The Two Types of Herpes Simplex

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Herpes is a viral infection transmitted through skin contact. The two most common strains, herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), cause oral herpes (cold sores) and genital herpes infections. Between 50% and 80% of people in the United States have HSV-1, and almost 12% of people between the ages of 14 and 49 have an HSV-2 infection.

Read on for more information on both herpes simplex viruses, including transmission, symptoms, diagnosis, and treatment.

Woman applying cold sore cream on lips in front of mirror
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Types of Herpes Simplex

There are two types of HSV strains:

  • HSV-1: This strain typically causes an oral herpes infection but can cause symptoms in the genital area if that is where the virus was transmitted.
  • HSV-2: This virus strain typically causes symptoms in the genital and anal area. It may also cause an infection in or around the mouth.

While each strain does commonly cause an infection on a particular part of the body, it is possible for either to infect the mouth, genitals, or anal areas. Both cause chronic (lifelong) infections.

HSV-1 vs. HSV-2 Transmission

Both HSV strains are primarily transmitted through skin-to-skin contact. Contact with saliva or genital fluids may also transmit the virus, as follows:

  • Oral herpes is often transmitted through kissing, oral sex, or by sharing items such as forks or towels.
  • Genital herpes is often transmitted through sexual contact, including oral, anal, or vaginal sex. It is considered a sexually transmitted infection (STI).

HSV can also be transmitted to a baby from an infected pregnant person during pregnancy or childbirth, though this is rare.

The greatest risk of transmission is during an outbreak (when an infected person has lesions). However, transmission can occur between outbreaks when no symptoms are present through viral shedding.

Herpes Simplex Symptoms

HSV infections typically cause painful, fluid-filled blisters (lesions). They appear on or around the lips with oral herpes, or around the genitals or rectum with genital herpes.

Symptoms of oral or genital herpes may only typically appear during an active outbreak. Some outbreaks are mild or may not be noticeable for some people. Between outbreaks, you often will have no symptoms.

During an Outbreak

Initial outbreaks can occur between two and 12 days after exposure and tend to have more severe symptoms.

For either oral herpes or genital herpes, initial outbreak symptoms may include flu-like symptoms such as:

These symptoms are accompanied by fluid-filled blisters that appear in clusters around the area of infection. In time, the blisters will leak the fluid and become open sores, which can be painful. Eventually, the sores will crust over as they begin to heal, which occurs in about one to two weeks.

Other oral symptoms can include:

  • Sore throat
  • Pain while swallowing

Other genital symptoms may include:

  • Atypical vagina discharge
  • Pain during urination
  • Trouble clearing your bladder

Recurrent Outbreaks

After the initial outbreak, subsequent outbreaks can occur for some people. The frequency will differ from person to person. However, they often are milder and occur less frequently over time.

Before an outbreak, you may experience tingling, itching, or burning at the site where the lesions will appear. Recurrent outbreaks may be triggered by emotional and physical factors such as stress, injury, or menstruation.

What Causes Herpes Simplex?

Herpes simplex virus enters the body through the skin. After the initial infection and symptom onset, the virus will have periods of inactivity.

However, the virus doesn't go away. It stays dormant in the body's nerve cells. During this time, you likely won't experience symptoms. Periodically, it can be reactivated and cause additional outbreaks.

Risk Factors and Complications

Many people are exposed to HSV-1 as children, often between the ages of 6 months and 3 years old.

There are more specific risk factors for genital herpes. You may be at a higher risk if you:

  • Are assigned female at birth
  • Have had many sexual partners
  • Had sex for the first time at a young age
  • Have had another STI

HIV and HSV-2

Having HSV-2 can increase the risk of contracting human immunodeficiency virus (HIV). One reason is that genital herpes lesions allow HIV to enter the body more easily. People who have HIV and HSV-2 are at a higher risk for transmitting HIV to others. Having both viruses can increase the amount of HIV in your blood and the viral shedding that occurs with HSV-2.

With either strain of herpes simplex, there are a number of potential complications:

  • Severe symptoms: Immunocompromised people are more likely to experience severe symptoms and more frequent outbreaks.
  • Other severe infections: Though rare, more severe infections can occur with HSV-1, including infections of the brain (encephalitis) or the eye (kerititis).
  • Social concerns: Some people living with herpes experience negative impacts on their quality of life, social networks, and sexual relationships.
  • Neonatal herpes: If a baby contracts herpes either before, during, or after birth, it can lead to neurological and physical disability, and even death.

Diagnosing Herpes Simplex

A healthcare provider can diagnose a herpes simplex infection by:

  • Performing a physical examination to look for lesions
  • Taking a swab sample from a lesion to detect HSV-1 or HSV-2
  • Ordering a blood test to confirm, particularly if you do not have active symptoms

Being screened for HSV without symptoms is not recommended for everyone. If you have suspected exposure, other STI symptoms, or have had multiple sex partners (particularly in the case of genital herpes), it may be beneficial.

At-Home Tests

There are at-home tests to screen for herpes. However, it's still important to be evaluated by a healthcare provider to confirm any test results and discuss treatment.

Herpes Simplex Treatment and Management

Herpes simplex infections can't be cured, but treatments are available to reduce the number and length of outbreaks. The risk of transmitting the infection to others is also reduced.

