Courtesy CDC
Herpes is a sexually transmitted virus that primarily infects the mouth and the genitals. It is transmitted by bodily fluids – penetration isn’t required for transmission, oral-oral or oral-genital contact will suffice.
There are 2 types of sexually transmitted herpes: herpes type 1 and herpes type 2. Both types cause painful cold sores. It used to be that we (doctors and researchers) thought of herpes 1 as primarily infecting the mouth (“above the belt”) and herpes 2 as primarily infecting the genitals (“below the belt”), but we know now that is just not the case. Fifty percent of new cases of genital herpes are actually herpes type 1.
More than 90% of the population is positive for herpes 1 and about 16% is positive for herpes 2, but many people don’t know they are positive, because most people with herpes do not have outbreaks.
While you can transmit either herpes 1 or 2 while you have a cold sore, with herpes of either type, shedding of the virus (being contagious) when you have no symptoms or sores happens on a fairly regular basis. In fact, 70% of transmission of herpes is believed to occur while someone is shedding the virus but has not obvious outbreak. As many people with herpes don’t know they have it, they are unknowingly passing it along and that is why it is so common.
While both herpes 1 and 2 cause the same type of painful cold sore, the key difference between the two types is recurrence risk. While you can certainly get herpes 2 on your lips and herpes 1 on your labia or penis, this is mostly likely going to be a one shot deal. This is because herpes 1 prefers to be “above the belt” and herpes 2 “below the belt.” In a nut shell, herpes 1 on the genitals is far less likely to shed sporadically or give you recurrent cold sores and the same goes for herpes 2 in the mouth. They thrive best in their native habitat.
That’s one of the reasons to get a lesion swabbed on your genitals, to get it typed to see if it is herpes 1 or 2. If it is herpes 1, you are far less likely to shed the virus and have recurrent outbreaks and are also less likely to transmit it to your partner. That information may just give you some piece of mind. If it’s herpes 2, there are ways to deal, and we’ll review that in another blog later this week.
Peace of mind is an understatement!!! Reading this article after finding out my genital herpes is simplex 1 is like a little ray of sunshine through a dark cloud that’s been hanging around far too long!
Posted by jgirl | November 2, 2011, 1:04 amUm…I know you’re a doctor, but I think this is kind of crap. Does the data really show that only 16% has HSV2? I also think you are misleading about the one-shot deal of HSV1 below the belt- it’s not like someone will only get one outbreak down there and never get an outbreak (or shed down there) again. Sure, one might be prone to less symptoms in the naughty bits with HSV1, but they still are symptomatic.
And why are you not advocating blood tests to determine HSV1 vs. HSV2? I have HSV2, had an outbreak, it was swabbed, and came back negative. A blood test confirmed it.
I look forward to further explanation…and reality.
Posted by Herpes Goddess | November 9, 2011, 6:50 pmThe percentage statistics comes from the NHANES studies. Read them yourself. NEJM.
Posted by Dr. Jen Gunter | November 9, 2011, 6:51 pmA swab test can come back negative if the lesion is healed, and no longer shedding the virus; even though you still have it. Also blood tests can be inconclusive if the infection is new; thus a negative result in the blood reveals no antibodies are present, even if your lesion culture is positive for HSV1 or 2. The Dr.’s stats are legitimate, as are the detection techniques.
Posted by abc | January 12, 2013, 5:43 pmsame with me…. i had a herpes outbreak and had it swabbed and it came back negative i think i had an outbreak swabbed two times actually that were negative…. and i was becoming frustrated so i asked the place i was going if its possible to get a blood test done and they told me it wasnt. wth? then when i was pregnant my husband was adamate that he had a blood test done for it… so i demanded it… and low and behold i have type 2.
Posted by Beautifulness | February 17, 2013, 12:41 pmI just got diagnosed with HSV1, and reading this actually made me not feel like crawling up in a little ball and crying like a baby. The outbreak I have right now is genital and in my throat and mouth, I talked to the doctor who did the blood test on me and said over time that it would eventually get much better. She said that what I’m having is a massive outbreak and is unusual, but that it may be due to the fact that I stressed myself out over it so much. She also told me even though I have it in the genital area that It doesnt mean that I needed “private to private” contact to acquire it. But this did make me feel a whole lot better about the whole situation. For anyone else to has HSV1 or 2, I wish you the best of luck
Posted by samantha | December 19, 2011, 10:07 amHSV 1 on the genitals is very unlikely to recur on any kind of regular basis. I hope that also helps.
