HSV-1 and HSV-2 Both Cause Herpes — Does the Difference Matter?

HSV-1 transmission

HSV-1 is usually spread through:

• Saliva: The virus can be present in someone’s saliva, even when they don’t have any active symptoms or sores.

• Contact with someone who has open sores: For example, kissing can pass the virus to someone’s mouth. And oral sex can pass the virus to someone’s genitalia.

• Contact between your own sores and different parts of your body: This can happen if you touch your mouth and then touch your genitals or anal area.

• Contact with a contaminated object: You can get HSV-1 by coming into contact with contaminated objects, such as drinks or razors. However, this is much less common, since the virus doesn’t survive on surfaces for long.

• High-contact sports: The virus can be transmitted while playing high-contact sports, like rugby and wrestling.

A person with HSV-1 may not have any sores in the mouth or genital areas and still pass the virus to someone else. This is called asymptomatic shedding. When this happens, the virus is usually spread through saliva.

HSV-2 transmission

HSV-2 transmission is similar. It’s usually spread by: 

• Direct contact with an open sore or blister from a person with the infection

• Contact between your own sores and different parts of the body 

• Sexual intercourse

• Mother to child during birth

HSV-2 can also be spread when a person with the infection has no symptoms or visible sores. Asymptomatic shedding can happen through saliva or genital fluids.

Oral herpes symptoms

Symptoms of oral herpes infection typically occur within 1 to 3 weeks from the time of infection:

• Before you notice any sores or blisters, you may feel tired, lose your appetite, or even have a fever. 

• The first noticeable symptom is usually a cold sore or blister, which can form on the gums, lips, mouth, or throat. 

• Some people may also have a sore throat, or pharyngitis. 

Symptoms may last up to 3 weeks before they completely resolve. 

Genital herpes symptoms

Symptoms of a genital herpes infection usually occur within 2 to 14 days from the time of infection. Before blisters appear, there may be tingling, burning, or itchy feelings. 

Other symptoms include:

• A decrease in appetite, muscle aches, and fever

• Tender lymph nodes and pain with urination

• Painful sores or blisters on the genitals or around the anus

Blisters typically last for 1 to 2 weeks and then go away.

Herpes symptoms in children

Herpes can also occur in children. In children, HSV is usually caused by HSV-1. Symptoms will likely appear 1 to 2 days after infection. 

Some children experience a cold or flu-like illness before the sores are noticeable. Sores and blisters typically form in clusters around the mouth and lips. The sores typically last about 1 week.

Frequency in HSV-1 vs. HSV-2 outbreaks

The frequency of outbreaks vary from person to person. Outbreaks are more common with HSV-2 infection. If an outbreak happens, symptoms usually start with itching or burning in the area where the sores will appear. 

Compared to the initial infection, symptoms are usually less severe and shorter in duration in following outbreaks. 

Causes of herpes outbreaks

Many things can lead to an outbreak:

• Increased stress (emotional or physical)

• Pregnancy 

• Any type of illness

• A weakened immune system

• Sunlight (This can be a trigger for someone with oral herpes.)

A swab test

A licensed healthcare professional can swab an open sore to collect fluid and skin cells. This sample can then be used for:

• A viral culture test: This test uses cells from the sample, then grows them in a lab to see if HSV is present. It can take several days to get results.

• A PCR test: PCR is short for polymerase chain reaction. It tests for genetic material from the swab sample. It’s usually quicker than the culture.

Both of these tests require an open sore or blister for testing. The swab itself is gentle and usually painless.

A blood test

The second test is a blood test, which looks for HSV antibodies. The body makes these antibodies in response to infection, and will make different antibodies for HSV-1 versus HSV-2. 

This test can be done with or without sores or blisters present. But it does require a blood draw, which can be uncomfortable for some people.

It’s also important to note that a person with HSV-2 has a higher risk for HIV infection. If you’re being tested for genital herpes, consider asking a healthcare professional for an HIV test, too. This can be done at the same time as a blood test for HSV.

Medications for HSV-1 and HSV-2

Antiviral medication is the most effective way to treat and prevent outbreaks. These prescription medications include:

• Valacyclovir (Valtrex), which is taken 2 times a day 

• Acyclovir (Zovirax), which is taken 5 times a day 

Both medications are effective. Many people prefer valacyclovir, since you only have to take it twice a day. But it’s often more expensive than acyclovir. The duration of treatment depends on the severity of your infection. It also depends on whether it’s your initial infection or an outbreak.

Most people take these medications only when they get an outbreak. But people who experience frequent outbreaks can also take a lower dose every day to prevent an outbreak from happening. 

At-home methods to soothe an HSV infection

Antiviral medications treat the infection. But the following options can also help with pain:

• A warm bath 

• Wearing loose clothing

• Over-the-counter (OTC) pain medications

• OTC creams

Scientists are also looking into vaccines to help prevent HSV or treat symptoms, but these aren’t yet available.

References