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Difference between Herpes Simplex 1 and 2

What is the difference between HSV1 & HSV2?

In telling a new partner about a genital herpes infection, it’s common to compare cold sores – an oral herpes infection – with a genital one. However, is that really a good comparison? The emotional and social attitudes surrounding the two infections are wildly different, and those perceptions alone can make an objective comparison and subsequent discussion quite difficult.

Is there a worse infection? Is HSV1 (commonly cold sores) and HSV2 (commonly genital herpes), virtually, the same thing? By comparing the infections, we can help answer those questions while also beginning to understand why there is a polarizing difference in the way society views oral herpes vs. genital herpes.

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Scientifically Speaking

Under a microscope, the HSV1 and HSV2 strains look nearly identical. They share approximately 50% of their DNA and 85% of their genetic material. While the percentage of DNA they share is relatively low when considering humans share over 98% of their DNA with chimps, how the DNA behaves and forms into genes is more important, because they share the major segments of DNA that are needed to contribute to biological functions – the genetic material.

That means HSV1 & HSV2 behave similarly, but from an evolutionary stand-point, they sort of diverged years ago when humans started having sex face to face. That’s why a lot of their DNA is different, despite their genetic make-up remaining strikingly similar. What’s important to understand from this is that the genes the strains share have a big impact on the viruses’ appearance and behavior, and in both the HSV1 and the HSV2 strains, the genetic material looks and behaves similarly.

How are HSV1 & HSV2 the same?

Both the herpes simplex type 1 and the herpes simplex type 2 viruses infect the body’s mucous membranes (usually the mouth or genitals, but there are also mucous membranes located in the nose, eyes, and ears). Once infected, they establish latency (lie dormant) in the nervous system.

When the viruses become reactivated due to physical or emotional stimuli, they replicate and then travel the nerve pathways to the surface of the skin – sometimes that results in a physical outbreak, other times, it results in viral shedding. That is why both strains can recur and then be transmitted to others even when there are no noticeable symptoms present.

Clinically, HSV1 & HSV2 present identically, meaning, you can’t differentiate between one strain of the virus or the other by the severity of the initial outbreak or how the lesions look alone. The physical symptoms of HSV1 & HSV2 are indistinguishable.

For both HSV1 & HSV2, it is thought that at least two-thirds of infected people experience no symptoms at all or symptoms that are too mild to notice. As a result, it’s estimated that as many as the same amount (two-thirds) of people are entirely unaware they are infected.

How are HSV1 and HSV2 different?

The primary difference between HSV1 & HSV2 is where the virus typically establishes latency in the body. HSV1 usually remains dormant in the nerve cells near the base of the neck, and from there, viral shedding and outbreaks tend to occur on the mouth or face. HSV2, on the other hand, usually establishes latency in the nerve cells near the base of the spine, and from there, it recurs in the genital area.

However, that difference is not absolute, and either strain can reside in either parts of the body while infecting oral or genital areas. Unfortunately, most people aren’t aware that HSV1 and HSV2 can reside in both locations (more than 30% of new genital herpes infections are the result of HSV1), and that is one of the primary contributors to the recent rise in genital HSV1 infections: the misconception that the strains are fundamentally different.

‘People don’t understand that you can have type 1 genitally or orally and that the two types are essentially the same virus,’ says Marshall Clover, manager of the National Herpes Hotline. ‘One type is associated with stigma, the other is ‘just a cold sore’ – our society has a euphemism for it so we don’t even have to acknowledge that it’s herpes.’

HSV1 Might be More Risky

Because of the euphemisms we’ve attached to HSV1, people assume that oral herpes is a mild infection, occasionally bothersome, but never dangerous. For most, that assumption is accurate. When it infects the lips, face, or genitals, HSV1 is often quite mild and more of a nuisance than anything else.

However, for some, HSV1 occurs in the eye, causing ocular herpes, and ocular herpes is a potentially serious infection that can lead to blindness. In rarer cases, HSV1 spreads to the brain, causing herpes encephalitis, and herpes encephalitis is a dangerous infection that can lead to death.

The range and potential severity of HSV1 infections has led some experts to view the virus as more risky than usually perceived. ‘This is here say, but I think type 1 is a more significant infection than type 2,’ says Spotswood Spruance, MD, an oral HSV specialist at the University of Utah. ‘Type 1, and the morbidity associated with it, is underestimated.’

HSV2 Still Poses Some Risks Too

Herpes simplex type 2 is the most frequent cause of neonatal herpes, a very uncommon, but dangerous infection in newborns.

HSV2, however, unlike HSV1, rarely causes other complications or spreads to different areas of the body outside of its original vicinity. Under most circumstances, it is not a major health threat.

Should I compare colds sores to genital herpes?

So, is the comparison accurate?

Since the primary difference between HSV1 and HSV2 lies in where the strain establishes itself in the nervous system, comparing the two infections can help partners understand an HSV infection while also alleviating some misconceptions.

There are some obvious differences between the two viruses when comparing location of infection, risk, and social perceptions, but the viruses themselves look and behave similarly, so an initial comparison can be quite helpful.

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DR.Laura Berman - Facts About Herpes 1 and Herpes 2

There are many misconceptions about herpes. Discover the differences between the HSV-1 virus and the HSV-2 virus.

Many STDs are asymptomatic or take months or even years to surface. In fact, 90 percent of people who have herpes don’t know it! Many people discover it during the first outbreak, and it can take them by surprise because they may not have had sex or sexual contact in a while. It is more common for women than men to contract herpes, and, shockingly, one in four women has genital herpes. ( What causes herpes

There are two types of herpes: HSV-1 (oral herpes) and HSV-2 (genital herpes).