Posted by Dr. Jen Gunter | December 19, 2011, 10:18 amSo that means since I have herpes 1 I had a bad outbreak for the first time back in 2010. I have never seen or had any outbreaks since. What is the likely Hood of another out break.
P.s the outbreak was gentiles n oral
Posted by me | May 25, 2012, 11:47 amHi Doctor,
I am so glad I found your blog….so helpful.
I am at a total loss right now…I just received a blood test showing positive for herpes 1, though I have no idea where it is in my body right now. I had a very complicated set of circumstances, and I just can’t figure it out.
I recently had a new sexual partner. Prior to him I was in monogamous relationships for the last 17 years. The three people I have been with in that time, (including him) have all tested negative for both herpes types very recently.
Before having sex with the new partner (unprotected for literally 1 minute before he put condom on, and he performed oral sex as well), I was having a little vaginal irritation, and a little tickling…(not tingling) before we had sex. The night before sex I also had vaginal waxing done, and the girl waxed my labia (though I didn’t ask for that) and it was horrific!!! She caused a great deal of trauma, and I think removed some skin.
The vaginal irriation continued the next day and still continues. I still feel sore in the labia area just like I had ripped my hair out during bikini wax. Then about 2-3 days later I noticed an area that appeared raw in my labia area, it healed very quickly within a day or so.
By the time I went to the Doctor, there was nothing to see, all healed up. Doctor tried swabbing the genital area anyway, but it came back negative.
She did find that I had bacterial vaginosis, and she gave me medicine for that, which I have recently finished.
No other classic symtoms at all….I feel great otherwise. But still sore down there….
Blood test does show herpes 1, but blood drawn was at 9 days after sex ( and he is negative anyway). Since test was done so quickly after this partner, it leads me to think the virus has been in my body for a long time, (but again partners from 17 yrs all test negative)
Is it likley that the herpes 1 is in my mouth since all these partners have tested negative?
The doctor gave me acyclavir to take for 5 days, no change in how I feel. No sores or raw areas at all, but still feeling numb down there like I did after waxing 3 weeks ago.
I’m totally freaked out and confused. Sorry for the long explanation, but my Doctor has not been very helpful in trying to figure this out with me.
Posted by Daisy | July 8, 2012, 6:33 pmi also just got diagnosed with it, not sure if its HSV-1 OR HSV-2, mine is genital, nothing above the belt so far,
deffinitly stressed about it but before i knew anyting about it and before i knew it was herpes i was picking at the sores in the genitals, and now i believe i have it on my right middle finger, its swollen and hurts…no open sores, but im scared to touch my face incase it is on my finger..what should i do?
Posted by stephanie | February 5, 2013, 1:48 pmI have cried myself to sleep many nights but reading this has brought my partner and I so much peace of mind.
Posted by L | December 27, 2011, 12:21 amOk, so my gf has what we believe Herpes 1 at least that is what the doctor think it is. She is taking antibiotics etc to get it to go away. And it is. She had a tiny cold sore in the lips but I kiss her nontheless and i have nothing. She got it we believe from shaving down there and she cut herself then the wound didn’t heal and started looking like a big pimple then it was not one it was various. Also, she got a strep infection. So, the doctor told her that due to the body going thru so much that Herpes 1 (which like you said it is always active on us) outbreak on her already wounded genital area. No, I haven’t tested myself but I seem healthy. So, my question is could I get it? If so how? By fluid exchange, going down on her? And how long until it has fully clear up can I have sex with her again?
Posted by Natalia | January 11, 2012, 4:48 pmThis has made me feel so much better! I was diagnosed with HSV-1 last week and I was devastated! However knowing this had made me feel happier and much more confident!
I wish anyone who is diagnosed with either HSV-1 or 2 the best of luck! and just look after yourself! LOVE yourself!
Posted by c :) | January 12, 2012, 11:41 amI have HSV 2 and my girlfriend just got diagnosed with HSV 1 after having a below the belt outbreak; is it possible that my HSV 2 gave her HSV 1or would she have to have gotten HSV 1 from someone else?
