Are Cold Sores Herpes or What?

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And what does it mean if I have one?

Herpes. We’ve all heard of it, but what do we really know? Well, for starters, herpes is not just one virus—it’s a full family of 8 viruses. Family members include the following: herpes simplex viruses 1 & 2, varicella-zoster virus (Chicken Pox & Shingles), Epstein-Barr virus (Mono), cytomegalovirus (CMV), herpesvirus 6 (Roseola), herpesvirus 7, and Kaposi’s sarcoma (an HIV Defining Illness) [1].

Wait, there are different types of herpes?

Yep. The two members of the family we are talking about in this article are herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). Both are super common and are spread via skin-to-skin contact. The virus does not discriminate; anyone can contract herpes regardless of their gender or sexual identity (or that of their sexual partner(s)). While many people are grossed out by the idea of herpes, as  it turns out, most people actually have the infection; 67% of the global population have HSV-1 and 11% have HSV-2 [2]. How, you ask? Well, we just more commonly refer to the common symptom of HSV-1 as a cold sore. So yes, to answer the title of this article, a cold sore is caused by the herpes simplex virus HSV-1.

Tell me more about cold sores.

Cold sores typically occur on the face, usually in or around the mouth, but they can occur elsewhere, such as on the genitals. By comparison, HSV-2 causes genital herpes (so lesions only on the genital or rectum areas). HSV-1 is sometimes known as herpes labialis because of its predilection for the lips (mouth lips, not vulval lips). Someone contracts HSV-1 when the virus is exposed to an area of the skin known as a mucous membrane. A mucous membrane, such as the mouth, nose, and vagina, is porous to allow the area to stay moist, but sometimes things can also get in. Enter HSV-1, which goes through the top layer of the skin (epidermis) then the next layer (dermis) and then into a nerve cell (neuron). The virus lays dormant in the neuron, essentially hiding from the body’s immune system. It is possible to have the virus but never have an outbreak. Most Americans are infected with HSV-1 virus by the age of 20 [3].

And genital herpes?

Similar to HSV-1, HSV-2 infects someone by crossing a mucous membrane. In this case, however, the sores are in the genital area or rectum and the infection is spread via sexual contact. Again, an outbreak occurs and then it goes away. The key difference with HSV-2 is that even in its dormant state, it is much more infective than HSV-1. Note that both types of herpes can be spread even if the partner with the infection does not have an active outbreak. It is easier to spread HSV-2 even if the person doesn’t have lesions at the time of intercourse.

Should I get tested for herpes?

Some providers are satisfied with a clinical diagnosis (deciding the condition based on signs and symptoms), but there are plenty of arguments for confirming with laboratory testing. Doctors used to perform a Tzanck smear, but that method has largely been replaced by an antibody test. The best way to test for herpes is something called a Polymerase Chain Reaction (PCR) where a sample is taken and the DNA is copied numerous times. Don’t worry, they don’t give you the copies back-it just makes it easier to look at the DNA and confirm the diagnosis. The test results are usually returned to you within 24 hours.

Can I get rid of cold sores?

The super frustrating thing about herpes is that it is incurable. As discussed, the virus lays dormant in cells and then emerges as an outbreak. Most outbreaks occur when the body is stressed from fighting off another infection like a cold—thus the name—or from you know… simply being stressed. When the body’s immune system is busy, the virus rears its ugly head, popping up as a painful lesion on the mucous membrane and surrounding skin. Many people with herpes notice a “tingling” sensation when an outbreak is emerging, followed by the presence of a painful lesion that lasts for a few days. After about a week, the lesion will scab, heal, and disappear… until the next outbreak.

While herpes can’t be cured, it can be treated. Fortunately, there are a few medicines that have proven to have positive effects on outbreaks. They can be taken orally or applied topically. The most commonly used agent is called Acyclovir. Acyclovir and medicines like it usually help the outbreak clear a little faster than without the medicine[4]. Some people also turn to natural remedies.

How can I prevent herpes?

The best way to prevent herpes is by avoiding contact with the virus. If someone you know has an active cold sore, wash your hands a few extra times and encourage that person to do the same. It’s also advisable not to swap saliva (shared drinks, making out) during this time or to perform oral sex, especially without the use of barrier protection (external or internal condom, dental dam, etc.).

To prevent genital herpes, if you, someone you are having sexual intercourse with, or someone your partner is having sexual intercourse with has genital herpes (even if not right this second), again, use condoms/dental dams.

As someone with HSV-1, I can tell you from personal experience that cold sores are painful and highly annoying. They are especially painful to touch. I get mine on my nose, so it hurts to even blow my nose. I can only speculate how painful and uncomfortable it must be to have lesions on the genital area. So, please take the appropriate measures to prevent infection. I constantly wash my hands when I have an outbreak because I do not want to spread the virus. That being said, the virus is spread via skin-to-skin contact and can be spread without an active sore present, so complete avoidance is fairly challenging.

Remember

I’m not sure how I acquired my infection and honestly, it doesn’t really matter. Most importantly, just because I have oral herpes does not make me or anyone else any better or “healthier” than someone with genital herpes. There is a great deal of stigma associated with STIs, but there really shouldn’t be [5]. People like to have sex, to kiss, and to be intimate. Over the course of a lifetime, it is not uncommon to have sex with more than one person, nor is it uncommon to contract an STI. There are 1 million new cases of STIs every day worldwide [6]!

These infections thrive off of our sexual desires, which, again, are totally normal. STIs are a prevailing aspect of the human existence. We shouldn’t stop having sex, but we should protect each other the best we can. So, please use protection, get tested regularly, and have honest conversations with potential sexual partners.

P.S.

If you are pregnant or thinking of becoming pregnant, talk to your doctor because a herpes outbreak can be very dangerous for the baby during delivery.

Sources

[1] https://www.ncbi.nlm.nih.gov/books/NBK8157/

[2] https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus

[3] https://medlineplus.gov/ency/article/000606.htm

[4] https://www.uptodate.com/contents/treatment-of-genital-herpes-simplex-virus-infection

[5] https://www.theatlantic.com/health/archive/2014/07/the-overblown-stigma-of-genital-herpes/374757/

[6] http://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)


Header image illustrated by Leonor Carvalho

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Evan Gooberman, DO, MPH

Evan Gooberman, DO, MPH

Evan Gooberman, DO, MPH is a resident physician at Abington - Jefferson Health in PA and the Chair of the Alan Z. Gartzman, DO Memorial Fund.