HSV-1 vs. HSV-2: What’s the Difference Between the Herpes Viruses?

Patient Expert

Cold sores are so common that you can find treatments for them next to lip balms at local convenience stores. But what many fail to realize is that cold sores are caused by the herpes simplex virus, also known as HSV-1. When people discover that herpes and cold sores are interchangeable terms, fear may set in due to the uncomfortable stigma associated with the herpes virus. But further educating yourself and others can make the experience of having any form of the herpes virus much more manageable.

What are the different types of herpes?

The herpes simplex viruses that cause cold sores and genital herpes are part of a larger family of viruses, known as herpesviridae. According to the NIH, there are eight known members in this family that “commonly infect humans, and close to 100 percent of the adult population is infected with at least one.” The five types that cause the most concern are:

1. Herpes simplex virus (HSV) type 1 — HSV-1 is also known as herpes labialis, cold sores, or oral herpes. It is mainly spread through oral-to-oral contact, but in recent years, the NIH notes that there has been a documented rise in the frequency of genital herpes caused by HSV-1. This is likely because of an increase in oral sex, leading to more oral-to-genital contact. Those with HSV-1 who engage in unprotected oral sex with a partner are at risk for spreading the virus.

2. Herpes simplex virus (HSV) type 2 — This type is associated with outbreaks of blisters on the mucosal membrane of the genitals; in rare occurrences, HSV-2 has been documented to cause blisters in and around the mouth.

3. Epstein-Barr virus (EBV) — This is typically found in children and is spread through bodily fluids. This strain is responsible for causing infectious mononucleosis (“mono”).

4. Cytomegalovirus (CMV) — CMV is a common infection that typically shows no symptoms. It is so common that by age 40, nearly 50 to 80 percent of American adults have a CMV infection.

5. Varicella zoster virus (VZV) — VZV is more commonly known as the chickenpox in children and shingles in adults. It’s defined as an outbreak of rash or blisters on the skin that can cause itching or pain.

People may have knowledge of most of these viruses by their more common names, even if they aren’t aware of the clinical terms used for them. Despite the fact that these viruses come from the same virus family, much stigmatization and questioning still exists around the term “herpes.”

How do I know if I have HSV-1 or HSV-2?

There is no way to determine which type of herpes simplex you have based on appearance alone. You can find out which type you have though serological (blood) testing or, if you have visible symptoms, by taking a culture (swab) of a skin sore. Many people show no symptoms at all and are considered asymptomatic carriers.

Which test should I ask for?

According to the American Sexual Health Association, a culture taken within 48 hours of your first herpes outbreak will yield the most reliable results. A culture retrieved beyond this period or during a later outbreak is more likely to yield a false negative result.

Although the CDC currently does not recommend testing for herpes when there are no symptoms present, blood testing can provide you with an accurate result without the presence of sores. The most accurate blood test detects IgG antibodies of the herpes virus. An antibody is the body’s immune response to the virus, since the virus itself is undetectable in the bloodstream. Antibodies take a longer period of time to develop, so it's possible for someone to have herpes lesions yet test negative on an IgG blood test. It is recommended that a second test be done 12 weeks after the first outbreak to be sure.

Is there a difference between cold sores and genital sores?

As mentioned earlier, while each variation of the virus may have a “preference” for a specific area, either form can make a home orally or genitally. Once either strain enters your body, it remains dormant there for life. Typically, HSV-1 settles in nerves on the base of the neck, while HSV-2 stays close to the base of the spine. HSV-1 statistically has a lower chance of recurrences than HSV-2, but HSV-2 symptoms have been shown to become less severe as time passes. Beyond these differences, the largest difference between these two is the stigma associated with genital herpes.

How are HSV-1 and HSV-2 transmitted?

HSV-1 can be spread through the skin through oral-to-oral contact, or through oral-to-genital contact. It is rare, but not impossible, for someone who is already infected orally with HSV-1 to contact it genitally. Genital HSV-1 may also be transmitted from a mother to child during a vaginal birth.

HSV-2 is mostly spread through sexual contact of the genitals, anus, and sores or fluids. It is important to note that even skin that appears normal is still able to spread the virus to a partner through what is called asymptomatic shedding. Like HSV-1, mothers with HSV-2 may transfer the virus through childbirth.

Is one virus ‘better’ than the other?

Although incurable, both viruses are treatable and manageable in day-to-day life. Beyond this fact, each person’s body chemistry and immune system are unique, and although the virus strains have their preferences, they are not set in stone. Developing awareness of your own body and becoming educated about the herpes simplex virus strains can help you make more sensible decisions and help defeat the stigma of a member of the herpesviridae family.

See more helpful articles:

How I Found the Positives in a Positive Herpes Diagnosis

STD vs. STI: Is there a difference?

Just Been Diagnosed with Herpes? Read This