Cold Sore Stages, Causes, Symptoms: Is It Contagious?

Cold sores are a manifestation of the herpes simplex virus. According to Wikipedia, there are 8 different types of herpes viruses that can infect humans, but the blister-like lesions are caused by the HSV-1 or herpes simplex virus type 1. On the rare occasion, a person can get cold sores on the mouth if he or she engages in oral sex with someone who is infected with HSV-2 (herpes simplex virus type 2) that causes genital herpes. In either case, these lesions often cause pain and embarrassment whenever they pop up. Here is some information about cold sores to help you deal with this condition.

StagesHealing Stages of Cold Sores

During a 7 to 10 day period, your cold sores will pass through five different stages and exhibit varying symptoms in each of these stages

  1. Stage One: In the beginning, you may experience tingling, burning, tightness, soreness, or itching in the area where the cold sore is about to erupt. This may last anywhere from  several hours to a couple of days. The skin may also turn red and swell as the infection advances. This stage typically lasts for up to two days.
  2. Stage Two: Around the second day, small lumps begin to appear, which may then multiply. The lumps will begin filling with a red-colored fluid as your body sends white blood cells to the infection site to fight off the virus. The disease becomes contagious during this stage, which may last up to two days..
  3. Stage Three: The blisters will continue to grow and become more painful until they get to this stage where they may start popping. Open sores (ulcers) will form and the area may be surrounded with inflammation. This stage, which occurs on the fourth or fifth day of the outbreak, is the most painful one and you will continue to be contagious. However, the sores should begin to scab over by the end of the day.
  4. Stage Four: At around days 5 through 8, the sores begin scabbing over. The pain should be less, compared to the previous stage. However, the wounds may crack and bleed, which can hurt. You may also experience itching, but it is important that you avoid scratching the scabs because it will only increase your pain and irritation.
  5. Stage Five: This is the last stage that begins about 8 to 10 days after the outbreak started. During this stage, the body has got the virus under control. The scabs should fall off naturally, leaving behind pink or red skin that may be dry, flaky, and mildly swollen.

Causes: How Do You Get Cold Sores?

The underlying cause of cold sores is the herpes simplex virus (type 1). This disease is highly contagious, and you can become infected by coming into contact with the oozing blisters. The infection can also spread via the exchange of bodily fluids by sharing eating utensils, razors, needles, or by kissing or engaging in oral sex with an infected person.

Once a person is infected with the HSV -1 virus, cold sores can be triggered by a multitude of factors including:

  • Stress or psychological/emotional distress
  • Menstruation
  • High fever
  • The onset of another infections such as the flu or bronchitis
  • Fatigue
  • Injury to the lips
  • Exposure to strong sunlight
  • Cold weather and wind
  • Dry air
  • Changes in your immune system such as immunosuppression

Everyone is different, therefore, the triggers may differ from person to person. It is a good idea to keep a journal tracking your outbreaks so that you can learn about your personal triggers and control them.

How long is Cold Sore Contagious?

Cold Sores are contagious primarily when the blisters are oozing because that is when the lumps are filled with the virus. However, as noted previously, you can transmit the virus to another person at any time.


The term symptom typically refer to how you feel and the physical manifestations of the disease that you report to a medical professional, while a ‘sign’ is generally used to refer to something observed by the medical professional that points to a particular diagnosis. For instance, you may report pain as a symptom but the doctor may see the lumps as a sign of a cold sore.

The incubation period for herpes is anywhere between two to seven days. Oftentimes a person will not show any signs or symptoms of having the herpes simplex virus for weeks or months after being infected, if ever. Some people have outbreaks two to three times a year, whereas others never have them. The latter will typically be simply carriers of the virus, with the virus never becoming active in their system.

People who are infected with the herpes virus when they are young may be symptom-free until they are older; after which, the cold sores may occasionally be triggered by internal or external factors such as stress and sunlight.

Sometimes there are signs of infection which include:

  • Herpes simplex gingivostomatitis – small painful sores that form on the gums, making them swollen and inflamed
  • Increased saliva production
  • Possible swallowing difficulties
  • Fever (temperature above 100.4 degrees Fahrenheit)
  • Sore throat
  • Swollen lymph nodes
  • Nausea
  • Mouth or tongue lesions
  • Blisters and ulcers in the mouth
  • Swollen lymph nodes
  • Mouth or tongue pain
  • Lip swelling
  • Headaches
  • Dehydration

The sign of infection are the same for children and adults. However, children are more likely to have herpes simplex gingivostomatitis, which will last for 7 to 14 days. Adults may also have bad breath and develop sores around the mouth that may turn into ulcers that are colored yellow or grey in the center.

The cold sores themselves will exhibit a few symptoms during the onset such as:

  • Mild to severe tingling, itching, or burning at the site where the sore will form
  • Blisters erupting after a day or two; these usually occur around the outside edges of the lips
  • Oozing and crusting of the blisters after they burst

The sores will only erupt around the mouth. You will never get sores on your tongue, nose, cheeks, chin, or any other part of your face. The symptoms will vary depending on how long you’ve had the disease, but they typically last for only a few days.

Recurring cold sores tend to erupt in the same place. They are typically less severe than the first infection, but may grow bigger. However, cold sores that erupt in subsequent outbreaks also heal faster, forming scabs within 48 hours after the first signs of a cold sore (e.g. tingle sensation).


Typically, your physician will be able to diagnose  cold sores by visual inspection. However, tests using a sample of blood or the fluid from the sore may be ordered to confirm the diagnosis for people with weak immune systems, such as those with HIV/AIDS.


There is no cure for the herpes simplex virus, even if it is diagnosed early. Therefore, treatment typically focuses on mitigating the symptoms. Cold sores will go away on their own in two to four weeks without treatment. However, your doctor may prescribe an antiviral medication such as acyclovir, valacycloir, famciclovir, or penciclovir to speed up the healing process.

When to See a Doctor

Without treatment, cold sores will usually clear up within 7 to 10 days. Most people don’t experience any complications from cold sores. However, you seek out medical care if:

  • The cold sores don’t respond to treatment or heal after 14 days
  • You experience severe symptoms
  • Your immune system is weakened due to medication or disease (e.g. HIV/AIDS)
  • The cold sores frequently return
  • Your eyes become irritated

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