Is It Common To Get Cold Sores (Fever Blisters) During Pregnancy?

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Cold sores or fever blisters erupt inside the lips or cheeks, around the mouth, or near the nose and chin (1). 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? Keep reading to know more about cold sores during pregnancy.

What Are The Causes Of Cold Sores During Pregnancy?

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 (2). Cold sores are likely to be common in women who have experienced them in the past (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 fear and stress during pregnancy 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).

Alexandra Harbushka, a vlogger who deals with recurring herpes, shares her experience with a food she decided to avoid during her pregnancy. She explains, “Things that cause outbreaks for me… which I was like, it’s not going to cause an outbreak—eggplant of all things! Eggplant’s very inflammatory. I love eggplant; I have eggplant in my garden. So I was like, I’m going to eat my eggplant. And every time I ate my eggplant, I got an outbreak. So I’m not eating my eggplant anymore (i).”

• The immune system naturally becomes slightly modulated during pregnancy to support the growing fetus. While the immune system is still functional, protecting the mother and the developing baby is prioritized. This adjustment makes pregnant women more prone to frequent or severe cold sore episodes compared to when they are not pregnant (7).
• Pregnancy often leads to physical exhaustion and disrupted sleep patterns, which can lower immunity and increase the likelihood of a cold sore outbreak (8).

What Are The Signs And Symptoms Of Cold Sores In Pregnancy?

The common signs and symptoms that could indicate cold sores during pregnancy include (9):

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

There are five stages of a cold sore where 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.

What Are The Different Stages Of Cold Sores?

The cold sores last for seven to 12 days, and during this time, they might progress in different stages (10).

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 prenatal 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 scabsⁱCrusty, dark red or brown layers that keep bacteria out of the wound while allowing the skin cells to recover 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.

Are Cold Sores Contagious?

According to the World Health Organization (WHO), herpes infections are highly contagious when symptoms such as ‘cold sores’ are present (11). 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 (12).

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 (13).

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 (3).

When To Seek Medical Advice?

Pregnancy requires regular consultation with a doctor for any discomfort. So, if you have cold sores during pregnancy, it is best to seek medical care instead of self-medication. Visit a doctor immediately if you have (9):

• A weakened immune system
• Severe signs like large and painful sores
• Persistent sores that are not healing
• Recurrent sores
• Cold sores that are spreading near your eyes
• Signs of infection like redness around the sores and fever

To identify the infection accurately, a sample from the base of a cold sore might be taken and analyzed under a microscope. Additionally, a PCR (polymerase chain reaction) test can be performed in a pathology laboratory to detect the virus (14).

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

You may try some home remedies to ease the cold sore-related pain and discomfort (15):

• Placing a cold compress (wet, cool cloth, or towel) on the sores may help reduce the redness and pain.
• Eating and drinking cool foods and beverages can also make meals more comfortable.
• Apply a lip balm (SPF 30 or higher) before going outside (16).
• Maintain a healthy diet, get enough sleep, and practice relaxation techniques to reduce stress (17).
• Diluted apple cider vinegar, lemon balm, and aloe vera gel are a few natural remedies that may help treat cold sores at home (18).

Consult your doctor to ensure the safety of these natural remedies. Your doctor can provide personalized advice and recommend safe, effective treatments to manage cold sores while prioritizing the health of both you and your baby.

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 during pregnancy (19). These fall under pregnancy category B medications of the US Food and Drug Administration. While valacyclovir and acyclovir are often recommended for both primary and recurrent HSV infection that causes cold sores, famciclovir is not considered the first choice of drug during pregnancy. A research paper states, “ Studies have shown that the use of acyclovir or valacyclovir is not associated with an increase in birth defects. Limited data exist for famciclovir, and therefore, it would not be considered a first-line choice for treatment of herpes during pregnancy (20).”

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 it is not uncommon for expecting women to experience them. But they may not be an early sign of pregnancy. A woman may get cold sores at any point during the gestationⁱThe period between conception and delivery of the baby 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 (14). 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 meningitisⁱA swelling of the linings that protect the brain and spinal cord . However, it occurs in less than 1% of births, and the development of meningitis from HSV-1 infection is quite rare (13).

Infographic: Precautions For Cold Sores When Pregnant And Postpartum

For most women who have experienced cold sores before, developing them while pregnant or after having a baby is not uncommon. If you are concerned that cold sores could impact your pregnancy or baby, the safety tips in this infographic could ease your worry and help you prevent them while pregnant, and protect your newborn from acquiring the infection.

Illustration: Momjunction Design Team

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Reviewer Expert Author Editor Fact Checker

Dr. Ben Abbes Taarji HichamMD

Dr. Ben Abbes Taarji Hicham is a practicing obstetrician and gynecologist with around 20 years of experience in the field. Having worked in various Moroccan hospitals, he currently runs a private practice. Dr. Hicham specializes in rejuvenation and cosmetic gynecology, medically assisted reproduction, breast and gynecological cancers, HPV diseases, hysteroscopy and laparoscopy, and hormonal disorders.

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  Dr. Alan LindemannMD, MS Dr. Alan Lindemann is an obstetrician and maternal mortality expert, who worked as a clinical associate professor at the University of ND. An alumnus of the University of ND and the University of Minnesota, he is a member of the American College of Obstetricians and Gynecologists and the American Medical Association.
  
  Dr. Alan Lindemann is an obstetrician and maternal mortality expert, who worked as a clinical associate professor at the University of ND. An alumnus of the University of ND and the University of Minnesota, he is a member of the American College of Obstetricians and Gynecologists and the American Medical Association.

Rebecca MalachiBSc

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU).

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Dr. Ritika ShahBDS, CLC

Dr. Ritika Shah is a certified lactation counsellor (CLC) from iNational Health Care Academy, Singapore and a dental surgeon with more than seven years of clinical experience across various cities in India. She did her graduation in Dentistry from KM Shah Dental College.

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Reshmi DasMSc

Reshmi Das has over four years of experience as a clinical coordinator, medical content writer and medical conference coordinator. Her continuous interest in medical journals and writing makes her write well-researched articles for MomJunction.

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