Cold sores ( Herpes simplex ) - Management of Infection Guidance for Primary Care

Publication: 30/09/2010  
Next review: 05/12/2020  
Clinical Guideline
ID: 2265 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2016  


This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Cold sores (Herpes simplex)



Cold sores (Herpes simplex)

Cold sores resolve after 7–10 days without treatment. Topical anti-virals applied pro-dromally reduce duration by 12-24hrs 1,2,3B+
Prophylaxis may be considered for patients who suffer from severe recurrent cold sores

Principles of Treatment

  1. This guidance is based on the best available evidence but its application must be modified by professional judgement.
  2. Where a ‘best guess’ therapy has failed or special circumstances exist, microbiological advice can be obtained from LTHT Microbiology (Mon-Fri 9am-5pm and Sat and Sun 9am-1pm: 0113 39 23962/28580; Otherwise via LTHT switchboard - ask for the On call Microbiology Registrar)


Record: 2265
  • to provide a simple, empirical approach to the treatment of common infections
  • to promote the safe, effective and economic use of antibiotics
  • to minimise the emergence of bacterial resistance and reduce the incidence of Healthcare Associated Infections in the community
Clinical condition:

Cold sores (Herpes simplex)

Target patient group:
Target professional group(s): Primary Care Doctors
Adapted from:

This guidance was initially developed in 1999 by practitioners in South Devon, as part of the S&W Devon Joint Formulary Initiative, and Cheltenham & Tewkesbury Prescribing Group and modified by the PHLS South West Antibiotic Guidelines Project Team, PHLS Primary Care Co-ordinators and members of the Clinical Prescribing Sub-group of the Standing Medical Advisory Committee on Antibiotic Resistance. It was further modified following comments from Internet users. The guidance has been updated annually as significant research papers, systematic reviews and guidance have been published. The Health Protection Agency works closely with the authors of the Clinical Knowledge Summaries.

Evidence base

Grading of guidance recommendations
The strength of each recommendation is qualified by a letter in parenthesis.

Study design


Good recent systematic review of studies


One or more rigorous studies, not combined


One or more prospective studies


One or more retrospective studies


Formal combination of expert opinion


Informal opinion, other information


Letters indicate strength of evidence:
A+ = systematic review: D = informal opinion
Cold sores

  1. Sprurance SL, Nett R, Marbury T, Wolff R, Johnson J, Spaulding T. Aciclovir cream for the treatment of herpes labialis: results of two randomized, double-blind, vehicle-controlled, multicentre clinical trials. Antimicrob Agents Chemother 2002;46:2238-2243. RATIONALE: Aciclovir 5% cream reduced the mean duration and pain of an episode by about half a day.
  2.  Sprurance SL, Rea TL, Thoming C, Tucker R, Saltzman R, Boon R. Penciclovir cream for the treatment of herpes simplex labialis. A randomized, double-blind, multicentre, placebo-controlled trial. JAMA 1997;277:1374-1379. RATIONALE: Penciclovir 1% cream reduced the mean duration of cold sores by 0.7 days.
  3. Raborn GW, Martel AY, Lassonde M, Lewis MA, Boon R, Sprurance SL. Effective treatment of herpes simplex labialis with penciclovir cream: combined results of two trials. J Am Dent Assoc 2002;133:303-309. RATIONALE: Penciclovir cream reduced the mean duration of cold sores by 1 day.
  4. Arduino PG and Porter SR. Oral and perioral herpes simplex type 1 (HSV-I) infection: review of its management. Oral Dis 2006;12(3):254-70. RATIONALE: Prophylaxis with oral antivirals may be of use for those with frequent, severe episodes, or predictable triggers e.g. sunlight, or for immunocompromised individuals (i.e. at higher risk of complications). Seek specialist advice if long-term prophylaxis is being considered.

Document history

LHP version 1.0

Related information

Not supplied