Herpes is a general term used to describe both oral herpes (also known as herpes labialis) and genital herpes. While these conditions may go by this same name in casual conversation and have some similarities, each is caused by a different type of the herpes simplex virus (HSV).
HSV-2, or type 2, is thought to almost exclusively cause genital sores.
In both cases, the herpes virus enters the epidermis—the outermost layer of the skin—and causes lesions to develop. These lesions are open, have a tendency to recur, are spread by skin-to-skin contact, and can be managed with (though not cured by) antiviral therapy.
Though the sores can be quite profound, some people with these infections may exhibit no symptoms at all. In fact, many people who have been infected with herpes will never have a noticeable outbreak.
Here's a snapshot of the main differences between HSV-1 and HSV-2. Read on for more details about these two infections.
Most often affects lips and mouth area
Often spreads by kissing or sharing cups
Pain, burning, itching may occur before sores appear
Lesions range from slightly raised, reddish areas to crusted blisters
Now causes more than half of all cases of genital herpes (spread by oral sex)
Affects genital area
Spreads by sexual contact and also from mothers to babies during childbirth
Sometimes has no symptoms prior to breakout
Lesions are red, fluid-filled, or crusty
Outbreaks generally become less frequent over time
HSV types 1 and 2 both cause blistery, red sores, but the two infections have some differences.
- Slightly raised, reddish areas
- A group of small, fluid-filled blisters appearing on a red area of skin
- Blisters that quickly develop a crust on them
t may hurt to eat, drink, talk, or pee, depending on the location and severity of a cold sore. Children may develop a mild fever and swollen glands in their neck when they are first exposed to the HSV type 1 virus.
HSV type 2, on the other hand, does not always cause symptoms, particularly in men. When it does, symptoms typically include pain in or around the vagina or penis. The pain may be more noticeable when urinating or during sexual activity. Sores may appear red, fluid-filled, or crusty, and they may appear, resolve, and recur for years unless they are treated.
The viruses that cause herpesare highly contagious and transmitted by direct contact.
HSV type 1 is spread by contact such as kissing or sharing cups, which makes it difficult to identify where you might have acquired the infection. Because of the mode of transmission, it's easy for people of all ages to acquire the infection. About 85 percent of the population is infected with HSV type 1 at some time. HSV-1 can also be transmitted via oral sex. More than half of all cases of genital herpes are now caused by HSV type 1.
HSV type 2 is sexually transmitted, so only those who engage in sexual contact with someone who has the virus are at risk. HSV-2 is less common, though many people who have it do not know that they are infected—and potentially passing it along to others. Pregnant women can also transmit HSV type 2 to their babies during birth, sometimes with serious consequences. The greatest risk of transmission during birth is for women who become infected with HSV type 2 during pregnancy.
While the above is true for most cases of herpes, it is possible to have an HSV type 2 infection of the mouth or an HSV type 1 infection of the genital area. This can occur with transmission through oral sex. In these instances, it is not possible to distinguish which virus you have based on your symptoms, as they are very similar. It may be possible to tell if you take a type-specific herpes blood test and are only positive for one type of the virus.
Cold sores are also known as "fever blisters" as they often recur when you have an infection or a fever. Generally, an illness, emotional stress, or physical trauma can cause reactivation of HSV type 1 or 2. If your immune system is impaired, whether due to illness or medication, you also have a greater chance or reactivation of HSV type 1 or 2.
Because of the location and look of cold sores, HSV type 1 lesions are often recognized by patients themselves (or, in the case of children, parents or teachers). Doctors can make a diagnosis based on the same signs and symptoms.
You can also recognize HSV type 2 by its appearance. However, because many people do not have symptoms, testing may be needed to confirm a diagnosis of genital herpes.
Tests, which can distinguish between HSV-1 and HSV-2, include:
- Viral cultures: A sample is collected by brushing a swab on a sore (if you have one) and the material is grown in a lab to look for viral activity.
- Antibody test: If you do not have any lesions, you may still have the virus. This blood test can look for proteins your body creates in response to infection with either type of HSV. That said, dormant infections, rather than just active ones, can deliver a positive result.
- Blood test for the virus: You can also have a blood test that identifies the virus itself. However, this type of test, unlike the antibody test, is not very sensitive and may come back negative even when having the infection.
Herpes simplex virus infections generally do not completely go away, although the sores appear and resolve periodically. Treatment for both types is generally focused on comfort, though that of HSV-2 is also centered on reducing the spread to sexual partners and preventing the transmission of the infection to newborns (if applicable).
Treatment of Cold Sores
Untreated cold sores usually go away in seven to 10 days. Cold sores can be treated with either topical or oral (by mouth) antiviral medications.
Medications aren't always needed, but they can help the sores heal more rapidly and decrease pain, if necessary.
Initial infections are often treated with oral antiviral medications, whereas recurrences are often treated with topical antivirals. Topical medications are not thought to be as effective in treating cold sores if symptoms are severe.
Medications currently available for cold sore treatment include Zovirax (acyclovir), Famvir (famciclovir), Valtrex (valacyclovir), and Abreva (benzalkonium).
Treatment of Genital Herpes
Genital herpes is treated with antiviral therapy, and treatment is recommended for people who are experiencing a first outbreak or recurrent ones.
Treatment may involve Zovirax (acyclovir), Famvir (famciclovir), or Valtrex (valacyclovir), and dosing will depend on your treatment needs as determined by your doctor.