Oral and Genital Herpes
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Medically reviewed by Lauren Schlanger, MD
Herpes is an infection caused by the herpes simplex virus. There are two types of herpes: HSV-1 and HSV-2. People contracting the virus may experience an outbreak on their genitals or around the mouth. Both types of the herpes simplex virus are incurable but can be managed with the right approach.
This article discusses the difference between HSV-1 and HSV-2 symptoms, transmission, and treatment options.
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HSV-1 vs. HSV-2
HSV-1 and HSV-2 are both herpesviruses of the Simplexvirus genus. HSV-1 typically causes oral herpes, whereas HSV-2 leads to genital herpes. However, HSV-1 can also cause genital herpes in some cases.
Oral herpes (HSV-1) causes cold sores or fever blisters around the mouth and lips. In some cases, HSV-1 can affect the eyes. HSV-1 can also spread to the genital area, leading to genital herpes in rarer cases.Genital herpes (HSV-2) is considered a sexually transmitted infection (STI) because of how it is transmitted. It leads to genital sores.
Both types of herpes infections have a pattern of outbreaks, meaning that once the virus is in the body, sores and symptoms will develop periodically.
How Common Are HSV-1 and HSV-2?
Around 67% of people younger than age 50 have HSV-1, and 13% of people between the ages of 15 and 49 have HSV-2 globally. The transmission mode plays a role in those numbers, as HSV-1 is easier to transmit. Both types can also be asymptomatic (occur without symptoms), making the spread of HSV that much easier.
Learn More: When Do Herpes Symptoms Show Up?
Herpes Symptoms
The symptoms that develop in both oral and genital herpes can be similar, but there are some differences.
Oral Herpes Symptoms
You may be infected with oral herpes without having symptoms. You can then spread the virus to others (through shedding of the virus) even when sores are not present. However, not everyone will be asymptomatic. Painful blisters around the mouth, lips, and under the nose are the first signs of infection in people who experience symptoms. Once the blisters break, they turn into sores and crust over.
The initial infection may present with symptoms, including:
Headache
Swollen lymph nodes
Genital Herpes Symptoms
Like oral herpes, genital herpes can be present without symptoms or can be so mild it's hard to notice the signs of infection. When someone contracts genital herpes, they may experience:
Fever
Body aches
Swollen lymph nodes
Blisters in the genital, buttocks, upper thigh, and anal areas
One singular blister may develop, but they can also occur in clusters
Does Genital Herpes Hurt?
Like the sores that develop in oral herpes, those on the genitals are usually also painful and can occur with other sensations, such as burning or itching.
How Long Do Sores Last?
Genital and oral herpes have different timelines. For oral herpes, roughly four to six days following the initial outbreak, the sores crust over and heal until they are gone.
With genital herpes, that process could take as long as two to four weeks during the initial infection and between three to seven days in the following outbreaks.
How the Body Prepares You for an Outbreak
Before a herpes outbreak, you may experience burning, tingling, or itching in the area where the sores will develop. These precursor symptoms are called the prodrome. A prodrome is a sign of illness before significant symptoms.
How Does Herpes Spread?
Transmission of herpes depends on the type. The spread of HSV-1 is transmitted through oral contact, such as kissing, touching, or oral sex. Oral sex can lead to HSV-1 genital herpes.
HSV-2 is an STI because it is primarily spread through condomless vaginal or penile sexual intercourse with someone who has an active infection. Transmission commonly occurs following contact with a partner who has herpes.
Other possible modes of transmission for genital herpes are:
Oral sex
Anal sex
Touching genitals with your hands and then touching other body parts
Coming into contact with infected bodily fluids, such as semen or vaginal discharge
Sharing sex toys
Is Someone With Herpes Always Contagious?
Viral shedding is the process that leads to the transmission of herpesvirus. Shedding of the herpesvirus can occur anytime, even if you are not experiencing an outbreak. People with asymptomatic HSV-2 infections can spread the virus 10.2% of the time, whereas people with symptoms can spread it to someone else 20.1%.