Posted by Mike | January 19, 2012, 3:51 pmDear Doctor;
Thank you for your ongoing online efforts RE Herpes 1\2 education.
I have a curious (and quite painful) situation to report and had hoped you could shed some light on it.
My soon to be ex-wife contracted herpes 1 and 2 while I tested positive for herpes 1 only. This happened immediately after the final time we had sex (which included oral sex.) I HAVE been tested for all other STD’s and am negative, but DID test positive for LGL-Leukemia (so my immune system has been compromised for some time.)
I can’t explain why or how she got herpes 2 as, again, I tested negative for herpes 2. I have been monogamous since 1994 after various extra-marital affairs. Test results are available should you desire to review them, but two independent MD’s firmly reported I have herpes 1 and NOT 2.
So my two questions are :
1: How could she get it and I not have it? Could the LGL combined with shedding of herpes 1 be a factor in my wife’s infection?
2: Can I keep this from recurring with other partners? Are antivirals effective to limit the potential of further transmission of the virus?
Confused; Rich S
Posted by Rich S | April 3, 2012, 7:51 pmIsn’t there anyway at all to get ride of herpes 1 at all? I just found out that I have it please tell me there is because I don’t know how I’ll tell my partner :’(
SCARED, OZZY
Posted by OZZY | April 29, 2012, 10:42 amU can’t get rid of it, but don’t be afraid, its not gone to ruin your life, u can still live healthy and happy and have a happy sex life, I know because in 2010 I was diagnosed with herpes 1. I have only had one out break n none since, u should tell ur partner because if u have it, where else could u have gotten it from if they are the one who is ur partner, either u or ur partner cheated. Not saying u did, but telling them is better for ur n their health. Good luck sweetie ull be ok
Posted by me | May 25, 2012, 11:54 amthats not true if you have had oral sex with your partner and he has cold sores that is how you have got it ,l got it that way its just bad luck .
Posted by jackie hurst | August 23, 2012, 6:02 ami feel the same way
Posted by confused | October 1, 2012, 10:46 pm*peace of mind
Posted by shelby | May 11, 2012, 4:34 pmI have herpes simplex 2 I have never passed it to none of my partners in the past and here it is years later and they still have no symptoms and have been tested. I have to watch out when I have my outbreaks and make sure I do not have sex around that time. I was also able to have my son natural birth with no c-section and here it is 6 yrs later with a healthy boy that does not have herpes. Im famiiar with the shedding stages and I can feel when Im contagious I know that sounds weird but I just had to take the time to learn my body over the years.
Posted by jam | May 17, 2012, 9:58 pmI have herpes 1 n only had one outbreak in 2010 and that’s it.
Posted by me | May 25, 2012, 11:58 ambe careful please!!!!!!!!! I got type 2 10 years ago. Was in 2 long term relationships- 4 years each. They never got it /had them get blood tests. Then single for 2 years, no sexual partners. Then I find this WONDERFUL GUY and I tell him before we even get into a relationship. I just got THE CALL, he got it. After 2 weeks of sex. I feel really crappy right now as his outbreak is way worse then I ever had. Oh I’ve been on valtrex the WHOLE TIME 500mg once a day. He is understanding as I warned him before, but how bad I feel about it just sucks! I only had one outbreak when I first got it so many years ago. I had no symptoms and still don’t. So just FYI!
Posted by carrie | August 30, 2012, 1:01 amI also have herpes simples 2 and I have been extremely worried the last couple of days and your post has given me a little bit better of an understanding and even some peace of mind. The thing ive been most worried about is passing it during childbirth in the future. But thank you for your post.
Posted by Candy | October 13, 2012, 9:03 amHi Dr. Gunter, I know you’re busy but I’m hoping for a response from you. I am a man and I recently had an encounter with a woman during which I performed oral sex on her. Three to four days after the encounter I developed a blister on my upper lip. In the article you mentioned the risk of re-occurrence to be quite low. My question is a) does this mean I will still be infected, and b) Should I be going to the doctor and getting a swab test like you recommended in the case of HSV1 on the genital area? Thank you for your time and reply.
