Reviewed by Patrick Carroll, MD
Written by Our Editorial Team
Cold sores are small blisters and sores that can develop on and around the lips. They’re known medically as “herpes labialis” and they’re an extremely common occurrence, with about 2.5 out of every 1,000 people experiencing at least one outbreak per year.
Like other forms of herpes sores, cold sores are caused by the HSV-1 or HSV-2 viruses. Most cases of cold sores are the result of HSV-1, which is estimated by the World Health Organization (WHO) to affect more than two thirds of people aged 49 or below.
Cold sores typically heal on their own, usually over the course of one to two weeks. Most people that develop cold sores will experience occasional recurrence, as the virus that causes cold sores remains dormant in the body even when you don’t exhibit any physical symptoms.
Like all forms of the herpes simplex virus, cold sores are highly contagious. Kissing and cold sores is risky business, because if you kiss someone while you have one or more cold sores, there’s a significant risk of the other person being exposed to and infected by the virus.
In this guide, we’ll explain how cold sores can transmit HSV-1 (and less frequently, HSV-2) from one person to another. We’ll also explain when it's safe to kiss someone after a cold sore, engage in oral sex or have any other kind of oral contact.
Cold sores spread through contact with infected people. Since cold sores are so prevalent, most people are already infected with the HSV-1 virus that causes them. In fact, most research suggests that around 47.8% of all people aged 14 to 49 are infected with the HSV-1 virus.
Most people are infected with HSV-1 without ever realizing, often through intimate contact with a partner, an innocent kiss from a relative or even contact with infected things like eating utensils, razors, etc., that unintentionally transmits the virus.
Even if you already have HSV-1 (or, less frequently, HSV-2), you might not ever develop a cold sore. This is because only a small percentage of people infected with HSV-1 or HSV-2 develop physical symptoms, such as oral herpes (cold sores) or genital herpes.
Still, it’s important to take precautions to prevent cold sores from spreading, even if you’re fairly confident you or your partner already have HSV-1.
Cold sores usually take one to two weeks to heal. During this healing period, they’ll go through a consistent process, starting as a small blister on the lip that develops into an open sore before it heals over. So, even then, if your question is, "Can you kiss someone with a cold sore scab?" the answer is a definitive hard no.
In fact, the development and healing process for a cold sore can be divided into eight stages, all of which have the potential for the virus to shed and spread to other people:
The first stage is the latent period. In this stage, the herpes virus is dormant in the body and you, if you’re infected with the virus, won’t notice any symptoms. During this stage, your body may still be shedding the HSV-1 or HSV-2 virus even without symptoms.
The second stage is the prodromal stage. During this period, people often experience a tingling sensation on or around the lips and red skin in the affected area. This stage lasts for one to two days in most people. It's in this phase that you're most likely to stop a herpes outbreak in its tracks. But even then, you're still contagious.
The third stage is the inflammation stage. At this point, if you haven't taken proper precautions in the prodromal stage, the herpes virus targets cells in the lips or mouth, beginning the process of creating a sore. This takes around one day, with swelling and discomfort in the affected area. p.s. there is a difference between herpes vs pimple on lip
The fourth stage is the pre-sore stage. Over the course of one to two days, one or multiple small, hard blisters will begin to develop on or around the lips. These blisters are often painful and can make eating, chewing and moving the lips uncomfortable for the affected person.
The fifth stage is the open herpes lesion stage. During this period, the blister (or blisters, if you have multiple sores) will open into an exposed sore. Most cold sores remain open for one to two days, during which they are highly infectious.
The sixth stage is the crusting stage. At this point, the body’s immune system begins to actively heal the sore by developing a brown, immunoglobulin crust. It usually takes two to three days for the crust to develop into a scab.
The seventh stage is the healing stage. At this point, a scab has fully enveloped the sore and new skin is developing underneath. The scab will typically remain for up to five days, during which the cold sore is still infectious.
The eighth and final stage is the post-scab stage. At this point, the sore will have healed and the skin will be returning to normal. It’s still possible for some redness to linger in the affected area for two to three days.
While cold sores usually develop on or around the lips, they can also develop inside the mouth — a form of herpes infection called herpetic stomatitis.
Cold sores are contagious during all stages of the development and healing process, meaning you shouldn’t kiss anyone, share eating utensils, have oral sex or engage in any other oral contact throughout the entire process of a cold sore developing and healing. Kissing and cold sores (and any other physical activity during or after the outbreak) is dangerous business.
When is a cold sore healed enough to kiss? The short answer is that it's not. In general, it’s best to wait until after the scabs and sores completely disappear before you kiss someone or engage in oral sex. This is because the herpes virus can continue shedding in the late stages of a cold sore healing, even if there’s no viral fluid present.
The longer you wait after an outbreak, the lower your risk of transmitting cold sores to a partner or other person. As always, it’s best to be patient and wait for the outbreak to completely clear up before you put yourself in a situation where spreading the virus is possible.
Cold sores can be extremely annoying, especially if they get in the way of you being intimate with your partner. Unfortunately, they can also carry a social stigma, making meetings, lunch with friends and other normal situations embarrassing and stressful.
There are several highly effective medications on the market that you can use to speed up the healing process and treat cold sores when they flare up. Often, treating cold sores in its early stages (the prodromal stage) can prevent it from fully developing.
Of these medications, one of the most widely used is valacyclovir. Our Valacyclovir 101 guide covers everything you need to know about using valacyclovir to treat cold sores, from the medication’s mechanism of action in the body to common dosage periods, side effects and more.
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Dr. Patrick Carroll is the Chief Medical Officer and a board member of Hims & Hers. Dr. Carroll oversees all matters pertaining to provision of care, clinical outcomes, patient safety, healthcare information systems and strategic initiatives and programs to enhance the Hims & Hers care model. In addition, Dr. Carroll is instrumental in managing relationships with health systems and collaborating with the executive team in the development of new clinical programs.
Prior to joining Hims & Hers in June of 2019, Dr. Carroll was the Group Vice President and Chief Medical Officer of Walgreens. Over his 5 year tenure he oversaw retail clinics, healthcare strategy, health system collaborations, quality programs as well as the development of the Walgreens Neighborhood Health Destination initiative.
Prior to joining Walgreen’s in May 2014, Dr. Carroll served as the Chief Medical Officer of Integrated Care Partners, Hartford HealthCare’s clinical integration organization. He was also the Medical Director for Hartford HealthCare’s Medicare Shared Savings Program which currently has over 20,000 patients in a Medicare/CMS shared-risk pilot program. He played a key role in leading the Hartford HealthCare’s efforts in the transition to value-based care in a time of a rapidly changing healthcare landscape.
From 2010–2012, Dr. Carroll served as the Chief Medical Officer for the Granite Medical Group in Quincy, Massachusetts. Granite Medical Group is a 40-provider Multi-specialty/Primary Care Group which is part of Atrius Health, a 1000 Medical Provider Group.
Dr. Carroll received his bachelor’s degree from the College of the Holy Cross and his medical degree from Dartmouth Medical School. He completed his residency training at Middlesex Hospital in Family Practice, where he served as Chief Resident.
Dr. Carroll is Board Certified in Family Practice and in Adolescent Medicine. You can find Dr. Carroll on Linkedin for more information.