Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPreventionFAQs
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Prevention
FAQs
Herpes simplex virus type 1 (HSV-1)andherpes simplex virus type 2 (HSV-2)are two highly contagious viruses that can cause outbreaks of watery blisters on the skin andmucous membranesof the mouth, lips, nose, genitals, rectum, and eyes.
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Today, there is an increasing crossover between the two herpes types, and only diagnostic testing can reveal which virus is causing which type of infection. Differentiating the two can be important as the treatment approach for each can differ significantly.
This article looks at the differences and similarities between HSV-1 and HSV-2, including their symptoms and causes and how each is diagnosed and treated.
In most cases, HSV-1 is passed through mouth-to-mouth contact, causing oral herpes (also known asherpes labialis), while HSV-2 is almost exclusively passed through sexual contact, causing genital herpes (orherpes genitalis).
Beyond the location of the outbreak, the symptoms of HSV-1 and HSV-2 are largely indistinguishable.
In symptomatic people, HSV-1 and HSV-2 both develop in characteristic stages:
Is It HSV-1 or HSV-2?
One key difference between HSV-1 and HSV-2 is the risk of recurrence. All herpes viruses tend to recur (repeat) after the initial outbreak, often within the first year. But, with a genital herpes outbreak, HSV-1 is 80% less likely to recur within a year.In some cases, you would only have one outbreak with no recurrence.
In contrast, recurrence is common with HSV-2. If left untreated, some people may experience recurrent outbreaks anywhere from one to 12 times per year. Moreover, the recurrent episodes tend to be far more severe than with HSV-1 and can persist for many years.
Genital Herpes Statistics You Should Know
HSV-1 and HSV-2 belong to a family of viruses called Herpesviridae,which also includes thevaricella-zoster virus (VZV)cauaingchicken poxandshingles.
As with VZV, HSV-1 and HSV-2 are never cleared from the body after the infection. Instead, the viruses embed themselves in nerve cells, where the viruses remain in a latent (dormant) state. In some people, HSV-1 and HSV-2 can spontaneously reactivate and cause a new outbreak of oral or genital herpes.
During reactivation, a process known as viral shedding occurs in which the herpes virus starts to multiply and migrate to the skin at the site of the initial infection. It is then that the virus can be transmitted (passed) to others through close physical contact.
The transmission can occur both when there are visible sores and also when a person with HSV-1 or HSV-2 is asymptomatic. This is known as asymptomatic shedding.
In fact, according to the Centers for Disease Control and Prevention (CDC), the transmission of HSV-2 most often occurs when a person is asymptomatic and may not even realize they have the virus.
While the same can occur with HSV-1, a genital HSV-2 infection is substantially more severe in terms of recurrences and viral shedding. With HSV-2, high rates of shedding can occur years after the first outbreak. Shedding with HSV-1 tends to wane quickly, and it becomes less transmissible.
How Common Is HSV-1 and HSV-2?
More than half of all adults in the United States have HSV-1, while nearly 1 in 7 sexually active adults have HSV-2. The prevalence of both increases with age.
Differences Between HSV-1 and HSV-2
While the mechanisms of transmission are similar, HSV-1 and HSV-2 vary in several key ways, including:
How Do You Get Herpes?
Diagnosis of HSV-1 and HSV-2
HSV-1 and HSV-2 are both diagnosed in the same way and with the same tools. The tests are commonly used to:
Newer herpes tests can detect herpes and differentiate between HSV-1 and HSV-2, the differentiation of which may influence the treatment plan.
What Does a Herpes Sore Look Like?
Types of Tests
Herpes testing is usually done as a swab test, a blood test, or alumbar puncture(spinal tap). The test you get will depend on the type of symptoms you have:
CDC Screening RecommendationsThe CDC recommends testing for all people with genital herpes symptoms to confirm if they have herpes. The CDCdoes notrecommend testing for those without symptoms as doing so has not been shown to alter risk behaviors or slow the spread of the virus.
CDC Screening Recommendations
The CDC recommends testing for all people with genital herpes symptoms to confirm if they have herpes. The CDCdoes notrecommend testing for those without symptoms as doing so has not been shown to alter risk behaviors or slow the spread of the virus.
HSV blood testing may be useful if:
How Herpes Is Diagnosed
HSV-1 and HSV-2 are both treated withantiviral drugs. The drugs don’t “cure” herpes but rather prevent the virus from binding to and infecting healthy cells.
There are three oral antivirals approved for the treatment of HSV-1 and HSV-2:
While these drugs can treat both HSV-1 and HSV-2,howthey are used can vary significantly based on which virus is involved and whether it is a first or subsequent outbreak.
For instance, if you have a cold sore, your healthcare provider will likely forego testing and prescribe a course of antivirals to shorten the duration and severity of the infection.
The same may not be true if you have genital herpes. While the differentiation of HSV-1 and HSV-2 won’t necessarily alter the course of treatment, particularly during a first outbreak, it can when there is a recurrence.
According to the CDC, genital HSV-1 and HSV-2 should be treated in the following manner for first and recurrent episodes:
How Herpes Is Treated
With HSV-1, which is mainly spread through oral contact, this means avoiding kissing and any other contact with a cold sore.
