you take these antiviral drugs (Valtrex, Acyclovir) daily, they can reduce transmission by around 50 percent. Usually your doctor will only prescribe this if you’ve had a certain number of outbreaks in a short amount of time, but you can also talk to her if you’re particularly worried about passing your HSV along.

No medicine comes without its downsides. For instance, Valtrex’s possible side effects include headaches, dizziness, fatigue, nausea, depression, pain in your stomach, joints, or uterus, and rash. Just because these side effects have been identified doesn’t mean you’ll get them, but you might so they are good to know about. It’s also possible for you to develop a tolerance to the available drugs over time, although this seems to be very rare.

Why Do Outbreaks Happen In The First Place?

If you are one of the people who gets outbreaks from HSV, your first outbreak is very likely to occur a couple weeks after you are infected. This is your body reacting to the new virus inside it. But after that, blisters only pop up every once and a while. They are triggered by a few things that you can do your best to minimize (or at least look out for). These include changes in your health, such as an infection, fever, or any shifts in your immune system, changes in your menstrual cycle, sun exposure, stress, and anything that lowers your immune system so that it can’t fight off the virus from bursting onto the scene.

Can Drinking Or Lack Of Sleep Make You Get A Cold Sore?

If you drink a lot of alcohol, it can actually suppress your immune system, which we just learned is one of the things that can trigger a herpes outbreak. So it is possible for you to experience an outbreak after drinking heavily. One drink probably won’t do it though, so if you notice that you start to feel an outbreak coming on after just a drink or two, there’s probably something else going on. However, an alcohol allergy probably isn’t the culprit. If you’re allergic to alcohol, the symptoms can include a flushed face, hives, a runny or stuffy nose, nausea or throwing up, low blood pressure, or diarrhea.

Lack of sleep can also trigger a herpes outbreak. Fatigue is one of the main culprits for herpes blisters, and often goes hand in hand with stress. You can start feeling the onset of an outbreak just hours after a bad night of sleep, because sleep supports your immune system. If you don’t get enough of it, your body is more likely to be felled by a virus (ahem, like HSV), and fatigue can also make it harder for your body to recover quickly. So take care of yourself!

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