A cold sore, herpes, or something else entirely?

We get a lot of questions about this on Dr. Q&A, and it can be a little confusing. So, we’re here with some of our top doctor advice to sort out what’s what, and what you need to do if you think you may have one of these ailments.

One virus, different types

Cold sores and genital herpes are two different expressions of the same virus.

HSV-1 — meaning herpes simplex virus, type 1 — is usually what people have when they have a cold sore on their lip. Around 50% to 80% of Americans have it, according to Johns Hopkins Medicine, and they contract it early in life.

HSV-2 — herpes simplex virus, type 2 — is what most people are referring to when they use the term “herpes.” This is the virus that results in sores and lesions on or around the genitals and rectum. About one in six people aged 14 to 49 have it.

It is possible to have genital lesions caused by HSV-1 or a cold sore caused by HSV-2. “For example,” the University of Michigan writes, “HSV-1 infection can be transmitted from mouth to genitals during oral sexual contact.” 

What about canker sores?

Canker sores are a completely different ailment. This is from Dr. Robert Kwok, Director of Health Informatics at HealthTap, and who has worked as a pediatrician for nearly 30 years:

Cold sores are on the lips or on the face near the lips. They are caused by recurrences of herpes virus, which live in the nerves after an initial infection, and then travel down the nerves to cause the cold sores at the skin surface from time to time. Canker sores are inside the mouth, and are not from herpes, but are due to the immune system reacting to something on the inside of the mouth.

How do people get HSV-1 and HSV-2?

Both types of the herpes virus are contagious. 

HSV-1 can easily spread by something as simple as an infected person sharing a glass of water. (Also, you should avoid touching sores because you can spread them to other parts of your body.) What’s more, a person can spread the virus when they’re asymptomatic — that is, when they aren’t showing symptoms — and a lot of people don’t even know they have it.

You can get HSV-2 from having anal, oral, or vaginal sex with someone who is already infected. You can also get it by having skin-to-skin contact with someone who is infected, even if they don’t have visible herpes sores. Some people who have it don’t even know they’re infected.

As the CDC notes, “You will not get [genital] herpes from toilet seats, bedding, or swimming pools, or from touching objects around you such as silverware, soap, or towels.”

Is herpes dangerous?

It depends. 

For most people, an HSV-1 or HSV-2 infection is not life-threatening. But it can be uncomfortable and painful. Additionally, a genital herpes infection can interfere with your sex life and cause social stigma, which can affect your mental health.

In very rare cases, a herpes virus can cause meningoencephalitis, a very serious infection of the brain and surrounding tissue.

Neonatal herpes, which is caused when a pregnant mother with a genital herpes infection passes the virus to her child, can cause serious brain damage and death. Doctors usually recommend suppressive therapies to prevent the virus from being transmitted during childbirth. You should talk to your doctor if you have genital herpes and are pregnant or are planning to become pregnant.

One last serious risk factor is related to HIV. Herpes causes open lesions on the skin to form, which creates an opening for HIV to enter the body. If your sexual partner has herpes and HIV, for example, you are at greater risk for contracting HIV. 

Is there a cure?

No. As Dr. Booth Wainscoat explains:

Once infected, the virus travels to sensory nerves and remains there lifelong. There is no treatment to eliminate the virus permanently. Reactivation or 'outbreaks' of herpes can be managed effectively with anti-virals. Frequent outbreaks can be prevented with daily anti-virals taken for a year or longer with close supervision from a doctor.

How can I avoid getting it?

The only surefire way to avoid getting herpes is to not have intimate contact with someone who has the virus. 

If you are sexually active, the CDC recommends that you:

1. Be in a monogamous relationship with someone who has tested negative for STIs
2. Use latex condoms when you have sex 

HealthTap can help

If you’re worried about symptoms you’re having, your HealthTap Personal Care Doctor can help. They can write prescriptions, order lab tests, and in many cases make diagnoses based on visual exams over a video call.