Posted by AL.MOE | June 11, 2012, 10:12 amI have type1 and I’m very young… 16 and the doctor told me I infected myself “below the belt” by touching or going to the bathroom ect. And I had one outbreak. My mouth was terrible I could not eat drink or sleep. But genitally I had very few. And right now I have 3 white bumps on my tounge.. Herpes or cold sores??? I’m on medicine everyday to prevent out brakes. And I keep stressing about it because my partner has been having sex with me with NO condom and for a little while now.. What if he has it? He’s not being treated at all..
Posted by Ihatethis333 | June 13, 2012, 8:11 pmHello, my fiance has herpes simplex 1 on his lips. He just recently got them this year. Never had them before. The first time he got it was when he got the flu. Me and him have been trying to be careful he’s even stop giving me oral sex, sharing stuff, and kissing on the mouth when he feels and gets an outbreak. However, my main concern is that we still have sex. Can I still get herpese? I know I’m at high risk because of shedding but because our bodily fluids are getting passed to on another can I still get herpese especially down there? I’m very concern.
Posted by lene | June 28, 2012, 11:18 amAlso another question. If a woman has herpes in her cervix, can she still have children. And if yes will the fetus/baby be in danger? And what are sympotoms of herpes in the cervix??
Posted by lene | June 28, 2012, 11:59 amHi Doctor,
I just found out that I have the herpes 1 virus today. I’m devastated. I have always been very healthy, and had very recently had a complete blood panel done, all negative. But I understand that herpes is not part of the standard panel, so I may have had this for awhile.
I just started a new relationship, and the first time we had sex I gave him a condom. I realized he had not put it on. Sex was unprotected for only 1-2 minutes, literally.
He also performed oral sex for a short period of time.
Oddly enough I had recently had a bikini wax, and think they may have caused a small abrasion in this area. …so it makes everything very complicated.
Is it possible that I had the virus in my body before, and the small sore I noticed after our sex had nothing to do with my partner, and possibly was brought on by the bikini waxing? Again, a blood test confirmed that I do have the herpes 1 virus…
Furthermore, does this mean I should never give or receive oral sex again??
Posted by Daisy | June 29, 2012, 4:21 pmDr. and Daisy,
I read both your post and it sounds pretty much like my story. I was married 16 years and in the last four years been in two relationships…this last one, I got sick after spending the weekend with him for the first time. I went to the hospital from being so miserable…diagnosed with Bacterial vagnistis and a UTI. Took all my meds and was cleared up. Went to my OBGYN for a follow up and he did blood work on me because every thing looked fine but wanted to check to be safe. My test came back positive for type 1. Here is the thing, never had a break out-soars or anything. So I am confused about if my test might be a false positive. I am so scared because I dont know how long have a had this…my kids drink from me, etc… I am scared to consider starting any relationships now. I have read on this and it says that you can get it by kissing, using some ones tooth brush, drinking after them. Is this true? I am concerned like the lady that posted this. Can you please respond to our post doctor?
Posted by scared | October 11, 2012, 10:41 pmIf I conceived a baby when my husband had an active colesore in his mouth ( I have never had hsv1 or hsv2) is the unborn child at risk as hsv1 can be in seminal fluid?
Please help
Posted by JB | July 2, 2012, 4:21 amVERY IMPORTANT QUESTION: ok so I recently met a wonder, beautiful, & caring young woman. I really like her…she is like my dream girl but just informed me she has herpes type 1. I have not kissed her, had sex, or any contact with her in that manner. I have to kno, what should I do? I mean I have been reading up but hell can I even kiss her, can we have sex both oral & genitally? I just want us to be able to have normal interaction & not contract the virus. I really like her & desperately need answers. I was schocked but didnt just blow her off…i rly like hee but Im scared & dont wanna put myself at risk PLEASE HELP!!!
