Remember that your patient may feel ashamed or embarrassed about the cold sore outbreak, so offer assistance as discreetly as possible.

Begin the conversation by introducing yourself, offer good eye contact and a smile. Reassure your patients that cold sores are a common condition and let them know that they are very contagious. Counsel them on ways to reduce the risk of transmitting the virus. Be careful however when using the term "herpes", because this word itself can cause additional embarrassment and confusion.

Before making any treatment recommendations the following questions may help counseling effectiveness:

• Have you had these lesions before?
• How often do you get these lesions?
• Where do they occur?
• How do they begin? What triggers an episode?
• Can you tell when these lesions are coming on?
• How long do they last?
• Do you have any other skin conditions or a rash?
• Do you have a medical condition that may affect your immune system?
• Do you currently have an elevated temperature?
• Have you had a recent bout with the flu or an upper respiratory infection?
• Are you taking any medications?

Cold sore sufferers will usually give you enough information to help you make the right treatment decision. Refer your patient to a physician if:

• They have not been previously diagnosed with a cold sore.
• They are deemed at risk (as with the elderly, or those who are immunocompromised)
• Their lesions are accompanied by other symptoms, such as a fever or rash, or are occurring somewhere other than the lip area.

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