What is the herpes simplex virus (HSV-1 vs HSV-2)?

Herpes simplex virus (HSV) is a common sexually transmitted infection (STI) that impacts about 1 in 8 people in the US. Many people who have herpes never have symptoms and may not even know they carry the virus. Others may experience outbreaks that come and go, with symptoms like painful blisters around the mouth and/or genitals. While the virus cannot be cured, you can manage outbreaks and prevent spreading the virus with medications and certain habits. In this detailed guide, we’ll discuss the symptoms, causes, available treatments, and the myths surrounding this virus. 

If you have been diagnosed with herpes, telehealth clinics like Hey Jane have licensed clinicians who can prescribe medications to help treat HSV-1 and HSV-2 outbreaks. If eligible, you’ll have a consultation—entirely virtually via text, chat, phone or video call—with one of our providers before being prescribed FDA-approved herpes medications. The prescription is sent to your local pharmacy for fast, easy pickup so you can start feeling better ASAP. Fill out our quick intake form to get started with herpes treatment with Hey Jane.

Oral vs. genital herpes

There are two types of herpes: HSV-1 and HSV-2. HSV-1 is more common than HSV-2, and affects somewhere between 50 to 80 percent of adults in the US. It is typically associated with oral herpes (cold sores around the mouth) but may also appear in the genital area after oral sex with a partner who has HSV-1. People with the infection can be asymptomatic (experience no symptoms), or get outbreaks that vary in frequency depending on the person. 

HSV-2 is less common, but still impacts an estimated 12% of US adults. It primarily causes genital herpes, and is transmitted through sexual contact.

Oral herpes (HSV-1)

Also known as herpes labialis or cold herpes, oral herpes is an infection of the lips, mouth, or gums caused by HSV-1. It is spread through intimate or personal contact (e.g., kissing or oral sex) with someone who has the infection.

Genital herpes (HSV-1 or HSV-2)

Genital herpes (herpes genitalis), also known as vaginal herpes, is a sexually transmitted infection (STI) that can arise mainly from HSV-2 but can also occur from HSV-1. This virus can spread through vaginal, anal, or oral sex or from skin-to-skin contact. Genital herpes can cause sores to appear on your genital or rectal area, buttocks, and thighs.

What are the symptoms of herpes?

Herpes symptoms typically appear as clusters of small, painful blisters filled with fluid. With oral herpes, you may see these blisters on the edges of your lips or around your mouth. During the initial outbreak, the blisters may burst, leak fluid, and form painful sores that will crust over and heal.

For genital herpes, blisters appear around your genitals or anus that can ooze fluid and cause some unwanted discomfort. You may also get tingling or shooting pains in your legs, hips, or buttocks.

The most common symptoms or outbreaks of oral herpes can include the following:

• Painful, fluid-filled blisters that appear on the lips or under your nose (aka cold sores)
• Blisters that leak fluid and become sores
• Headache 
• Severe, flu-like symptoms (fever, body aches, swollen lymph nodes)

Common genital herpes symptoms during an outbreak may include:

• Bumps or blisters around the genitals or anus
• Blisters that ooze fluid, leading to pain and discomfort
• Pain when urine touches sores while peeing
• Vaginal or penis discharge
• Swollen glands in the groin 
• Severe, flu-like symptoms (fever, body aches, swollen lymph nodes)

Remember that not everyone experiences symptoms of herpes and that regular testing isn’t recommended if you aren’t experiencing an outbreak. If you do want to confirm your diagnosis, the best time to get tested is when you have open sores. If you have been diagnosed with herpes and are experiencing symptoms, you can consult with a Hey Jane clinician who can prescribe treatment to help manage your outbreaks from home.

Early signs of herpes

Before herpes blisters appear, warning signs indicate an outbreak is about to happen. These early signs of the herpes simplex virus may include tingling, itching, or burning that may last 24 hours or longer. 

