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Cold sore early pregnancy symptoms


How Common Are Cold Sores (Fever Blisters) During Pregnancy?

You may contract the virus again while pregnant if it was contracted before.

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Cold sores or fever blisters erupt inside the lips or cheeks, around the mouth, or near the nose and chin. These itchy and tingly sores might sometimes be painful too. Usually, cold sores are likely to disappear in a couple of weeks. But what happens when they occur during pregnancy? What should you do about them?

We tell you about it in this MomJunction post. Keep reading to know more about cold sores during pregnancy.

Are Cold Sores Common In Pregnancy?

Cold sores are usually caused by herpes simplex virus (HSV), especially type 1 of the virus (1). Therefore, they are likely to be common in women who have experienced them in the past (2).

What Are The Causes Of Cold Sores During Pregnancy?

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Cold sores are caused by the herpes simplex viruses named HSV1 and HSV2. The virus transmits from one person to another through skin to skin contact during touching, sexual intimacy, kissing, or sharing contaminated items (3).

Once a woman has contracted the virus, the following risk factors could trigger the cold sore virus.

  • Hormonal changes that frequently rise and fall could make the body susceptible to viral infection, including a cold sore outbreak (4).
  • Psychological concerns, such as stress and fear could trigger the virus (5).
  • Certain foods (acidic, spicy, or salty), citrus fruits, exposure to the sun, and hot water could trigger the virus and cause cold sores (6).

Related: Reasons For Postpartum Hormonal Imbalance And Ways To Deal

Signs And Symptoms Of Cold Sores In Pregnancy

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The common signs and symptoms that could indicate cold sores during pregnancy include:

  • Swelling of the lips
  • Small, painful blisters
  • Redness
  • Tiny bumps over your lips
  • Fever
  • Pains and aches
  • Sore throat

Cold sores develop gradually, in five different stages, when you might experience the above symptoms. Understanding the changes in each of these stages might help you take the right steps to prevent them from spreading to other parts of the body.

Stages Of Cold Sores

The cold sores last for seven to 12 days, and during this time, they might progress in different stages (7).

Stage 1: The tingling stage

You may experience a tingling sensation for about a couple of days. The skin (inside your lips, on your lips, or inside the cheeks) might turn sore and red and might even swell and become itchy.

Stage 2: The blister stage

This stage lasts for about two days. During this stage, new blisters may form and spread to other parts in the absence of proper care.

Stage 3: The weeping stage

At this stage, the blisters may burst, and you might experience pain. The cold sores might scab over at this point.

Stage 4: The scabbing stage

The scabs may crack and even bleed. They could be itchy, but make sure you are not poking them.

Stage 5: The healing stage

In this stage, all the scabs flake off and disappear soon after. Even the scars slowly vanish.
Observe the progress of cold sores and treat them in time to prevent the infection from spreading.

Related: C-Section Scar Wound Infection

Are Cold Sores Contagious?

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According to the World Health Organization (WHO), herpes infections are highly contagious when symptoms such as ‘cold sores’ are present (8). The virus may be passed from one person to another. If the bump ruptures, the active virus could spread via lipstick, cups, utensils, kissing, or through oral sex (9).

According to the UT Southwestern Medical Center, HSV 1 or the cold sore infection could pass from the infected person to the baby. This usually happens when the person kisses the baby or when the baby is touched after the cold sore is touched (10).

Therefore, it is important to treat the cold sore in pregnancy to prevent the virus from spreading to the baby after it is born. Herpes infection is mild for the mother but can be life-threatening for the baby.

Point to consider

Pregnant women contracting herpes infection for the first time (primary infection) have a higher infection transmission rate. A newly infected mother doesn’t have the antibodies to provide natural protection to the baby (2).

Related: Threatened Miscarriage: Causes, Symptoms And Risk Factors

How To Treat Cold Sores In Pregnancy?

Home care measures for the sores might alleviate pain and discomfort. In some cases, medication may be necessary.

1. Home treatment

Image: iStock

  • You may try some home remedies to ease the cold sore-related pain and discomfort
  • Placing a cold compress (wet, cool cloth, or towel) on the sores may help reduce the redness and pain.
  • A mouthwash containing baking soda may also reduce the soreness.
  • Apply sunscreen before going outside.

You may apply aloe vera gel or lip balm containing soothing ingredients on the sores.

2. Clinical medicine

Before you take any medication for cold sores in pregnancy, talk to your doctor. Ideally, antiviral medications are prescribed to treat cold sores. According to the American Academy of Family Physicians, the common options include valacyclovir, famciclovir, and acyclovir (11). These fall under pregnancy category B medications of the US Food and Drug Administration.
If the cold sores get severe, the doctor may change the dose or prescribe other treatment.