Posted by Andrew | July 6, 2012, 11:52 pmI have herpes type 1 for 2 weeks now. My girlfriend does know about this and I am very open to her. We both have sex regularly. But I am getting worried my girlfriend has already been infected with it but can’t see any symptoms yet. Question: Should I quit having contact with her? Thanks
Posted by Jon | July 7, 2012, 8:21 pmsome information was left out of this though very informational 1 is that herpies can be passed down geneticly ((though i probly do have it i never had symptoms)) i know my mother had it , my younger sister had it and her oldest son ((who is 8)) has it i rember my younger sister having symptoms sence age 5 but we never knew what itt really was. 2ndly out breaks can be some what controlled by our immune system keep the imune system boosted up and your less likely to get an outbreak most outbreaks occur when our immune system has a drop in how strong it was or supose to be or something weekend it
i am not a doctor nor an expert on the subject but i have researched it and have had personal expereince with it i hope the information helps calm people down who may be infected and its a pretty common virus OH another thing if you had chicken pox congrats you got another form of herpies ((forget wich one it is)) sooo again very common virus 1 day the whole population will have it and it wont matter
Posted by justin | July 12, 2012, 7:22 amHerpes can not be passed “genetically.” Herpes type 2 can rarely be transferred vertically, from mother to child, during birth. That is why a woman with active genital herpes requires a c-section.
Posted by Dr. Jen Gunter | July 14, 2012, 10:52 amIf Herpes 1 antibodies are present in between 58-90% of the population and many in childhood and adolescence -why is it classified as an STD?
Posted by Gerard Freisinger | January 12, 2013, 2:51 amHo I have a cold sore on my lip and usually get these prob twice a year. , but have noticed that I have a couple of sores appear on my penis , which I have never had??? Is it poss I have down there too now?
Posted by Jodie | July 15, 2012, 12:29 pmTrying to get a grip on this. I had an outbreak of a rash onb my back about two years ago and went to the doctor. He looked at it and said it was shingles and gave me some meds. I took them and it all passed. about a year later it came back, I had changed doctors so I went to the new doctor and explained the whole past, she said its was unusual to get shingles twice but said it wasnt impossible. Meds again, and again it passed. then it came back again so I talked to her about and she said its not shingles it herpes and sent blood to get it tested. It came back positive for type 2. I have read a lot about the differences between type 1 and 2, one being the “above the belt” type and 2 being the “below the belt” type.
I cant figure out how I would get herpes type 2 on my back. Is it possible that both my doctor and the blood test are wrong? If I do in fact have type 2 and the outbreak is on my back can I pass it while having sex? I really confused about this and feel like my social life is done. Im 47 years old and recently divorced. I have been with three women since my divorce (over 4 years ago) unfortunatly I wasnt parcticing safe sex.
I was married for 14 year and as far as I know my ex never cheated on me and I neve cheater on her. So it had to be one of those three women, correct? Actually one of two as I had my outbreaks before meeting the last one.
Help me understand this and how I can possible move forward and be in any kind of relationship ever again.
Posted by Rob | July 18, 2012, 12:46 pmDear Doctor, i’ve just been diagnosed with herpes & i was wondering is it just contagious where the lesions are located or is my entire penis contagious? I ask to keep my gf safe because she likes to give me oral so we are trying to educate ourselves on the do’s & don’ts because we were wondering is it safe to lick in places that the lesions are not due to the fact that i only have a small spot on the shaft right below the head???? We really would appreciate your feedback…… Thanks in advance!!!
Posted by Tall Guy | August 24, 2012, 10:15 ami really dont understand any of this. My blood test came back positive for antibodies for herpes 1. ive never had an outbreak or any other issue i always tested negative . i have been with my girlfirend almost a year and i got tested three months ago and just got the positive results . does this mean she gave it to me.. she has also never had any visible cold sores. my son is four years old and he has drank out of my water and things like that. does that mean he also has it.i havent spoken to her about the results and i honestly have no idea what to do ..please help!!
Posted by confused | October 1, 2012, 10:41 pmMe and my partner went to a clinic n they said you could of had it since your first sexual partner, so it doesn’t necessarily mean either of you have cheated
Posted by jade | October 4, 2012, 10:30 amI am a 23 year old female and my boyfriend just told me he got herpes type 1. I have been with him for 3 years. I love him but I am really scared. He has never had any type of breakouts (well I haven’t seen them at all) and we do have sex and oral sex. He told me that the doctor said that its not contagious unless we do oral sex while he has a breakout. But now that I’m reading I’m not that sure. Please somebody help me. I need to know what to do from now on. I don’t want to have herpes or any type of disease. I have always been really careful with stuff like this and I still can’t believe this is happening to me. How about if I have kids with him.. Please help
Posted by hola1212 | October 21, 2012, 2:57 pmI cut myself shaving and I was sore and then my underwear began to bother me. My partner has herpes 1 so he gets cold sores but he also takes antibiotics for them. we use condoms all of the time and we never have oral sex when he has them. Can you get genital herpes from someones spit without it touching the cold sore and while they’re on antibiotics?
