Herpes Simplex Virus: What You Need to Know about HSV-1 vs HSV-2

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The herpes simplex virus impacts a significant portion of the worldwide population. According to the World Health Organization, 3.7 billion people younger than 50 have HSV-1 and over 417 million have HSV-2.[1] Since it’s so common, there should be more awareness about the differences between herpes virus type 1 (HSV-1) and herpes virus type 2 (HSV-2), symptoms, and treatment. Herpes can impact various parts of the body: people experience symptoms on the anal region, external genitalia, mucosal surfaces, and skin. They appear as cold-sores, turn into blisters, and heal within a week. This is what’s known as experiencing an “outbreak.” [2]Although there is no permanent cure for herpes, a lot of people infected with the virus will never experience physical symptoms. Here’s what you should know about HSV-1 vs HSV-2.

HSV-1 infection is the most common form of herpes. It’s highly contagious, and people usually get infected with it during their childhood. If you are diagnosed with HSV-1, you are far from alone.

These are a few statistics regarding HSV-1:

  • The National Institute of Health estimates that by the time they turn 50, 90 percent of adults will have been exposed to it. [3]
  • In the United States, 50% of adults have HSV-1. [4]
  • The Center for Disease Control found that the older you are, the more likely you will have the infection. [5]

HSV-1 symptoms tend to manifest themselves on the mouth but they can also happen on other parts of the face, tongue, and skin. [6]  However, you can still get HSV-1 on your genitalia through oral sex. Part of what makes prevention tricky is that people without visible symptoms can still spread it.

Here are the symptoms of HSV-1:

  • Pain and itching.
  • Tender, enlarged lymph nodes.
  • Cold sores around the mouth.
  • Painful blisters or open sores called ulcers in or around the mouth.
  • Red blisters on the skin.

Oral herpes can last anywhere between 2 to 3 weeks. If you’re experiencing any of these symptoms, it’s best that you consult with a doctor to get a proper diagnosis. Despite not being that severe in people with healthy immune systems, HSV-1 can still lead to some difficulties for people who are suffering from a weakened immune system. In those cases, it can become fatal through spreading to the liver, brain, lungs and other organs. [7] Specifically, people with atopic dermatitis — eczema — and HIV are at serious risk of this condition becoming detrimental.

Though HSV-1 is more common, HSV-2 is still significantly prevalent amongst the population. HSV-2 is generally sexually transmitted and is the cause for genital herpes. Although treatment can help lessen its severity and frequency of symptoms, there’s no cure and it’s a lifelong condition. HSV-2 is more prevalent amongst women. In the United States, amongst 14-49 year olds, 15.9% women and 8.2% men, have been infected with HSV-2. This is because it’s easier for men to give women genital herpes in penetrative sex.

Here are a few more important statistics:

  • In 2012, 417 million people around the world were living with the infection. Prevalence of HSV-2 infection was estimated to be highest in Africa (31.5%), and the Americas (14.4%). [8]
  • 15.5 % of people in the U.S. aged 14-49 have been infected with HSV-2. [9] [10]
  • 10-20% of people diagnosed with HSV-2 have noticed the symptoms before they are diagnosed. [11]

There are various symptoms of HSV-2:

  • Vaginal discharge
  • Experiencing pain while urinating.
  • Fever
  • Generally feeling unwell.
  • Blisters and ulcers on genitals, vagina, and the cervix area.

Outbreaks last anywhere between 2-4 weeks and initial symptoms can manifest anywhere between 2-10 days after the virus enters the body. During the first year after infection, recurrent outbreaks are common. In the course of one year, someone can experience four to five outbreaks. [12]Usually, outbreaks decrease over time as their immune system becomes used to the virus. Before an outbreak, individuals with HSV-2 may experience itching or a burning sensation in the area that was initially infected.[13] Both HSV-1 and HSV-2 can lead to the fatal condition of neonatal herpes, the transference of herpes from a mother to her child when giving birth. [14] Though this is very severe, it’s quite rare and only happens in one in every 3000 births.

While there isn’t a long-term cure for herpes, there are various medical treatments that can help alleviate symptoms and shorten healing time.  These treatments are all antiviral drugs, meaning they stop viruses from growing in your body. Instead of outright eliminating the virus, they just control it from spreading.  These medications can also help people who don’t have symptoms reduce the chance of them passing the virus to other people.

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These are a few medications available for both HSV-1 and HSV-2:

Acyclovir (ACV)

ACV has been used as a genital herpes medication since the late 1970s. It can be effective for chicken pox, both types of Herpes, and shingles. The medication is taken for both treatment and preventative purposes. Typically, ACV should be consumed anywhere between two to five times daily for a duration of 5 to 10 days. As a preventative measure to stop outbreaks from occurring, ACV is consumed for 12 months for two to five times daily. [15]

Here are some ACV side effects[16]:

  • Swelling and pain in an infected area
  • Reduced appetite
  • Nausea
  • Vomiting
  • Tiredness


Famciclovir is an antiviral drug that’s prescribed for herpes infections and is primarily used for shingles and chickenpox. However, the drug can be beneficial for patients with compromised immune systems who have HSV-1 or HSV-2.