Related: What to Know Before and After an Anal Herpes Diagnosis
Who’s at Risk of Developing Herpes?
There are several risk factors associated with contracting herpes. They can be broken down into two categories: health and lifestyle.
People with weakened immune systems are at a higher risk of contracting herpes. Examples include:
Having an immune-affecting disease, such as human immunodeficiency virus (HIV)
Having antibody deficiencies
Lifestyle factors associated with a higher incidence of contracting herpes include:
Having condomless sex with multiple partners who could be infected
Kissing, touching, or engaging in sexual activity with a person who has the herpesvirus
Sharing certain products, such as a toothbrush, a straw, a cup, or lip balm
Skin-to-skin contact
Safer Sexual Practices With Herpes
Condoms are a good way to lower the risk of spreading herpes. However, condoms only cover a small surface area. If the infection is elsewhere on the skin, in an area not covered by the condom, the virus can still be spread through sexual intercourse even when a condom is used.
Wear a condom properly during sexual intercourse if you or your partner has herpes and avoid sexual activity during outbreaks to protect yourself from the infection.
Taking antiviral medications to suppress outbreaks and asymptomatic shedding of the virus is another important way to hinder transmitting the infection to others.
Read Next: Living With Herpes
Herpes Testing and Diagnosis
Diagnosing herpes involves an assessment of symptoms alongside a health and lifestyle history. Once a healthcare provider has gathered that information and suspects herpes, they will likely conduct HSV nucleic acid amplification tests (NAAT).
NAATs are used because they are highly sensitive cultures and can detect herpes in many cases. These tests work by taking a sample of the sore or fluid from the lesion and sending it to a lab to determine the virus's DNA or RNA.
While swab tests are typically considered a first-line diagnostic tool, they are not always the best route because they may not accurately diagnose someone with low or no viral shedding.
Other possible routes of diagnosis include:
Blood tests to look for antibodies created to combat the virus
Biochemical assays, which look for specific markers of infection
These tests are often used in people without symptoms of herpes as they can detect specific proteins in the body made in response to the virus, even without signs of infection.
Should You Wait to Test During an Outbreak?
If you suspect you have herpes and want to get tested, you may want to wait until the sores have reappeared. Without the sores, getting a proper diagnosis is a bit more challenging.
Treatment for Herpes
To treat and manage herpes, healthcare providers will likely take a multipronged approach. Therapies used to limit outbreaks and soothe symptoms include:
Antiviral medications, such as Zovirax (acyclovir), Famvir (famciclovir), and Valtrex (valacyclovir)
Topical antivirals that can be applied directly to the affected area
Stringent hygiene practices, such as keeping the site clean and dry
Over-the-counter (OTC) topical agents that can reduce inflammation to alleviate symptoms
Learn More: Effective Treatments for Herpes
Relieving Symptoms During an Outbreak
The symptoms and pain felt during an outbreak can be hard to cope with, but self-care options are available to reduce uncomfortable sensations during an outbreak. They include:
Using OTC pain medications, such as Advil (ibuprofen), Tylenol (acetaminophen), or aspirin, to help relieve pain
Using a cool compress on the area a few times a day to relieve itching and pain
Urinating in water if the sores hurt during urination
Washing the sores with gentle soap and warm water
Avoiding bandaging, picking, or using unapproved ointment on the area
Wearing loose-fitting cotton clothing
Lifestyle Changes to Help Manage Herpes
If you want to help limit outbreaks, you can ensure your immune system is as strong as possible by:
Getting enough quality sleep
Eating whole foods with high nutrition profiles
Managing stress
Protecting yourself from the sun, wind, cold, and heat
Using sunscreen, especially on the lips
Is Herpes Curable?
There is no cure for herpes. The virus will remain in the body for your entire lifetime, sporadically causing outbreaks.