How to identify herpes

It can be difficult to determine whether your symptoms are herpes or another condition. Herpes can present with sores or blisters around the mouth or genital areas, but similar symptoms can be found among other conditions that cause blisters, such as ingrown hairs, molluscum, or syphilis. If you have a lesion on your genitals, it’s important to be seen as soon as possible by a health care provider to ensure you get accurate testing and appropriate treatment. Once a lesion has healed, your accurate testing window is over.

This is why it is so important to see a licensed health care provider for a proper diagnosis of herpes simplex virus. A herpes diagnostic test usually involves a physical examination and laboratory tests, such as swabs, viral cultures, or polymerase chain reaction (PCR) tests.

Herpes vs cold sores

Cold sores, also known as fever blisters, are common herpes symptoms. They can appear around your mouth and are caused by HSV-1. You can catch this virus from kissing or sharing items. These herpes blisters can come back whenever you're feeling stressed or sick. 

Herpes vs canker sores

Canker sores are not the same thing as cold sores, but they are another condition that can resemble a herpes outbreak. Canker sores are small, painful mouth ulcers that appear inside the mouth—usually on the gums, inner cheeks, or tongue. They can appear as a painful white or yellow ulcer surrounded by a red area. 

Unlike herpes, canker sores aren't contagious and are often triggered by stress, minor mouth injuries, hormonal changes, a lack of certain vitamins and minerals in your diet, or food allergies.

While both canker sores and herpes simplex virus can be painful, herpes sores are caused by a virus and can spread to others, whereas canker sores are just bumps that only affect the person with them.

Herpes vs pimples

Pimples may also resemble herpes. Pimples are caused by blocked hair follicles and oil glands and can appear anywhere on your face or body. Pimples are not contagious and usually look like red bumps or whiteheads filled with pus. Ingrown hairs or folliculitis (when the hair follicle is inflamed) may also resemble herpes. 

In comparison to herpes simplex virus, pimples are just a skin issue that you won’t have to worry about spreading to someone else, while herpes sores are known to spread to others through various forms of contact.  

What causes herpes?

There are several risk factors linked to HSV-1 and HSV-2. While oral herpes is primarily caused by direct contact with an infected person’s saliva and skin (e.g. kissing), genital herpes is spread through direct sexual contact with a person who has the virus—including oral sex.

What causes oral herpes (HSV-1)?

Here are some common causes and modes of transmission for HSV-1:

• Kissing: Close contact with the saliva of a person with oral herpes can easily spread the virus.
• Sharing personal items: Lip balm, razors, toothbrushes, towels, or similar items may carry the virus if they have come into contact with an infected area.
• Oral-genital contact: Although HSV-1 is usually associated with oral infections, it will also cause herpes genitals through oral-genital contact.
• Touching sores: The virus can be transmitted through direct contact with herpes or fluid from sores. Touching a sore and touching another part of your body can spread the virus to new areas.
• Asymptomatic shedding: Even without visible sores, a person with oral herpes can still shed the virus and transmit it to others.

What causes genital herpes? (HSV-2)

Below are some common causes and modes of transmission for HSV-2:

• Sexual contact: The most common way HSV-2 is spread is through vaginal, anal, or oral sex with someone who has the virus.
• Skin-to-skin contact: The virus can be transmitted through direct contact with the infected area—even if there are no visible sores.
• Asymptomatic shedding: HSV-2 can be spread even when the person with the virus shows no symptoms or visible sores. The virus can shed from the skin and be transmitted to others.
• Mother-to-child: Pregnant people with HSV-2 can transmit the virus to their babies during childbirth if not on an antiviral medication to prevent an outbreak at the time of birth. While there can be risks to a fetus if the pregnant parent contracts herpes for the first time while pregnant, the risks are different for people who have already had a herpes outbreak.

Once infected, the virus remains in the body and may reactivate, leading to recurrent outbreaks. Stress, illness, and a weakened immune system may trigger the reactivation of the herpes simplex virus.

How to treat herpes

So, does herpes go away on its own? Sort of. While there are no treatments to cure herpes and completely remove it from your body, you can prevent and treat outbreaks with medication. 

In some instances, herpes blisters will heal on their own without treatment. However, pursuing herpes treatment may provide faster relief rather than waiting for an outbreak to disappear.

