Herpes Simplex vs Herpes Zoster

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 to carry a contagious STD for life? 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.

Order safe and effective treatment for genital herpes

Famciclovir from $18.00

Valacyclovir from $16.00

View all treatments

First, let’s make things super clear.

Zoster

Simplex

Caused by Herpesviridae-3 (HHV-3)
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 persisting even when 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 Bell’s palsy, or rarely, strokes.
Has a vaccine.
Can be treated with Valacyclovir, Famcyclovir or Acyclovir, with preference for 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 is also 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 ganglions in the face and neck.
The ‘classic’ HSV1 symptom is the cold sore, while the ‘classic’ HSV2 symptom is 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 as a cold sore as well.
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 of herpes simplex include encephalitis,which 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 experience depression.
Another serious concern is a mother infecting her 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.

Show all

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 treatment can reduce symptom duration and suppress additional 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. If you can’t cover the ulcer with a condom, it's best not to have sex until the ulcer has healed, as there’s a good chance of contact infection. Herpes is most contagious immediately before and after an outbreak, 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 ‘asymptomatic shedding’ so there is always some risk of transmission. This 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 guaranteed, it is possible to infect someone with herpes by giving them oral sex. You ought to wait until it’s healed, and take antivirals in the interim.

If you do suffer from cold sores or have had shingles, you are not at all alone: 1 in 3 will adults develop shingles, and more than 1 in 2 Americans will have a simplex outbreak at least once in their life. Only a bit more than 1 in 10 Americans between the ages of 14 and 49 have genital herpes. The prevalence has significantly decreased from 1999, when a bit less than 1 in 5 Americans in that age bracket had genital herpes. 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, there’s alway a chance 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 come into contact with. You can minimize your risk by avoiding intimate contact with people who are experiencing an active outbreak.