Are Cold Sores An Early Sign Of Pregnancy?

Cold sores are common, and most pregnant women may experience them. But they may not be an early sign of pregnancy. A woman may get cold sores at any point during the gestation period.

Are Cold Sores During Pregnancy Harmful To The Baby?

According to the Royal Hospital for Women, Australia, cold sores may not affect newborn babies. But they are infectious and should be treated in time, so they don’t spread to the infant (1). However, if you have genital herpes, then there are chances of the virus transmitting to the baby during the process of childbirth (known as acquired herpes). This can be very dangerous for the baby. Hence, a cesarean section is indicated to avoid contact of the baby with the cold sores.

Did you know?

Neonatal herpes infection may result in viral meningitis. However, it occurs in less than 1% of births, and the development of meningitis from HSV-1 infection is quite rare (10).

1. Can pregnancy flare-up cold sores?

Pregnancy modulates the immune system, and women who have herpes may have an increased risk of outbreaks of cold sores during pregnancy (12) (13).

2. Can pregnancy hormones cause cold sores?

Cold sores may be triggered due to hormonal changes during pregnancy or menstruation in women already exposed to the herpes simplex virus type 1 (HSV-1) (14).

3. Can I use Abreva for cold sores while pregnant?

The manufacturer’s instruction states that Abreva is not recommended for treating cold sores in pregnant or lactating women unless advised by a doctor (15).

4. Can I use cold sores cream when pregnant?

A doctor may prescribe cold sores creams containing aciclovir, an antiviral medication, for treating cold sores during pregnancy (2).

HSV1 and HSV2 can produce cold sores during pregnancy that can emerge inside the lips or cheeks, near the nose and chin, or around the mouth. The advancement and healing may occur in stages over seven to twelve days. It is advised to avoid touching the sores when they erupt, follow a well-balanced diet, and get plenty of rest to avoid cold sores during pregnancy. Also, stay away from spicy meals and wash your hands frequently. Though cold sores are not a cause for concern during pregnancy, you should visit your doctor and have them treated as soon as possible.

Key Pointers

  • Cold sores are blisters inside the mouth or near the nose, caused by the herpes simplex virus and commonly seen in women with past exposure.
  • The virus is contagious, and factors such as hormonal or psychological changes can trigger its occurrence in pregnant women.
  • It is not an alarming concern. You may try some effective home remedies or consult your ob/gyn for pregnancy-safe medications.

References:

1. Cold sores (herpes simplex type 1) – including symptoms, treatment and prevention; Government Of South Australia (2019)
2. Cold sores in Pregnancy and Breastfeeding; The Royal Hospital For Women (2016)
3. Cold sores in pregnancy; Pregnancy, Birth and Baby; Healthdirect Australia (2019
4. Cold sores; University of Wisconsin-Madison
5. D. B. Donahue; Diagnosis and Treatment of Herpes Simplex Infection During Pregnancy; Journal of Obstetric, Gynecologic & Neonatal Nursing (2002)
6. Herpes simplex; Mount Sinai
7. Cold Sores; San Diego State University
8. Herpes simplex virus; World Health Organization (2017)
9. D. Shipp; How contagious are cold sores?; The Ohio State University (2019)
10. R. Horsager-Boehrer and J. Kahn; How to protect your baby from herpes infection; UT Southwestern Medical Center (2017)
11. ACOG Releases Guidelines on Managing Herpes in Pregnancy; American Academy of Family Physician (2008)
12. Gil Mor and Ingrid Cardenas; The Immune System in Pregnancy: A Unique Complexity; American Journal of Reproductive Immunology (2010)
13. Cold sores in pregnancy; Pregnancy Birth & Baby
14. Cold Sores; Cleveland Clinic
15. Understanding cold sores; Abreva Canada

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Cold sores in pregnancy | Pregnancy Birth and Baby

Cold sores in pregnancy | Pregnancy Birth and Baby beginning of content

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What is HSV?

If you or your partner has the virus that causes cold sores or genital herpes, you might be worried about what could happen when you're pregnant or have a new baby. Here's what you need to know about herpes simplex virus (HSV), and how to protect your baby from infection.

The herpes simplex virus is a very common virus carried by most people. Sometimes it causes cold sores or genital herpes.

Cold sores are blisters that form on the lips, around the mouth and nose. Genital herpes is blisters or sores around the genitals or anus. The blisters may form a crust after about 3 days. The sores go away by themselves within 2 weeks.