Daily antiviral medications, such as acyclovir, valacyclovir, and famciclovir, may be prescribed. During an outbreak, self-care strategies can also help manage pain and discomfort.

For an oral herpes outbreak featuring cold sores or blisters around the mouth, do the following:

  • Clean the affected area and pat dry
  • Use over-the-counter (OTC) pain relievers or ointments with ingredients such as benzocaine or lidocaine
  • Apply OTC antiviral cold sore medication to the lesions to help them heal quicker
  • Use petroleum jelly to keep skin from drying out or cracking
  • Avoid acidic, spicy, or salty foods that may irritate your lesions

Self-care for a genital herpes outbreak may include:

  • Use OTC pain relievers or cool compresses to help manage pain
  • Wash affected area with mild soap and gently dry
  • Wear loose fitting, cotton underwear

Summary

Herpes simplex virus type 1 and type 2 cause lifelong oral and genital herpes infections. The virus is typically transmitted through skin-to-skin contact when lesions or blisters are present. It can also be transmitted without any symptoms. HSV can cause lesions and other symptoms in the mouth, genitals, or anal areas.

After an outbreak, the virus becomes inactive in the body. It can be reactivated and cause additional, often milder outbreaks.

Testing and diagnosis include a physical exam, testing sample lesions, or getting a blood test. There is no cure, but daily antiviral medication can reduce the risk of transmission to others, as well as the frequency and duration of outbreaks.

A Word From Verywell

Herpes simplex virus infections are very common. Despite this fact, there is a stigma associated with a herpes diagnosis. If you are living with herpes, it's possible to have a full life and fulfilling sexual relationships. Having honest discussions with your partner(s) about your diagnosis, treatment, and ways to practice safer sex can help you both feel reassured.

Frequently Asked Questions

  • What is more common, HSV-1 or HSV-2?

    Herpes simplex virus type 1 (HSV-1), which commonly causes oral herpes, is considered endemic (regularly found around the world). Globally, there are 3.6 billion people under the age of 50 living with HSV-1, compared to 491 million living with HSV-2.

  • How long do herpes simplex outbreaks last?

    An oral herpes outbreak (or cold sores) will typically last for about two to three weeks. An initial genital herpes outbreak may last between two to six weeks. Recurrent outbreaks may be shorter.

  • Can herpes simplex live on surfaces?

    HSV may be able to survive on some surfaces, but not for a long time. Getting oral herpes from sharing forks or other items may be possible. However, getting genital herpes from contact with items like a toilet seat or towels is not likely.

  • How does herpes simplex affect immune function?

    Researchers have found that HSV evades an immune response. After the virus enters a cell, it interrupts the ability for the cell to bring the virus to the cell's surface. This process disruption doesn't allow for the body's immune cells to detect and fight the virus. In turn, the virus remains in the body as a chronic infection.

  • Can you have both HSV-1 and HSV-2?

    Yes. Research has found that it's possible to have HSV-1 and HSV-2 at the same time. It's also possible that each strain can cause symptoms simultaneously.

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17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Mount Sinai. Herpes simplex.

  2. Centers for Disease Control and Prevention. Genital herpes-cdc fact sheet.

  3. Johns Hopkins Medicine. Oral herpes.

  4. World Health Organization. Herpes simplex virus.

  5. American Academy of Dermatology Association. Herpes simplex: overview.

  6. American Academy of Dermatology Association. Cold sores: signs and symptoms.

  7. MedlinePlus. Genital herpes.

  8. Banerjee A, Kulkarni S, Mukherjee A. Herpes simplex virus: the hostile guest that takes over your homeFront Microbiol. 2020;11:733. doi:10.3389/fmicb.2020.00733

  9. Looker KJ, Elmes JAR, Gottlieb SL, et al. Effect of HSV-2 infection on subsequent HIV acquisition: an updated systematic review and meta-analysisThe Lancet Infectious Diseases. 2017;17(12):1303-1316. doi:10.1016/S1473-3099(17)30405-X

  10. Whitley RJ. Congenital cytomegalovirus and neonatal herpes simplex virus infections: to treat or not to treat?Pediatric Infectious Disease Journal. 2019;38(6S):S60-S63. doi:10.1097/INF.0000000000002325

  11. Centers for Disease Control and Prevention. Genital herpes-sti treatment guidelines, 2021.

  12. Centers for Disease Control and Prevention. Genital herpes screening faq.

  13. UpToDate.com. Treatment and prevention of herpes simplex virus type 1 in immunocompetent adolescents and adults.

  14. American Academy of Dermatology Association. Cold sore: tips for managing.

  15. MedlinePlus. Genital herpes-self-care.

  16. Oldham ML, Hite RK, Steffen AM, et al. A mechanism of viral immune evasion revealed by cryo-EM analysis of the TAP transporterNature. 2016;529(7587):537-540. doi:10.1038/nature16506

  17. Kaneko H, Kawana T, Ishioka K, Ohno S, Aoki K, Suzutani T. Evaluation of mixed infection cases with both herpes simplex virus types 1 and 2J Med Virol. 2008;80(5):883-887. doi:10.1002/jmv.21154