Here are some Famciclovir side effects[17]:

  • Diarrhea
  • Headache
  • Stomach aches and nausea
  • Bleeding

Valacyclovir (generic Valtrex)

Valacyclovir, popularized under the brand name Valtrex in the US, has been a leading herpes treatment since 1995. When valacyclovir is consumed, it helps mitigate the symptoms of herpes through converting into ACV and subsequently stopping the virus from spreading. Valacyclovir can cut down healing periods after an outbreak. [18] In addition, it also reduces the likeliness of you infecting someone else with the virus. [19] One study estimated that people who take Valacyclovir for suppressive herpes therapy are 48% less likely to give their partners herpes. [20] Though it has similar effects to ACV, Valacyclovir stays in your body for a longer time and assists in reducing your outbreak. On top of that, a smaller dose of Valacyclovir is as effective as a larger dose of ACV. [21]

Here are some side effects of Valacyclovir[22]:

  • Muscle pain
  • Muscle stiffness
  • Bleeding
  • Cramps
  • Sore throat
  • Ear congestion
  • Congestion
  • Sneezing
  • Losing voice

Ultimately, it will be up to you and your physician which medication works best for your condition. Having herpes doesn’t prevent one from being generally healthy. That being said, it can still be a serious inconvenience. There are various ways in which you can prevent getting HSV-1 and HSV-2. The easiest way to prevent contracting HSV-1 and HSV-2 is being cautious and not coming into contact with cold-sores. If you do, wash your hands immediately and thoroughly. In addition, you should use condoms or latex barriers during oral and penetrative sex. Although condoms aren’t full-proof and there’s always a risk, condoms can help you not contract the virus.

For people who have herpes, there are things you can do to mitigate your chance of spreading it to other people. In addition to taking the aforementioned medications, a weakened immune system and irritation in the affected area can lead to outbreaks. [23] Take the proper precautions, eat healthy, and get a good amount of sleep to keep your immune system in check. Studies have shown that stress leads to a weakened immune system.[24] If you have herpes and want to prevent outbreaks, reducing your stress and anxiety can help boost your immune system and reduce your chance of having an outbreak. Here are a few things you can do to reduce your stress and anxiety:

  • Exercise
  • Sleep
  • Socialize
  • Seek therapy
  • Develop productive coping mechanisms

Having HSV-1 or HSV-2 can have an impact on one’s self-esteem. It’s important that people who have herpes are transparent and honest with their partners about their condition. Explain to your partners that despite the stigma, this is a very common condition and it’s manageable as long as one is taking antiviral medications and not engaging in sex during outbreaks. Over time, your body’s immune system will become stronger and more resistant to both HSV-1 and HSV-2. Hence, it’s a condition that will get less severe with time. With Valtrex, you can not only prevent outbreaks but reduce the risk of spreading it to your partners. If you suspect that you have either HSV-1 or HSV-2, it’s critical that you consult with a physician for a diagnosis. The CDC suggests that people only get tested if they are experiencing an outbreak or if they have recently have come in sexual contact with someone who has herpes. [25] Your doctor might also give you a herpes test if you have unprotected sex with multiple people. Regardless if you have HSV-1 or HSV-2, just know that there are medications out there that can help.

Herpes Simplex Virus infographic

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

[2] https://www.cdc.gov/std/herpes/stdfact-herpes.htm

[3] https://uhs.umich.edu/coldcankersores

[4]  https://www.cdc.gov/std/herpes/stdfact-herpes.htm

[5] https://www.cdc.gov/nchs/data/databriefs/db304.pdf

[6] https://www.aad.org/public/diseases/contagious-skin-diseases/herpes-simplex#symptoms

[7] https://health.ucsd.edu/news/releases/Pages/2013-06-06-herpes-virus-exploits-immune-response.aspx

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

[9] https://www.medicalnewstoday.com/articles/151739.php

[10] https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm

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

[12] https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm

[13] https://www.acog.org/Patients/FAQs/Genital-Herpes?IsMobileSet=false

[14] https://www.aafp.org/afp/2002/0315/p1138.html

[15] https://medlineplus.gov/druginfo/meds/a681045.html

[16] https://www.mayoclinic.org/drugs-supplements/acyclovir-oral-route-intravenous-route/side-effects/drg-20068393?p=1

[17] https://www.mayoclinic.org/drugs-supplements/famciclovir-oral-route/side-effects/drg-20063776?p=1

[18] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC149313/

[19] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687913/

[20] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687913/

[21] https://www.ncbi.nlm.nih.gov/pubmed/17692271

[22] https://www.mayoclinic.org/drugs-supplements/valacyclovir-oral-route/side-effects/drg-20066635?p=1

[23] https://www.merckmanuals.com/professional/infectious-diseases/herpesviruses/herpes-simplex-virus-hsv-infections

[24] https://www.apa.org/research/action/immune

[25] https://www.cdc.gov/std/herpes/screening.htm