As HSV-2 is almost exclusively passed through sex, the same rules regarding abstinence, condoms, and dental dams apply. If you have HSV-2 and are prone to frequent recurrence, speak with your healthcare provider about daily suppressive antiviral therapy to reduce the risk of transmission.
How to Prevent Genital Herpes and Cold Sores
Summary
Herpes simplex virus type 1 (HSV-1) is more commonly associated with oral herpes (cold sores), while herpes simplex virus type 2 (HSV-2) is more commonly associated with genital herpes. Even so, HSV-1 is increasingly linked to genital herpes due to oral sex.
While the symptoms of HSV-1 and HSV-2 are indistinguishable. HSV-2 is more likely to recur and cause high levels of viral shedding years after the initial infection. Moreover, with HSV-2 especially, viral shedding can occur with no symptoms, meaning that the virus can be passed without a person even realizing they have herpes.
This is why screening is recommended for all people with genital herpes symptoms. The differentiation of HSV-1 and HSV-2 can influence the treatment plan, especially when there are frequent recurrences.
Frequently Asked Questions
If you have herpes simplex virus type 2 (HSV-2), the type most commonly associated with genital herpes, the likelihood of recurrence is high. According to the CDC, between 70% and 80% of people with a first genital herpes outbreak will have future outbreaks.
Learn MoreHow to Prevent Sexually Transmitted Infections
15 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.World Health Organization.Herpes simplex virus.Ayoub HH, Chermaitelly 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-xCenters for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021: genital herpes.National Institutes of Health.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: herpes simplex virus.Sauerbrei A.Herpes genitalis: diagnosis, treatment and prevention.Geburtshilfe Frauenheilkd.2016;76(12):1310–1307, doi:10.1055/s-0042-116494Looker KJ, Magaret AS, May MT, et al.Global and regional estimates of prevalent and incident herpes simplex virus type 1 infections in 2012.PLoS One.2015;10(10):e0140765. doi:10.1371/journal.pone.0140765Sauerbrei A.Optimal management of genital herpes: current perspectives.Infect Drug Resist. 2016;9:129-141. doi:10.2147/IDR.S96164Centers for Disease Control and Prevention.Genital herpes – CDC detailed fact sheet.Whitley RJ, Hook EW.Shedding patterns of genital herpes simplex virus infections.JAMA.2022;328(17):1710-1711. doi:10.1001/jama.2022.18930McQuillan G, Kruszon-Moran D, Flagg EW, Paulose-Ram R.Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14-49: United States.NCHS Data Brief. 2018;(304):1-8.Nath P, Kabir A, Doust SK, Ray A.Diagnosis of herpes simplex virus: laboratory and point-of-care techniques.Infect Dis Rep.2021;13(2):518–539. doi:10.3390/idr13020049Galen BT.Screening cerebrospinal fluid prior to herpes simplex virus PCR testing might miss cases of herpes simplex encephalitis.J Clin Microbiol.2017;55(10):3142–3143. doi:10.1128/JCM.01129-17Whitley R, Baines J.Clinical management of herpes simplex virus infections: past, present, and future.F1000Res.2018;7:F1000 Faculty Rev-1726. doi:10.12688/f1000research.16157.1Chi CC, Wang SH, Delamere FM, et al.Interventions for prevention of herpes simplex labialis (cold sores on the lips).Cochrane Database Syst Rev.2015;2015(8):CD010095. doi:10.1002/14651858.CD010095.pub2Centers for Disease Control and Prevention.Fact sheet for public health personnel: condom effectiveness.
15 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.World Health Organization.Herpes simplex virus.Ayoub HH, Chermaitelly 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-xCenters for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021: genital herpes.National Institutes of Health.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: herpes simplex virus.Sauerbrei A.Herpes genitalis: diagnosis, treatment and prevention.Geburtshilfe Frauenheilkd.2016;76(12):1310–1307, doi:10.1055/s-0042-116494Looker KJ, Magaret AS, May MT, et al.Global and regional estimates of prevalent and incident herpes simplex virus type 1 infections in 2012.PLoS One.2015;10(10):e0140765. doi:10.1371/journal.pone.0140765Sauerbrei A.Optimal management of genital herpes: current perspectives.Infect Drug Resist. 2016;9:129-141. doi:10.2147/IDR.S96164Centers for Disease Control and Prevention.Genital herpes – CDC detailed fact sheet.Whitley RJ, Hook EW.Shedding patterns of genital herpes simplex virus infections.JAMA.2022;328(17):1710-1711. doi:10.1001/jama.2022.18930McQuillan G, Kruszon-Moran D, Flagg EW, Paulose-Ram R.Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14-49: United States.NCHS Data Brief. 2018;(304):1-8.Nath P, Kabir A, Doust SK, Ray A.Diagnosis of herpes simplex virus: laboratory and point-of-care techniques.Infect Dis Rep.2021;13(2):518–539. doi:10.3390/idr13020049Galen BT.Screening cerebrospinal fluid prior to herpes simplex virus PCR testing might miss cases of herpes simplex encephalitis.J Clin Microbiol.2017;55(10):3142–3143. doi:10.1128/JCM.01129-17Whitley R, Baines J.Clinical management of herpes simplex virus infections: past, present, and future.F1000Res.2018;7:F1000 Faculty Rev-1726. doi:10.12688/f1000research.16157.1Chi CC, Wang SH, Delamere FM, et al.Interventions for prevention of herpes simplex labialis (cold sores on the lips).Cochrane Database Syst Rev.2015;2015(8):CD010095. doi:10.1002/14651858.CD010095.pub2Centers for Disease Control and Prevention.Fact sheet for public health personnel: condom effectiveness.