Antiviral medications, such as acyclovir (Sitavig and Zovirax), Valacyclovir (Valtrex), and Famciclovir (Famvir), are first-line treatments for herpes symptoms. These therapies, available in pill form, can treat and prevent recurrences and prevent the spread of the virus to sex partners of people with HSV-2.

There’s also topical acyclovir, a prescription medication available as an ointment or cream that you can apply directly to the herpes blisters. Topical acyclovir may help relieve pain and discomfort and may encourage herpes sores to heal faster. 

Many providers also include a prescription for numbing or lidocaine gel to help with pain—a common symptom of herpes outbreaks. Our Clinical team recommends storing this gel in your refrigerator as the cool sensation can be extra soothing.

Home remedies for herpes

While medical treatment guided by a licensed health care provider is recommended for managing herpes, there are a few self-care practices you can do at home for symptom relief.

Possible home remedies for herpes symptom relief include:

1. Take over-the-counter pain medication

To relieve pain, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as acetaminophen (Tylenol), ibuprofen (Advil or Motrin), or aspirin (Bayer), may be taken as needed.

2. Keep the affected area clean and dry (when possible) 

Gently wash sores with soap and water and pat dry.

3. Cold compresses

Apply cold compresses, such as an ice pack or paper towel soaked in cold water, to the sores several times daily to relieve pain or itching.

4. Avoid picking at sores

This might cause further irritation and slow healing.

5. Wear loose-fitting cotton underwear 

Avoid nylon or any synthetic pantyhose or underwear if you have vaginal herpes.

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If you have herpes, Hey Jane can prescribe treatment to help with pain during outbreaks. Start your at-home consultation here.

How to prevent herpes

Whether you have the virus and don’t want to infect others or you don’t have the virus and want to be cautious, spreading herpes can be prevented by:

• Avoiding oral contact (including oral sex) with others and sharing objects that touch saliva.
• Abstaining from sexual activity when experiencing symptoms.
• Practicing safe sex by using condoms to prevent genital herpes.
• Informing your healthcare provider, if you’re pregnant and have herpes, of your condition to lower the risk of neonatal herpes.

Herpes myths

Many myths surround the herpes simplex virus, and it might be challenging to separate the facts from the fiction.Here are the most common myths about herpes, and the truths about them:

1. Myth: Herpes is not common

HSV-1 is a very common virus that affects billions of people worldwide. Many people don’t experience symptoms or frequent outbreaks which is why it may seem less common than it actually is.   

2. Myth: Herpes ruins your sex life

You can still enjoy sex with herpes, but it is crucial to take the necessary precautions to prevent transmission to your partners. Using condoms, taking antiviral medications, and having non-penetrative sex can help you find pleasure while reducing the risk of spreading the virus. 

3. Myth: You cannot have kids with herpes

Herpes has no impact on fertility, and people who have herpes are able to produce and conceive children. For pregnant people who have herpes , the chances of transmitting the virus to your child are very low, with less than 0.1 percent of babies born each year being diagnosed with neonatal herpes. If you want to have a vaginal birth, it’s important to tell your provider that you have herpes. They can prescribe an antiviral medication to prevent an outbreak at the time of birth.

For semen-producing people with herpes, it’s ok to have sex without a condom as long as you don’t have an active outbreak! If you are trying to conceive, avoid having unprotected sex during an outbreak to try and not pass it to your partner. Sometimes, in relationships where one person is positive and one is negative, the positive partner will take medication to prevent outbreaks instead of just when they have them.

4. Myth: STI testing screens for herpes

Blood tests for STDs shouldn’t include herpes, and if they do, they are often unreliable. This is because of the limitations surrounding a herpes blood test and the likelihood of getting the wrong results. The chances of getting a false-positive or false-negative result are higher among people at a lower risk of getting the virus.

5. Myth: Herbal medicine can cure herpes

Certain herbs, such as lemon balm, Chinese rhubarb, propolis, and tea tree, may help manage herpes outbreaks but cannot cure the virus. Prescription antiviral medications are recommended for herpes simplex virus outbreak treatment and prevention