Posted by sadie | October 22, 2012, 4:31 pmCan Herpes type 2 be detected with a full blood panel or an HIV test? please doctor, let me know. Thank you so much.
Posted by Krissy | October 25, 2012, 9:24 pmJust after a little advice.
I have the beginning of a cold sore on my top lip I believe (swollen, tingly, and possible a slight blister). I have had them before, but I believe my trigger is my menstral cycle. I have them about ones every year, and the last time I had a cold sore.
I have recently slept with my girlfriend for the first time. She has never had herpes above or below the belt. I do believe her as she has been with the same guy since she was 15, and now me, so I have no reason not to believe her.
We slept together on the 24th and 25th, and today is the 26th. I’m wondering if there is any chance she may be infected, or if it’s just when the ‘weeping’ stage of the virus occurs that it is contagious?
Thank you for reading this, and I eagerly await your reply.
Kind regards,
Claire.
Posted by Claire | November 26, 2012, 2:26 amIve been with this man and only him. i get tested for herpes and was told i had h1 and h2. when i let my friend no he goes to get checked his results came back only h1 i remember the nite he gave me oral sex and the next morning i see a cold sore didn”t think anything about it cause i didnt know that they were really herpes.untill i was tested 2 years later. we argue that he didnt give me h2 cause his test only state that he had h1 but i had not been wit anyone eles to have gotten h1 or h2 nor had i ever tested positive for it. so my question is can a person that has tested positive for h1 have oral sex wit partner and those sores of the mouth cause h2?
Posted by latunya gibson | January 15, 2013, 1:14 pmDear Dr.,
I just had my first outbreak, the swab came back negative, so I don’t know whether it is HSV 1 or HSV2. I went on Valtrex and the sore healed up (it was a very small outbreak). Then I had sex with a new partner (about 5 days after finishing the Valtrex) and the condom came off inside me. What are the chances I passed it along? I am feeling terrible about this.
Posted by Karen F. | January 17, 2013, 11:37 pmMy was recently diagnosed with herpes type 2.
The cops & cps workers think she was molested since type 2 is mostly a sexualy transmitted disease.
I honestly don’t think she has been sexualy abused.
Her father also has herpes type 2.
Is there anyway way my daughter could have caught the disease from her father without being sexualy abused??
Oh & my daughter is only 19 months old.
Posted by Carla | January 26, 2013, 12:03 pmhow can you get hsv-2 on the mouth if you never had an oral sex ? can you get hsv-2 on your lips when you were a kid ??
i always get a cold sore in my lip since i was a kid and i did not know its a virous i thought it comes with the flue but when i read about this virus i thought i have hsv-1 but when i went to do the blood test i found that i have hsv-2 so how come this happens to me ??
Posted by sam | February 13, 2013, 1:41 pmI would like to know how can a person get Hsv-2 on the mouth when they haven’t performed oral sex in 2years?
Posted by unknown | February 16, 2013, 1:53 pmAntibiotics do not work on viruses as they aren’t living like bacteria As such
Posted by Rewbee | March 4, 2013, 3:45 pmIf someone has HSV 1, and only experience cold sores around the mouth, can they still contract HSV 2 and experience sores around the genital area from someone with HSV 2?
Posted by Emy | April 8, 2013, 4:56 amI have a question… both my boyfriend and i have always had HSV1 “above the belt” but not “below the belt” and I had an outbreak and decided to give my boyfriend oral sex and then have regular unprotected sex… is it unlikely that he and i will catch HSV2 or HSV1 “below the belt”??? Because neither of us have HSV1 or HSV2 below the belt. We only have HSV1 above the belt. But since i gave him oral sex with a cold sore outbreak does that mean he now has genital herpes??
Posted by Noname | May 4, 2013, 2:47 pm