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Are cold sores the same as herpes?

September 24, 2020 • read

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Are cold sores the same as herpes?

As annoying as they are, cold sores are thankfully benign. Also known as “fever blisters,” cold sores result from a common viral infection that causes small blisters to emerge around your lips. After breaking, the blisters form scabs that last a few days. 

Typically, cold sores are caused by herpes simplex virus type 1 (HSV-1). On rare occasions they’re caused by herpes simplex virus type 2 (HSV-2), which also produces most forms of genital herpes. 

At the sound of the word “herpes,” most people think of a sexually-transmitted disease. While cold sores are caused by the herpes virus, they have no immediate relation to sexually-transmitted genital herpes. 

We’ll break down the differences between the two strains of HSV, and how to get help. Cold sores are never a welcome sight, but they’re very common and very treatable. 

Oral herpes versus genital herpes

The main difference between oral and genital herpes is the strain of herpes simplex virus that causes them — HSV-1 and HSV-2, respectively. HSV-1 and HSV-2 used to be the same virus, but they diverged approximately six million years ago on their evolutionary pathways. Herpes simplex 1 and 2 are lifelong infections that can’t be cured, but can be managed and treated with testing and medication. 

Oral herpes is extremely common, whereas genital herpes is much less widespread. In fact, 51.1% of adult Ontarians have HSV-1. By comparison, only one in seven Canadians have HSV-2. 

What’s confusing is that HSV-1 and HSV-2 can both infect your genitals and mouth. HSV-1 and HSV-2 both cause lesions on your body that manifest as blisters or scabs, undergo long periods of dormancy, and affect your nerve endings. Symptoms of oral HSV-1 include:

  • Tingling and irritation around the lips
  • Blisters and scabs
  • Crusted sores
  • Headache and fever
  • Achy muscles and joints
  • Sore or swollen throat
  • Pain in the affected area

Neither HSV-1 nor HSV-2 are life-threatening, but they can be pretty painful and annoying. Both viruses are also highly contagious, with HSV-2 transmission rates documented as high as 20% within a year in couples where one partner is infected. HSV-1 is so contagious that over two-thirds of the world’s population is estimated to have it. 

What causes a cold sore outbreak? 

Cold sores are caused by a variety of physical and mental triggers, including:

  • Stress
  • Acute fatigue
  • Changing hormone levels
  • A compromised immune system
  • Exposure to inclement weather or direct sunlight
  • Injury or trauma

If you have HSV-1, you can be asymptomatic. That means the virus is present in your body but it’s not currently causing any symptoms. The virus lies dormant in your nerve cells until something triggers an outbreak. However, some people who have HSV never even have a single outbreak. 

How are HSV-1 and HSV-2 transmitted?

You can transmit herpes unknowingly, even if you’re not currently having an outbreak. HSV-1, the strain that causes cold sores and fever blisters, is transmitted via intimate contact on the face, such as kissing or close hugging. HSV-2, on the other hand, is contracted through sexual activity. 

A pregnant mother with the herpes simplex virus can transmit the virus to her baby if the virus is active during childbirth. A 2014 study found that one in every 3200 births in the United States resulted in mother-to-child HSV transmission. HSV transmission in infants can have negative consequences for the baby’s nervous system development. 

Testing for oral herpes

Doctors can provide you with a herpes simplex virus antibodies test. Antibody tests have become increasingly rare and are prone to false positives. Instead, viral culture tests, where a sample of your sore is examined under a microscope, can find antigens in the infected cells. Antigen detection tests and polymerase chain reaction (PCR) tests sometimes return false negatives, and are used only for rare cases.If you’re not having an outbreak of herpes right now, rest easy. Testing and treatment aren’t recommended for asymptomatic HSV infections.

Managing your cold sores

If you want treatment for cold sores caused by HSV-1, you have several options to help manage your symptoms. In consultation with your doctor, you may receive pain medication such as lidocaine as a topical treatment for reducing pain and irritation. 

Preventative treatment can be as simple as wearing SPF 30 sunscreen on your lips. Lip balm with broad-spectrum sun protection can help shield your cold sores from irritation and reduce burning sensations in the affected area. 

If you’re prone to chronic cold sore flare-ups, you should visit a family doctor. They may be able to prescribe you an antiviral that can shorten the duration and reduce the intensity of an outbreak. Taking an antiviral daily can help mitigate the symptoms of HSV-1 and prevent cold sore breakouts.  

Preventing cold sores and HSV transmission

There are steps you can take to reduce your chances of transmitting the herpes simplex virus. If you’ve broken out with cold sores, avoid skin-to-skin contact with anyone else. That includes kissing, so sad news for any romantic partners.

Similarly, avoid sharing utensils, towels, lipstick, and lip balm while you have an outbreak of HSV-1 sores. You should also routinely wash your hands while you have cold sores. 

When to see a doctor for your cold sores

Cold sores are not the same as genital herpes. However, they both belong to the Herpesviridae family of DNA viruses, alongside chickenpox and shingles. Although herpes usually isn’t dangerous, both types of sores are irritating and contagious. Seeing a doctor is helpful to get outbreaks under control and prevent them in the future.

If you think you’re having an outbreak and want testing or medication, you should visit a doctor. HSV can be annoying, but it doesn’t have to be a big deal in your life. 

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