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.
World Health Organization.Herpes simplex virus.Ayoub HH, Chermaitelly 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-xCenters for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021: genital herpes.National Institutes of Health.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: herpes simplex virus.Sauerbrei A.Herpes genitalis: diagnosis, treatment and prevention.Geburtshilfe Frauenheilkd.2016;76(12):1310–1307, doi:10.1055/s-0042-116494Looker KJ, Magaret AS, May MT, et al.Global and regional estimates of prevalent and incident herpes simplex virus type 1 infections in 2012.PLoS One.2015;10(10):e0140765. doi:10.1371/journal.pone.0140765Sauerbrei A.Optimal management of genital herpes: current perspectives.Infect Drug Resist. 2016;9:129-141. doi:10.2147/IDR.S96164Centers for Disease Control and Prevention.Genital herpes – CDC detailed fact sheet.Whitley RJ, Hook EW.Shedding patterns of genital herpes simplex virus infections.JAMA.2022;328(17):1710-1711. doi:10.1001/jama.2022.18930McQuillan G, Kruszon-Moran D, Flagg EW, Paulose-Ram R.Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14-49: United States.NCHS Data Brief. 2018;(304):1-8.Nath P, Kabir A, Doust SK, Ray A.Diagnosis of herpes simplex virus: laboratory and point-of-care techniques.Infect Dis Rep.2021;13(2):518–539. doi:10.3390/idr13020049Galen BT.Screening cerebrospinal fluid prior to herpes simplex virus PCR testing might miss cases of herpes simplex encephalitis.J Clin Microbiol.2017;55(10):3142–3143. doi:10.1128/JCM.01129-17Whitley R, Baines J.Clinical management of herpes simplex virus infections: past, present, and future.F1000Res.2018;7:F1000 Faculty Rev-1726. doi:10.12688/f1000research.16157.1Chi CC, Wang SH, Delamere FM, et al.Interventions for prevention of herpes simplex labialis (cold sores on the lips).Cochrane Database Syst Rev.2015;2015(8):CD010095. doi:10.1002/14651858.CD010095.pub2Centers for Disease Control and Prevention.Fact sheet for public health personnel: condom effectiveness.
World Health Organization.Herpes simplex virus.
Ayoub HH, Chermaitelly 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
Centers for Disease Control and Prevention.Sexually transmitted infections treatment guidelines, 2021: genital herpes.
National Institutes of Health.Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: herpes simplex virus.
Sauerbrei A.Herpes genitalis: diagnosis, treatment and prevention.Geburtshilfe Frauenheilkd.2016;76(12):1310–1307, doi:10.1055/s-0042-116494
Looker KJ, Magaret AS, May MT, et al.Global and regional estimates of prevalent and incident herpes simplex virus type 1 infections in 2012.PLoS One.2015;10(10):e0140765. doi:10.1371/journal.pone.0140765
Sauerbrei A.Optimal management of genital herpes: current perspectives.Infect Drug Resist. 2016;9:129-141. doi:10.2147/IDR.S96164
Centers for Disease Control and Prevention.Genital herpes – CDC detailed fact sheet.
Whitley RJ, Hook EW.Shedding patterns of genital herpes simplex virus infections.JAMA.2022;328(17):1710-1711. doi:10.1001/jama.2022.18930
McQuillan G, Kruszon-Moran D, Flagg EW, Paulose-Ram R.Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14-49: United States.NCHS Data Brief. 2018;(304):1-8.
Nath P, Kabir A, Doust SK, Ray A.Diagnosis of herpes simplex virus: laboratory and point-of-care techniques.Infect Dis Rep.2021;13(2):518–539. doi:10.3390/idr13020049
Galen BT.Screening cerebrospinal fluid prior to herpes simplex virus PCR testing might miss cases of herpes simplex encephalitis.J Clin Microbiol.2017;55(10):3142–3143. doi:10.1128/JCM.01129-17
Whitley R, Baines J.Clinical management of herpes simplex virus infections: past, present, and future.F1000Res.2018;7:F1000 Faculty Rev-1726. doi:10.12688/f1000research.16157.1
Chi CC, Wang SH, Delamere FM, et al.Interventions for prevention of herpes simplex labialis (cold sores on the lips).Cochrane Database Syst Rev.2015;2015(8):CD010095. doi:10.1002/14651858.CD010095.pub2
Centers for Disease Control and Prevention.Fact sheet for public health personnel: condom effectiveness.
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