Saturday 17 March 2018

Ask the GP: An annoying virus and body-boosting bacteria


Nina Byrnes

Q: I developed a cold sore recently. I have never had them before so I was horrified to see one. What causes them and does this mean I will have them for life?

Dr Nina replies: Herpes simplex 1 virus is the common cause of cold sores. It is estimated that up to 60pc of the population have been exposed to the HS1 virus but not everyone develops cold sores.

HS1 virus is passed on by close contact with someone who is actively shedding the virus. The most common mode of transmission is by kissing someone; 90pc of people have contracted HS1 from someone who didn't know they had it at the time. Once a person has contracted the virus it then lies dormant in nerve cells but can be activated repeatedly over a lifetime due to a number of triggers.

The main cause of a cold sore flare is usually a dip in the immune system. This may occur during other colds or viral infections. Other possible triggers include exposure to UV light (sun exposure), stress, fatigue, menstruation, or poor nutrition.

Cold sores most commonly occur around the lips but can spread to other parts of the face or body. Symptoms commonly start with pain or tingling around the lip. This is followed a few days later by the development of painful red blisters, which ultimately break, ooze and then form a yellowish crust. The usual duration of a flare is 10 to 14 days.

Cold sores are highly contagious from the time they flare until the skin has fully crusted over and is healed. If you suffer with these it is important to avoid close contact with infants, those who suffer with eczema and dermatitis, or those whose immune function may be reduced. This would include those undergoing treatment for cancer, transplant patients or those with HIV. These people are at risk of severe complications if they contract HS1.

There is currently no cure for HS1 but there are a number of treatments, which can shorten the course of a flare and reduce the chance of reoccurrence. Antiviral creams such as acyclovir can be helpful if applied at the first sign of a flare and can be purchased without a prescription at your local pharmacy. If symptoms are severe or if sores are near the eye, it is important to see your GP, as prescription antiviral tablets will be required. This medication may also be prescribed to reduce the chance of flares in those with reoccurring infection. Cold sores can also cause pain. Simple painkillers such as paracetamol or ibuprofen may help. It is important to resist squeezing or picking the sores.

In order to prevent spreading cold sores, avoid close contact with people while the sore is present, don't share razors, lip balm or face towels, wash hands frequently and be careful not to touch other parts of the body after touching the sores. Try and identify and avoid your personal triggers and wear sunscreen to reduce exposure to UV rays. Some suggest that taking the amino acid lysine helps reduce reoccurrence.

Ultimately, if a sore does appear, try not to become too stressed. They may make you self-conscious but cold sores flare and then settle. They will go away.

Q. Is taking good bacteria important? They seem to be advertised everywhere as  essential to good health. Is there any proof they work? What is the best way to take them and how will they help?

Dr Nina replies: Probiotics, commonly referred to as ‘good bacteria’, are live microorganisms, either the same or similar to those found in the body, that scientific research has found to be beneficial to health. Probiotics are not new. They are the live active cultures found in yoghurt and cheese and we have been consuming them for years. The recent change is that they are now available in drinks, capsules and even health bars. Different strains of probiotics may provide different benefits.

Probiotics are most commonly used to promote digestive health. Taking these may help regulate bowel motions and help reduce bloating and wind associated with irritable bowel syndrome. Ulcerative colitis and Crohn’s cause inflammation of the intestines, which may come and go. Studies have suggested that gut bacteria may play a role in these conditions, reducing inflammation and delaying flares.

Probiotics have been shown in studies to help shorten cases of infectious diarrhoea especially in babies and small children. Taking probiotics when you are taking an antibiotic may also help reduce the chance of antibiotic-related diarrhoea.

The pill, childbirth, menstruation and menopause all cause hormonal change which may alter normal urogenital bacteria. Taking probiotics may help in this instance. 

Probiotics are considered generally safe but may not be suitable for those with reduced immune systems or in the elderly and they may interact with some medication. Their production is unregulated so strength and purity may differ. They are not routinely recommended in healthy individuals.

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