HSV-1 usually causes oral herpes (cold sores) and HSV-2 usually causes genital herpes, but either can infect either area.
HSV-1
Usually causes oral herpes (cold sores). Can also cause genital herpes through oral sex. About 67% of people under 50 worldwide have it.
HSV-2
Usually causes genital herpes. About 13% of people aged 15 to 49 have it.
Symptoms
Blisters, tingling and itching. Many people have none.
Treatment
No cure. Antivirals like acyclovir lower outbreaks.
Prevention
Condoms reduce risk, but don’t remove it.
Virus types
Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) are both common. HSV-1 traditionally causes oral herpes (cold sores), and HSV-2 usually causes genital herpes, but either can infect either area.
How common
The WHO estimates that 3.8 billion people under age 50 (64%) have HSV-1, and 520 million people aged 15 to 49 (13%) have HSV-2. In the US, about 12% of people aged 14 to 49 have HSV-2, according to the CDC.
Transmission
Spread occurs through skin to skin contact, including kissing and oral, vaginal or anal sex. The virus can spread when there are no symptoms (asymptomatic shedding).
Symptoms
- Tingling, itching or burning, followed by blisters that break into sores and crust over in 1 to 2 weeks.
- First outbreak can include fever, body aches and swollen lymph nodes.
- Many people have no symptoms or very mild ones.
Recurrence
HSV-2 genital infections recur more often than HSV-1 genital infections. The virus stays in nerve cells and reactivates with stress, illness or sun exposure.
Diagnosis
A swab of a sore for PCR or culture, or blood tests for antibodies.
Treatment
There is no cure. Antiviral drugs like acyclovir, valacyclovir and famciclovir shorten outbreaks and reduce transmission. Daily suppressive therapy cuts transmission to partners by about 50%.
Prevention
Condoms lower the risk, but do not eliminate it as sores may be in uncovered areas. Avoid sex during outbreaks and disclose to partners.
Pregnancy
Neonatal herpes is serious. Tell your obstetric provider if you have a history.
Prevalence and spread
Herpes simplex virus type 1 (HSV-1) typically causes oral herpes (cold sores) and is spread by close contact such as kissing. The World Health Organization estimates that about 67 percent of people under age 50 worldwide have HSV-1, and HSV-1 can also cause genital herpes through oral sex. HSV-2 mainly causes genital herpes, spread by sexual contact, and about 13 percent of people aged 15 to 49 worldwide, roughly 491 million, have it. The CDC estimates that about 12 percent of Americans aged 14 to 49 have HSV-2.
Symptoms and management
Many people have no or mild symptoms. When present, outbreaks cause tingling, then painful blisters that crust over in 1 to 2 weeks. HSV-2 recurs more often in the genital area than HSV-1. Antiviral medicines such as acyclovir, valacyclovir and famciclovir shorten outbreaks, and daily suppressive therapy reduces transmission. Condoms reduce but do not eliminate risk, and the virus can spread without symptoms. Pregnant women with herpes should tell their doctor, because neonatal herpes can be serious. Testing involves a swab of a sore or blood tests.
Based on data from the World Health Organization and the CDC
