Table of ContentsView AllTable of ContentsAre Cold Sores Herpes?SymptomsTransmissionTreatment
Table of ContentsView All
View All
Table of Contents
Are Cold Sores Herpes?
Symptoms
Transmission
Treatment
This article explains the similarities and differences between cold sores vs. herpes, including how you get them, what symptoms they cause, and how they are treated.
This photo contains content that some people may find graphic or disturbing.See Photoancoay/ Getty Images
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
ancoay/ Getty Images
Technically, both cold sores and genital herpes are herpes. Although many people will regard genital herpes as “herpes,” the terms “cold sore” and “genital herpes” are largely logistical. Cold sores occur on the mouth and lips; genital herpes occurs on the genitals or rectum.
But the cause of the infection can sometimes vary.
But that doesn’t mean that the viruses are indistinguishable or act exactly the same. While the two viruses share many of the same genetic and molecular characteristics, their differences influence how they cause symptoms, the transmission method, and the treatment.
Symptoms of Cold Sores vs. Herpes
During periods of reactivation, the virus will start to multiply rapidly and migrate fromspinal root nerveswhere it is embedded to the surface of the skin. Once there, the virus can cause a localized outbreak of a painful blistering rash.
Or it may not. In fact, the vast majority of people with HSV-1 and HSV-2 areasymptomatic(meaning without symptoms) and mayneverhave symptoms.
When symptoms do appear, they can vary based not only on the location of the outbreak but also on whether HSV-1 or HSV-2 is involved.
Symptoms of Cold Sores
Cold sores are mainly confined to mucous membranes of the mouth and lips but can also sometimes affect the skin of the face as well.
During reactivation, the virus will migrate up thetrigeminal nervethat services the face and cause symptoms in three characteristic stages:
Symptoms vary depending on whether this is your first or recurrent outbreak. If it is your first, the sores can take two to three weeks to fully heal. Subsequent outbreaks tend to be shorter.
Symptoms of Genital Herpes
This photo contains content that some people may find graphic or disturbing.See PhotoReproduced with permission from © DermNetdermnetnz.org2023.
Reproduced with permission from © DermNetdermnetnz.org2023.
Genital herpes is also mainly confined to mucous membranes of the genitals and rectum but can also affect the surrounding skin.
During reactivation, the virus will migrate up thelumbosacral dorsal root gangliaof the lower spine and cause symptoms in a similar pattern as with cold sores:
Symptoms again will vary based on whether this is your first or recurrent outbreak. If this is your first outbreak, the sores can take four to five weeks to heal. Subsequent outbreaks tend to be shorter and less severe.
How They Differ
Studies have shown that 80% of people with HSV-2 genital herpes experience recurrence, whereas less than 20% of those with HSV-1 genital herpes experience recurrence.
Transmission of Cold Sores vs. Herpes
Both cold sores and genital herpes are highly contagious. Herpes is transmitted when the virus passes through broken skin or throughmucous membranesthat are far more porous.
During periods of reactivation, the virus can be passed not only through contact with sores but also through skin-to-skin contact with people who is otherwise asymptomatic.
This latter phenomenon, called asymptomatic shedding, occurs when a virus passes through the intact skin of someone who may not even be aware they have been infected.
There are specific routes of infection for cold sores and genital herpes as well as common ones, like oral sex.
What Causes Cold Sores?
In addition to open sores, HSV-1 is found in high concentrations in saliva. Because of this, oral herpes can be passed through:
HSV-2 can also be passed from the genitals to the mouth during oral sex, although this is less common.
What Causes Genital Herpes?
HSV-2 is passed through vaginal sex, anal sex, or oral sex. While uncommon, the virus may also be passed through shared sex toys.
While HSV-2 is considered the primary cause of genital herpes, an increasing number of infections are attributed to HSV-1 due to oral sex.
Is There a Cure for Herpes? Treatments and Outlook
The same is not seen with HSV-2 and cold sores. Statistics suggest that HSV-2 is less likely to cause oral herpes. This may be due to the fact that many people will have gotten HSV-2 through sex and will already be immune to the virus.
Moreover, unless the skin of the lips is broken, HSV-2 may have a harder time establishing an infection compared to the porous tissues of the genitals.
Even with an HSV-2 genital herpes infection, the odds of an isolated non-genital outbreak (such as on the buttocks or thighs only) are pretty low.
Treatment of Cold Sores vs. Genital Herpes
There is no cure for HSV-1 or HSV-2 or any vaccines to protect against them. However, there are topical or oralantiviralsthat can reduce the severity and duration of an outbreak.
The antivirals most commonly prescribed are:
For people with frequent outbreaks, the drugs may be prescribed daily at a low dose to reduce the risk of recurrence as well as the risk of infecting others. This is calledherpes prophylaxis.
The way in which the drugs are used can vary based on the location of the outbreak, the frequency of the outbreak, and whether you have HSV-1 or HSV-2.
Treatments That Heal Herpes Sores Faster
How Do You Treat Cold Sores?
Valtrex is most commonly used to treat cold sores but Famvir can also be used. The drugs are generally prescribed as follows;
An over-the-counter option is a topical cream calledAbreva (docosanol)which can help shorten the length of an infection.
How Do You Treat Genital Herpes?
Zovirax, Valtrex, and Famvir appear equally effective for the treatment of genital herpes. The drugs are generally prescribed as follows:
While genital herpes is not treated with topical antivirals, a topical anesthetic called lidocaine 5% ointment can be used to help ease the pain.