Oral herpes. Oral herpes is more commonly known as cold sores and shows up as sores on the lips and surrounding areas of the face. A hundred million Americans have oral herpes.

Genital herpes. Genital herpes occurs below the belt. It may lie dormant for months and years, secretly holed up within the spine. Stress and certain triggers can cause an outbreak. In women, sores may appear on the inside and outside of the vagina; in men, the sores show up on the penis.

Transmission. Although it is possible for HSV-1 to spread to the genitals through oral sex, more commonly it is HSV-2 that is spread during sexual contact.

Symptoms. Symptoms of HSV-2 are similar to HSV-1, and these include blister-like sores that are often very painful or uncomfortable. They may also be accompanied by flu-like symptoms (such as fever, achy joints, nausea) and burning in the affected area.

Dealing With an Outbreak 
The first outbreak usually occurs within a few weeks of infection, and then outbreaks become sporadic, generally occurring a few times a year, particularly during times of stress. Medication can help treat herpes and diminish symptoms, but as of now, there is no cure for herpes. There is also no surefire way to prevent herpes, although using condoms and dental dams during oral sex can help, as well as using condoms during regular intercourse and anal sex, of course. And, remember, even if you aren’t having an outbreak, you can still pass on herpes to your partner!

You can still have great sex. Herpes does not mean that you can’t continue having a happy, healthy sex life, but you need to work at it. Reach out for support if you are suffering from feelings of shame or anxiety. Visiting a therapist can help you accept your condition and focus on moving forward. There are also online support groups for people with herpes. They can offer excellent information and connect you with others going through similar struggles.

Reduce outbreaks. A healthy lifestyle will help lessen herpes outbreaks. Getting enough sleep, eating right, and reducing stress all go a long way toward keeping breakouts to a minimum. Several medications on the market are also effective.

Moving forward. Negotiating sex with a new partner simply requires honesty. Everyone has something they don't like about their sexuality or their past. You should be clear about your diagnosis at the beginning of a relationship and if your partner is not willing to work around it, then that is not the right person for you. Arming yourself with the facts will help the conversation go more smoothly. Though there is a small risk of passing on the virus when you don't have any lesions (via a process known as shedding), studies show that consistent condom use largely minimizes this risk. When you have a visible herpes outbreak, sexual activity should be avoided entirely. This includes oral sex too, since herpes can be passed between the mouth and the genitals.

Remember, there is no such thing as safe sex, only safer sex. Abstinence is the only way to 100 percent protect yourself from STDs, yet by taking safer sex precautionsyou can protect your body as much as physically possible.


Charlotte Grayson, M.D. - The Truth About HSV1, HSV2, and Oral Sex

I am just beginning a relationship with a new partner.  He has revealed to me that he has HSV2 (genital), but is asymptomatic and has never had an outbreak.  I have HSV1 (oral), basically a cold sore 2 or 3 times a year.  We are using protection every time we have intercourse, but we're wondering about oral sex.  Since I already have HSV1, is it possible to transmit that to him (when no symptoms are present), and vice-versa.  If we were to have ORAL sex with no protection, can we pass HSV1 and HSV2 to each other, or is it "once you've got one of the viruses, you've got herpes"?  If we were to have oral sex, then kiss (again, symptom free), are we risking his currently unaffected mouth and my currently unaffected genital area?

HSV-1 and 2: Apples and Oranges or Just Apples?  Under a microscope, HSV – and 2 look nearly identical. Both types infect a mucosal surface, usually the mouth or the genitals and then ascend the nerves and lay dormant latency in the nervous system.

For both types, at least 2/3 of those infected have no symptoms or symptoms to mild to notice.

BOTH types can recur and spread even when symptoms aren’t present.  Studies show that people with recurrent oral HSV-1 shed virus in their saliva about 5% of the time even when they show no symptoms.I n the first year of infection, people with genital HSV-2 shed virus from the genital area about 6-10% of days when they show no symptoms, and less often over time.

The primary difference between HSV 1 and 2 are where they tend to establish latency.  HSV tends to live in a collection of nervesnear the ear.  From there it tends to recur on the lip or face.  HSV2 likes a collection of nerves at the base of the spine and tends to recur in the genital area.

However, did you know that either type can reside in either or both parts of the body and infect BOTH areas?  In some parts of the world,genital infection with HSV-1 is as common as HSV 2 genital infection.

But, if you already have one type of HSV, it is harder to get the other type.  That’s because the virus causes the body to produce antibodies that provide some crossover protection against the other type should it entering the body. 

That’s why when a person with a prior HSV infection does contract the other type, the first episode tends to be less sever than in a person who has no prior antibodies.

So, let’s look at a few scenarios:

You have genital HSV-1 and your partner has genital HSV-2 and you have unprotected sex.

There is a small risk that you will get HSV-2.  However, it’s not verylikely that your partner will get genital HSV-1.  It’s rare for a person with genital HSV-2 to get HSV-1.

Your partner has genital HSV-2 and you perform oral sex on him or her.  Will you get oral HSV-2?

Not likely. Almost 100% of HSV-2 infection is genital.  Part of the reason is that most people have oral HSV-1 – providing some immunity against infection against HSV-2.

  • You have genital HSV-1.  Can you give your partner a genital  HSV-1 with genital sex?

    Yep.  But not as easily as it istransmitted through oral sex. Remember.  The mouth is the preferred site for HSV-1 infection and the virus sheds less often outside its site of preference.  A study in 1995 shows that about 25% of people with asumptomatic genital HSV-1 shed virus vs.55% of people with genital HSV-2。

  • Related article: Women Herpes Symptoms

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