Herpes simplex vs herpes zoster

Shingles, chickenpox, herpes and cold sores

You’re confused: you got chicken pox when you were eight, so does that now mean you’re going to get herpes? You got a cold sore once, and people made fun of you for it. Does that mean you’re doomed for life to be infectious with an STD? Why are there two diseases both called herpes?  If you do have a cold sore, can you give someone herpes if you give them oral sex? All of these questions and more will be answered below.

First, let’s make things super clear.


  • Caused by Herpesviridae-3 (HHV3)
  • 3 to 4 people per 1000 will get Herpes zoster annually.
  • Disproportionally affects the immunocompromised (think people with transplants and/or being treated for autoimmune disorders), unvaccinated people 85 or older, and people with leukemia or HIV.
  • Other risk factors include being female, white, having a family history of zoster, and having asthma or diabetes
  • Associated with chickenpox and shingles.
  • Once you survive chickenpox as a child, the zoster virus lies dormant in bunches of nerves called ganglions.
  • When it’s reactivated, it can present in the form of shingles.
  • Shingles is, in essence, a rash on the skin that follows along a nerve, most usually the torso, face, arms and legs.
  • This rash starts off looking like a stripe of hives that doesn’t cross over onto the other side of the body.
  • Then, papules emerge, which develop into vacules and then pustules.
  • More lesions arrive a few days after the first ones set in.
  • These then crust over by day 10 and start to heal.
  • Complications include pain staying on even once the rash has subsided.
  • Painful, but the types of pain vary from pins and needles to drawn-out discomfort, to feeling pain from things that aren’t usually painful — like touching a blanket.
  • There are also neurological complications like stroke or Bell’s palsy.
  • Has a vaccine.
  • Can be treated with Valacyclovir, Famcyclovir or Acyclovir, with preference on the former two. They require fewer doses but are more expensive. For immunocompromised patients, intravenous Acyclovir is a common treatment.
  • Drugs can be prescribed to manage the pain.


  • Caused by Herpesviridae-1 or 2 (HSV1 and HSV2)
  • 8.4 people out of  1,000 will get Herpes simplex annually.
  • You’re more likely to get it if you’re female, black, have sex with many people, especially sex workers, or have a history of sexually transmitted infections.
  • Associated with genital herpes, oral herpes, cold sores, encephalitis, and inflammation of the lips.
  • Simplex also is a fan of nerve bundles (ganglions) — the sacral ganglions in the lower spine are where HSV2 goes to be dormant, while HSV1 goes to the central nervous system, or the ganglions in the face and neck.
  • The ‘classic’ HSV1 symptom is the cold sore, while the ‘classic’ HSV2 symptom are lesions on the genitals.
  • The cold sore is the common presentation of HSV1. You can get it from kissing someone who has oral herpes. That said, some strains of HSV2 can present with it also.
  • Genital herpes works fairly similarly to herpes zoster, except there is no initial rash, and after pustules, ulcers develop.  It’s chiefly caused by HSV2. You get it from having sexual contact with someone who has HSV2.
  • Complications for simplex include encephalitis. It happens when HSV1 reaches the brainstem.
  • Other neurological complications can involve meningitis and myelitis.
  • An additional effect of simplex is the psychological factor: people with simplex,  particularly when it affects their genitals, can feel low.
  • Another serious concern is the mother infecting the child during birth. The baby can suffer symptoms such as seizures, hepatitis, and inflammation of the lungs.  
  • Infects for life, and a vaccine is still being researched.
  • Can be managed with Acyclovir and Valacyclovir.

How to be sexually active while you have herpes

First, you should tell your partner — honestly, directly, and early on. You should not conceal a herpes infection, because having sex would risk infecting them with an incurable disease. There is no cure for HSV-1 or HSV-2, but the symptoms can be treated during outbreaks or to reduce outbreaks.

If you’re going to have sex, do it carefully. You should use barrier methods such as condoms, femidoms, dental dams etc. Use of antivirals and condoms significantly reduce the chance of infection. However, if you can’t cover the ulcer with a condom, best not to have sex until the ulcer has healed, because there’s a good chance of contact infection. Herpes is most contagious immediately before and after a resurgence, as well as during one. You should be aware that you can infect someone with herpes even if you have no visible sores, this occurs during ‘shedding’ so there is always some risk of infection - that is why it is so important that you discuss your infection with your partner.

Equally, if you’ve got a cold sore, while it’s not a guaranteed chance to infect someone with herpes by giving them oral sex, it’s certainly possible. You ought to wait until it’s healed, and take antivirals.

An upside is that you won’t really feel too alone: 1 in 3 will develop shingles, and more than 1 in 2 Americans will have simplex at least once in their life. The good news is only a bit more than 1 in 10 Americans between the ages of 14 and 49 have genital herpes. This is great progress from a bit less than 1 in 5 Americans in that age bracket back in 1999. If you can call that an “upside”. Also, since we’re discussing zoster here as well, it’s probably important to mention that there are five other notable herpes pathogens, but you generally don’t have to worry about them.

If you got chickenpox as a child, yes, there’s a chance of you developing herpes, but not the kind you’re thinking of. It’s one of the confusing things about the STI and the disease that cause shingles both being part of the same family. If you have chickenpox, the likelihood is that it will come back later in life in the form of shingles, unless you’re vaccinated. The likelihood of you developing herpes simplex is dependent on who you are, but so long as you have sex with people who don’t have herpes, you won’t get it either.


  1. Cohen J, Herpes Zoster N Engl J Med 2013; 369:255-263
  2. Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc. 2009;84(3):274-80.
  3. Kawai K, Yawn BP. Risk Factors for Herpes Zoster: a Systematic Review and Meta-Analysis. Open Forum Infect Dis. 2017;4(Suppl 1):S313–S314. Published 2017 Oct 4
  4. CDC, Genital Herpes - CDC Fact Sheet 2017
  5. Kimberlin, D. W., & Rouse, D. J. (2004). Genital Herpes.  N Engl J Med 2004 350(19), 1970–1977.
  6. Looker KJ, Magaret AS, Turner KME, Vickerman P, Gottlieb SL, et al. Global Estimates of Prevalent and Incident Herpes Simplex Virus Type 2 Infections in 2012. PLOS ONE 2015 10(1): e114989

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