However, there are ways to shorten or prevent outbreaks from occurring as frequently.
Preventing Oral and Genital Herpes
The best way to prevent oral and genital herpes is by avoiding close contact with someone with the virus. Because that’s not always possible, you can also:
Practice safer sex and always wear a condom or dental dam.
Get STI checks regularly.
Avoid sexual intercourse or contact with anyone you know who has herpes.
Avoid douching as it can increase the risk of contracting an STI.
Avoid sexual intercourse or contact with anyone you know who has the virus.
Preventing Herpes With an Active Sex Life
It’s not always feasible to be in a monogamous sexual relationship, but that doesn’t mean you will automatically get an STI. To prevent herpes while engaging in sexual activities with more than one partner, you can wear a condom or dental dam during all sexual contact (vaginal, penile, anal, oral) and discuss your sexual histories and testing before having sex with a new partner.
What Triggers Recurring Outbreaks?
Several things can trigger herpes outbreaks, depending on whether a person has HSV-1 or HSV-2.
Some common triggers for oral herpes include:
Fevers
Emotional stress
Menstruation
Physical injuries
Excessive exposure to direct sunlight
Surgeries
Genital herpes may be triggered by:
Other bacterial or viral infections
Menstrual periods
Physical and emotional stress
Fatigue
Irritation in the genital area
How Often Do Outbreaks Occur?
While everyone is different, outbreaks are typically more frequent in the first year following infection. Sometimes, a person may only have one symptom outbreak, while others experience it every month. As the years progress, with proper management, herpes outbreaks can dwindle significantly.
Learn More: What Are the Stages of Genital Herpes?
Complications of Herpes
Viral herpes infections can lead to health complications, some of which can be serious. Some possible complications associated with HSV-1 and HSV-2 include:
Keratitis (HSV-1)
Encephalitis (HSV-1)
Meningoencephalitis (HSV-2)
Disseminated infection (HSV-2)
Pregnant people with herpes have an added risk of passing the herpesvirus onto their unborn child during delivery. The risk is highest in people experiencing an active outbreak during labor and then for the following eight weeks after the baby is born.
If you contract the virus before becoming pregnant, your risk of transmission is low. Roughly less than one 1 out of 100 infants will contract herpes from their mother if the infection is contracted before getting pregnant or during the first trimester.
The risk increases significantly in people who get the herpesvirus during the last trimester, and roughly 30 to 50 out of 100 infants will have the virus passed on to them in this case.
Herpes in Infants
If an unborn child contracts the virus, it can be severe and life-threatening, so it’s essential to watch for any signs of infection and contact a healthcare provider immediately if you notice them. Signs can include:
Fever
Listlessness
Loss of appetite
Rash
Learn More: Encephalitis and Its Relationship to STDs
Living With Herpes
There is a stigma surrounding herpes. Because of that, people with the viral infection may develop feelings of shame or depression after getting diagnosed. They also may struggle with sexual intimacy because of the risk of passing the virus on.
Living with herpes can be made easier with the right approach. Follow all treatment advice from your healthcare provider, and consider attending a virtual or in-person support group to share your story and hear from others in a similar position.
When approaching sex with new partners, tell them about your condition well before engaging in sex. That will give them time to process the information and make a good decision for both of you. Being honest with your partner can help strengthen your connection and build respect.
Herpes Isn't Who You Are
It’s important to remember that herpes is incredibly common, and there is nothing to be ashamed of. Having the infection does not say anything about your character, who you are, or your worth.
Related: Living With STDs
Outlook for Herpes
If you contract herpes, you will have it for the rest of your life. While that may be difficult to hear, being aware of this can help you protect others. It can also put you on a path toward getting a treatment plan that limits your outbreaks and ensures that you care for yourself properly.
Modern medicine has created many viable options for people with herpes, making it easier than ever to manage the disease and limit the time you spend in an active infection.