Beyond the obvious difference in dosages, the treatment of HSV-1 and HSV-2 can also vary if you are at risk of infecting a sexual partner. In such cases, you may be prescribed herpes prophylaxis if you are at risk of frequent recurrence.
In people with genital herpes, HSV-1 is far less likely to recur and will often be a once-off event. This is not the case with HSV-2 which recurs in most people.
Determining which type of HSV you have—using anantibody blood test—can influence the decision as to whether herpes prophylaxis is needed at not. If treatment is indicated, Valtrex is commonly prescribed as a 500-mg daily dose.
Summary
Even so, HSV-1 is known to cause genital herpes in people who have oral sex. Less commonly, HSV-2 can be passed through oral sex and cause a cold sore. Without testing, it may be impossible to tell which type you have.
HSV-2 is far more likely to cause recurrence than HSV-1. It also is treated more aggressively and may require daily antiviral drugs to reduce the frequency and severity of outbreaks as well as the risk of infecting others.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Dermatology Association.Herpes simplex: Overview.Centers for Disease Control and Prevention.About genital herpes.MedlinePlus.Herpes - oral.MedlinePlus.Genital herpes.Sauerbrei A.Optimal management of genital herpes: Current perspectives.Infect Drug Resist.2016 Jun 13;9:129-41. doi:10.2147/IDR.S96164McQuillan G Kruszon-Moran G, Flagg WE, Paulose-Ram R.Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14–49: United States, 2015–2016.NCHS Data Brief No. 304. 2018.American Academy of Dermatology Association.Herpes simplex: Who gets and causes.Ayoub H, Chemaitelly H, Abu-Raddad LJ.Characterizing the transitioning epidemiology of herpes simplex virus type 1 in the USA: Model-based predictions.BMC Med.2019;17:57. doi:10.1186/s12916-019-1285-xVassantachart JM, Menter A.Recurrent lumbosacral herpes simplex virus infection.Proc (Bayl Univ Med Cent).2016 Jan;29(1):48–9. doi:10.1080/08998280.2016.11929356American Association of Dermatology Association.Herpes simplex: diagnosis and treatment.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Dermatology Association.Herpes simplex: Overview.Centers for Disease Control and Prevention.About genital herpes.MedlinePlus.Herpes - oral.MedlinePlus.Genital herpes.Sauerbrei A.Optimal management of genital herpes: Current perspectives.Infect Drug Resist.2016 Jun 13;9:129-41. doi:10.2147/IDR.S96164McQuillan G Kruszon-Moran G, Flagg WE, Paulose-Ram R.Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14–49: United States, 2015–2016.NCHS Data Brief No. 304. 2018.American Academy of Dermatology Association.Herpes simplex: Who gets and causes.Ayoub H, Chemaitelly H, Abu-Raddad LJ.Characterizing the transitioning epidemiology of herpes simplex virus type 1 in the USA: Model-based predictions.BMC Med.2019;17:57. doi:10.1186/s12916-019-1285-xVassantachart JM, Menter A.Recurrent lumbosacral herpes simplex virus infection.Proc (Bayl Univ Med Cent).2016 Jan;29(1):48–9. doi:10.1080/08998280.2016.11929356American Association of Dermatology Association.Herpes simplex: diagnosis and treatment.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Dermatology Association.Herpes simplex: Overview.Centers for Disease Control and Prevention.About genital herpes.MedlinePlus.Herpes - oral.MedlinePlus.Genital herpes.Sauerbrei A.Optimal management of genital herpes: Current perspectives.Infect Drug Resist.2016 Jun 13;9:129-41. doi:10.2147/IDR.S96164McQuillan G Kruszon-Moran G, Flagg WE, Paulose-Ram R.Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14–49: United States, 2015–2016.NCHS Data Brief No. 304. 2018.American Academy of Dermatology Association.Herpes simplex: Who gets and causes.Ayoub H, Chemaitelly H, Abu-Raddad LJ.Characterizing the transitioning epidemiology of herpes simplex virus type 1 in the USA: Model-based predictions.BMC Med.2019;17:57. doi:10.1186/s12916-019-1285-xVassantachart JM, Menter A.Recurrent lumbosacral herpes simplex virus infection.Proc (Bayl Univ Med Cent).2016 Jan;29(1):48–9. doi:10.1080/08998280.2016.11929356American Association of Dermatology Association.Herpes simplex: diagnosis and treatment.
American Academy of Dermatology Association.Herpes simplex: Overview.
Centers for Disease Control and Prevention.About genital herpes.
MedlinePlus.Herpes - oral.
MedlinePlus.Genital herpes.
Sauerbrei A.Optimal management of genital herpes: Current perspectives.Infect Drug Resist.2016 Jun 13;9:129-41. doi:10.2147/IDR.S96164
McQuillan G Kruszon-Moran G, Flagg WE, Paulose-Ram R.Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14–49: United States, 2015–2016.NCHS Data Brief No. 304. 2018.
American Academy of Dermatology Association.Herpes simplex: Who gets and causes.
Ayoub H, Chemaitelly H, Abu-Raddad LJ.Characterizing the transitioning epidemiology of herpes simplex virus type 1 in the USA: Model-based predictions.BMC Med.2019;17:57. doi:10.1186/s12916-019-1285-x
Vassantachart JM, Menter A.Recurrent lumbosacral herpes simplex virus infection.Proc (Bayl Univ Med Cent).2016 Jan;29(1):48–9. doi:10.1080/08998280.2016.11929356
American Association of Dermatology Association.Herpes simplex: diagnosis and treatment.
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