There are two main types of HSV:

  • HSV-1 causes mostly cold sores on the face and lips, and sometimes on the genitals
  • HSV-2 causes mostly genital herpes

Both viruses are transferred though contact of the skin, saliva or genitals, and the viruses stay in the body for life. The viruses do not always cause symptoms, so you can carry the virus without knowing it.

HSV-1 is very common, with about 8 in 10 Australians carrying it in their bloodstream. But only 1 in 3 people with the virus has ever had a cold sore. HSV-2 is less common.

It is common for women who have had cold sores in the past to experience an outbreak while pregnant.

What happens if I get cold sores or genital herpes during pregnancy?

Having the HSV virus does not affect your chance of becoming pregnant.

It is quite common for women to have a cold sore during their pregnancy, even if they haven’t had one for a long time. Cold sores should not affect your unborn baby. But they are infectious, so it’s a good idea to treat them.

Genital herpes should not affect the baby if you have your first outbreak or it comes back in the first 34 weeks. But it can be transferred to your baby during the birth, especially if it’s your first outbreak.

If you've ever had a cold sore or genital herpes and you become pregnant, or you develop these conditions during pregnancy, it's important to tell your doctor or midwife about it. Together you can make a plan for managing herpes during pregnancy and birth.

How is HSV treated during pregnancy or breastfeeding?

You can treat cold sores and genital herpes with:

  • aciclovir cream, available from a pharmacist without prescription
  • aciclovir or valaciclovir tablets, for which you need a prescription

These 'antiviral' drugs are known to be safe for pregnant and breastfeeding women and are effective most of the time.

Famciclovir tablets are not recommended to take during pregnancy. Speak to your doctor if the cold sore is severe.

How is genital herpes treated during pregnancy?

You should take acyclovir or valaciclovir tablets, as above.

If it's your first outbreak of genital herpes, your baby may be more at risk because you haven't had time to develop immune protection against the virus, which also helps protect the baby.

Some women experiencing an outbreak of genital herpes might be advised to have a caesarean. This would prevent the herpes virus passing from mother to baby during a vaginal birth. But most women in Australia with genital herpes do give birth safely to healthy babies vaginally.

It's often recommended that women who have ever had genital herpes take antiviral tablets prior to the birth, even if the herpes isn't active at the time.

Talk to your doctor or midwife about the best course of action for your situation.

How do I protect my baby from herpes?

Herpes can cause serious problems in a baby, such as infections to the eyes and throat, brain damage and even death.

A newborn baby can catch HSV-1 and HSV-2 from being kissed or touched by someone with cold sores, or during childbirth.

Fortunately, most babies born to women who carry the virus are not affected. But if you or your partner has a cold sore or genital herpes, talk to your doctor about keeping it under control during the pregnancy and after the birth. It is also important to treat these conditions aggressively while you are breastfeeding.

It's important to maintain strict hygiene habits when caring for a new baby if you, or anyone in close contact with the baby, have cold sores.

If you have cold sores, you should:

  • cover cold sores when you're around the baby
  • avoid kissing your baby until the sores are completely healed
  • avoid touching the cold sores then touching your baby
  • wash your hands thoroughly before touching your baby

What if I have a cold sore while breastfeeding?

If you have cold sores, it is safe to breastfeed your baby as long as the cold sores are not on the breast or nipple.

If they are, it may be wise to breastfeed from the unaffected nipple only until the lesions have cleared up. You would express and dispose of breastmilk from the affected nipple. Breastmilk itself doesn't contain the herpes virus but it can be contaminated through the skin lesions.

Talk to your doctor or midwife as soon as you notice any cold sores on your breast or nipple.

What happens if my baby gets herpes?

It is very important that herpes in a newborn is recognised and treated by a doctor in hospital immediately. Signs of herpes in a newborn include:

  • blisters on the skin
  • fever
  • irritability
  • tiredness
  • lack of appetite

If you think your baby might have the herpes virus, don't wait to see if they get better — seek medical help. Tell medical staff if you or your partner carry the herpes virus.

Resource and Support

If you are worried about your baby, see a doctor or midwife, or take them to the hospital.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

If you're not sure what to do or want more information, you call Pregnancy Birth Baby on 1800 882 436 to speak with a maternal child nurse.

Sources:
Family Planning NSW (Genital herpes), The Royal Woman’s Hospital (Genital herpes), Mothersafe (Cold sores in pregnancy and breastfeeding), Queensland Government Health (Genital Herpes and Pregnancy), SA Health (Cold sores (herpes simplex type 1) - including symptoms, treatment and prevention), Safer Care Victoria (Herpes simplex virus in neonates)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: May 2021


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Cold sores - Better Health Channel

Cold sores are blisters around the mouth and nose, caused by the herpes simplex virus.