Treating Cold Sores - Herpes Simplex Virus (HSV-1)

Herpes simplex (HSV-1) is highly contagious during an outbreak and is commonly known as cold sores which are characterised by tingling followed with small blisters that develop around the mouth and on the lips.  There are other versions of the virus; herpes simplex (HSV-2) which is an infection of the genitals, herpes zoster, commonly known as shingles, hand or finger (called a herpetic whitlow).  An outbreak often comes on during times of stress when the immune system is weakened. Inbetween outbreaks the virus can remain dormant in the spinal ganglion root.

Symptoms

·         Small, painful blisters filled with fluid around the lips or edge of the mouth

·         Tingling or burning around the mouth or nose, often a few days before blisters appear

·         Fever

·         Sore throat

·         Swollen lymph nodes in neck

Pathophysiology

·         Initial infection is through direct skin to skin contact of mucous membranes such as kissing during the time the virus is active.

·         When the immune system is supressed the virus becomes active travelling from the dorsal root ganglion down to the epithelial lining causing blistering of the skin.

·         The virus remains active on average for 7-10 days, during this time the blisters will burst causing a crust layer which should heal with no scaring

·         After shredding and the skin has healed the virus becomes supressed and is nolonger contagious

·         These episodes of attack can vary between people depending on their stress levels and immune system.

Medical Management

Antiviral medication, over the counter medication ie: zovirax, for recurrent infections, immune medication is used.  

Clinical Considerations

·         Compromised immune system as the viral attacks flare when the immune system is supressed

·         High stress levels of the individual has been strongly linked with the viral activation.

 

Nutritional Interventions

·         L- Lysine taken daily may reduce the severity and frequency of the lesions[i].

·         Curcumin inhibits herpes simplex virus immediate-early gene expression.[ii]

·         Garlic  rich levels of the component alicin in garlic has been shown to be virucidial[iii],[iv]

·         Probiotics lactic acid bacteria ie: l.salivarius has antiherpetic activity[v]

·         Resveratrol inhibits herpes simplex virus (HSV) replication by suppressing nuclear factor-kappaB[vi]

Diet/Adjuncts

·         Honey applied topically has been shown to be effective in managing recurrent symptoms[vii] 

·         Arginine ie: nuts, chocolate and coffee may the aggravate the virus

·         Peppermint oil application has shown to have 99% antiviral activity when used for 3hrs in incubation[viii]

·         Ice  wrapped up (to prevent frostbite) and applied to the area for 90 minutes to cold the area

·         Zinc Oxide applied topically reduced severity of symptoms and duration[ix]

·         Low laser treatment over a 6month period may lower the incidence recurrent infections[x]

·         Melissa officinalis (lemon balm) applied topically to inhibit the virus[xi]

---

[i] Thein DJ, Hurt WC.(1984) Lysine as a prophylactic agent in the treatment of recurrent herpes simplex labialis.Oral Surg Oral Med Oral Pathol. 58(6):659-66.

[ii] Kutluay SB, Doroghazi J, Roemer ME, Triezenberg SJ Virology. 2008 Apr 10;373(2):239-47. Epub 2008 Jan 14. PMID: 18191976

[iii] J. C. Harris, S. Cottrell, S. Plummer, D. Lloyd (2001) Antimicrobial properties of Allium sativum (garlic) Applied Microbiology and Biotechnology 57:282-286

[iv] Norbert D. Weber1, Douglas O. Andersen1, James A. North1, Byron K. Murray1, Larry D. Lawson2, Bronwyn G. Hughes (1992) In Vitro Virucidal Effects of Allium sativum (Garlic) Extract and Compounds Planta; 58(5): 417-423

[v] T M Liaskovs'kyĭ, S L Rybalko, V S Pidhors'kyĭ, N K Kovalenko, L T Oleshchenko (2007) Effect of probiotic lactic acid bacteria strains on virus infection Mikrobiol Z. 69(2):55-63.

[vi] Faith SA, Sweet TJ, Bailey E, Docherty J Antiviral Res. 2006 Dec;72(3):242-51. Epub 2006 Jul 14

[vii] Noori S Al-Waili (2004)

[viii] A. Schuhmachera, J. Reichlingb, P. Schnitzler (2003)  Virucidal effect of peppermint oil on the enveloped viruses herpes simplex virus type 1 and type 2 in vitro Phytomedicine  10: 504–510

[ix] H R Godfrey, N J Godfrey, J C Godfrey, D Riley (2001) A randomized clinical trial on the treatment of oral herpes with topical zinc oxide/glycine Altern Ther Health Med. 7(3):49-56.

[x] A Schindl, R Neumann Low-intensity laser therapy is an effective treatment for recurrent herpes simplex infection. Results from a randomized double-blind placebo-controlled study. Glia. 2009 Mar;57(4):402-13. PMID: 10469307

[xi] G Mazzanti, L Battinelli, C Pompeo, A M Serrilli, R Rossi, I Sauzullo, F Mengoni, V Vullo (2008) Inhibitory activity of Melissa officinalis L. extract on Herpes simplex virus type 2 replication Nat Prod Res 22(16):1433-40