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Pregnancy Wellness

How to Treat a Cold Sore While Pregnant

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What to do if you get a cold sore while pregnant

Cold sores are a fact of life for many pregnant people and nothing to be ashamed of, though you may be worried if there are safe and effective treatment options. Dealing with a cold sore is never easy, and we know your first priority is keeping your baby safe. We’re sharing details on HSV-1 during pregnancy, how it may affect your baby, and how you can combat cold sores while maintaining a safe pregnancy.

Why do you get cold sores?

Sometimes called fever blisters, they are a cluster of small blisters on the lip and around the mouth that are usually red, inflamed and filled with liquid or pus. They are caused by the herpes simplex virus (HSV-1, which is different from HSV-2, which causes genital herpes), a common virus that many people carry and transmit via contact, and not always sexual contact. According to the Centers for Disease Control, 48% of the U.S. population between the ages of 15 and 49 carry HSV-1, and many are asymptomatic. 

Is HSV-1 curable?

While HSV-1 is incurable, the virus is not fatal, and many people live normal lives. You may get cold sores periodically depending on your stress levels and hormones, such as:

  • Stress
  • Fatigue
  • Sun exposure
  • Illness (like a cold or fever)
  • Hormonal changes (like menstruation)

Can pregnancy trigger cold sores?

Yes. If you have HSV-1, the fluctuating hormones, fatigue, and stress of pregnancy may cause you to have more incidences of cold sores than normal. Pregnancy can weaken your immune system (making colds and the flu more severe), so an outbreak can lead to a more serious illness. To minimize outbreaks, try to control your stress, get plenty of rest, and take action to shorten the length of a cold sore at the first sign (tingling, itchy, or burning sensation on the lips).

How long do cold sores last​ when you are pregnant?

A cold sore during pregnancy lasts about as long as one does when you’re not pregnant, around one to two weeks. Your pregnancy won’t significantly impact the duration of the cold sore cycle. If your cold sore doesn’t go away by day 10 or you have frequent outbreaks (several outbreaks in a one to two-month span), you should contact your healthcare provider.  Will cold sores or HSV-1 affect my pregnancy or baby?

If you already had HSV-1 before getting pregnant, the chances of transmitting (or passing) it to your unborn baby are very low. That’s because your immune system has built antibodies against the virus. However, there are complications related to HSV-1 and HSV-2 that pregnant people need to be aware of.

Can I pass the virus to my baby?

If you contract either HSV-1 or -2 early in your pregnancy, it may lead to a miscarriage. If you contract the virus later in your pregnancy, your immune system may not have enough time to build antibodies, and you can pass the virus to your newborn. The risk of vertical transmission (transmitting the virus to your baby) is higher if you have HSV-2, especially if there are genital sores/lesions. If you are pregnant and believe you have contracted HSV-1 or -2, speak with your healthcare provider ASAP.

Neonatal Herpes: risks and symptoms in newborns

If you have passed the HSV-1 or -2 to your newborn or your newborn was exposed to the virus, that is called “neonatal herpes,” and while it is rare, it can pose serious risks and complications. Neonatal herpes can affect your baby’s central nervous and respiratory systems and can even cause organ failure or death. Symptoms include:

  • High fever
  • Irritability
  • A skin rash
  • Issues with feeding
  • Difficulty breathing
  • Seizures

The risk of neonatal herpes is much higher when the mother has HSV-2. If you were infected with either HSV-1 or -2 during pregnancy or your newborn was exposed to the virus, contact your healthcare provider immediately.

Cold sore treatment while pregnant 

The most common treatment for cold sores is docosanol (brand name Abreva). However, there isn’t enough research on whether or not it is safe to use while pregnant. Another option is Acyclovir cream, an antiviral topical treatment you can usually get without a prescription. Your healthcare provider may prescribe an oral antiviral medication such as Acyclovir or Valacyclovir. Even if you have had a cold sore before, check with your healthcare provider if you get one while pregnant so they can counsel you on the safest treatment option.

Antiviral use during pregnancy

There is some evidence that taking antiviral medications during pregnancy may cause harm to the growing fetus. Oral valacyclovir is generally considered to be safe during pregnancy. In a review of available data on in vitro exposure to the drug, there was no increased risk of congenital disabilities. Of course, always speak with your healthcare provider before taking any medication.

Managing cold sores during pregnancy

Unfortunately, because the HSV-1 virus and breakouts are often tied to circumstances outside of our control, it’s challenging to manage cold sores while pregnant. If you feel a cold sore coming on, you should:

  • Keep the infected area(s) clean and dry, and avoid touching and picking at the blisters
  • If your healthcare provider approves the use of topical creams, apply them as needed
  • Wash your hands frequently

When should I see the doctor?

If you get a cold sore while pregnant, consult your healthcare provider, even if you have dealt with them before. If you have never gotten a cold sore, it’s even more important to seek medical treatment since primary infection during pregnancy can increase certain risks. Your provider will not judge you; they are there to support a healthy pregnancy for you and your baby.

If you are searching for a judgment-free pregnancy doctor in Phoenix, Prescott, Tucson or the surrounding areas, contact us to request an appointment today. Our OB-GYNs, midwives and nursing staff will work with you to outline a safe and effective treatment option for your condition.