Cold Sore Symptoms

Blisters, fever, swollen neck glands, and soreness in the mouth or on the lips are some of the initial symptoms of a cold sore. Common symptoms that may occur with recurrent cold sores include pain, itching, and tingling, followed by blisters. The symptoms during an initial attack are usually more severe than those of recurrent attacks.

 

Before Cold Sore Symptoms: The Incubation Period

When a person is infected with a herpes simplex virus (the virus that causes cold sores), symptoms do not begin right away. This period between becoming infected and the beginning of symptoms is known as the incubation period. While this period can be anywhere from 1 to 26 days, the average herpes incubation period is six to eight days.
 

Initial Signs and Symptoms

For about 85 percent of people, the initial infection with a herpes simplex virus causes no cold sore symptoms. About 15 percent of people, however, develop many small, sometimes painful, fluid-filled reddish or purple blisters around the lips or corners of the mouth. Over several days, the blisters tend to merge and then collapse. A yellowish crust often forms over the sores, which usually heal without scarring within two weeks.
 
Besides blisters, other symptoms of a cold sore may include:
 
  • Fever
  • Swollen neck glands
  • Sore throat
  • Soreness in the mouth or on the lips
  • General body aches (malaise).
     

Recurrent Cold Sore Symptoms

After the initial infection (whether or not symptoms occur), the body is not able to completely get rid of the herpes simplex virus. Instead, the virus remains in a nerve located near the cheekbone. It may stay permanently inactive in this site (in other words, not cause symptoms), or it may occasionally travel down the nerve to the skin surface, causing a recurrence of blisters. Recurrent cold sores usually erupt at the outside edge of the lip or the edge of the nostril, but can also occur on the chin, cheeks, or inside the mouth.
 
One to three days before the cold sores return, many people feel pain, itching, tingling, or a burning sensation. This is known as a prodrome.
 
The symptoms of recurrent cold sore attacks are usually less severe than the initial attack. While different for everyone, a cold sore typically lasts 4 to 10 days and occurs three or four times a year, on average.
 
 
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Written by/reviewed by: Arthur Schoenstadt, MD
Last reviewed by: Arthur Schoenstadt, MD