Are cold sores the same as herpes?

As annoying as they are, cold sores are thankfully benign. Also known as “fever blisters,” cold sores result from a common viral infection that causes small blisters to emerge around your lips. After breaking, the blisters form scabs that last a few days. 

Typically, cold sores are caused by herpes simplex virus type 1 (HSV-1). On rare occasions, they’re caused by herpes simplex virus type 2 (HSV-2), which also produces most forms of genital herpes. 

Wondering if all cold sores are herpes? At the sound of the word “herpes,” most people think of a sexually transmitted infection (STI). While they are caused by the herpes virus, a cold sore doesn’t mean you have genital herpes.

Cold sores are never a welcome sight, but they’re common and very treatable. If you find yourself needing care, get in touch with a Canadian-licensed doctor on Maple in minutes 24/7 from your phone, tablet, or computer. 

Here we’ll break down the differences between cold sores and genital herpes and how to get help.

What are cold sores vs. genital herpes?

The main difference between oral herpes — also known as cold sores — and genital herpes is the strain of herpes simplex virus that causes them, HSV-1 and HSV-2. HSV-1 and HSV-2 used to be the same virus, but they diverged approximately six million years ago on their evolutionary pathways. HSV-1 and HSV-2 are lifelong infections that can’t be cured but can be managed and treated with testing and medication. 

Oral herpes is extremely common, whereas genital herpes is much less widespread. In fact, 51.1% of adult Ontarians have HSV-1. By comparison, only one in seven Canadians has HSV-2. 

What’s confusing is that HSV-1 and HSV-2 can both infect your genitals and mouth. Oral herpes that’s caused by HSV-1 can actually spread from the mouth to the genitals through oral sex, which is why genital herpes can also be caused by HSV-1. 

HSV-1 and HSV-2 both cause lesions on your body that manifest as blisters or scabs, undergo long periods of dormancy, and affect your nerve endings.

Cold sore symptoms include:

• Tingling and irritation around the lips
• Blisters and scabs
• Crusted sores
• Headache and fever
• Achy muscles and joints
• Sore or swollen throat
• Pain in the affected area

Symptoms of genital herpes include:

• Bumps around the genital area that can be painful, break open, and cause ulcers
• Pain inside of the vagina, head of the penis, or rectum
• Vaginal discharge
• Flu-like symptoms
• Trouble urinating
• Swollen lymph nodes
  

Neither HSV-1 nor HSV-2 is life-threatening, but they can be pretty painful and annoying. Both viruses are also highly contagious, with HSV-2 transmission rates documented as high as 20% within a year in a couple where one sex partner is infected. HSV-1 is so contagious that over two-thirds of the world’s population is estimated to have it.

What causes a cold sore outbreak?

Cold sores are caused by a variety of physical and mental triggers, including:

• Stress
• Acute fatigue
• Changing hormone levels (menstrual cycles)
• A weakened immune system
• Exposure to inclement weather or direct sunlight
• Injury or trauma

Cold sores typically develop on the surface of your lips, as opposed to aphthous ulcerations (canker sores) which are small bumps that grow on the inside of your mouth. If you have HSV-1, you can be asymptomatic. That means the virus is present in your body, but it’s not currently causing any symptoms. The virus lies dormant in your nerve cells until something triggers an outbreak. However, some people who have HSV never even have a single outbreak. 

As for how long cold sores are contagious, this is typically up to 15 days. Once your scab comes off, the cold sore scar isn’t contagious.

Remember never to pop a cold sore blister either. While it may be tempting, doing so can cause scarring and even spread your cold sore to others.

Who can get cold sores vs. genital herpes and what causes them?

It turns out that most people are infected with HSV-1 during childhood due to a weakened immune system, from contact with an infected person, or items the infected person has touched. But how cold sores spread isn’t just from childhood— adults can get them later in life from close contact too, including kissing, close hugging, and even through shared eating utensils, drinks, and cosmetics like lip balm or lipstick. 

Genital herpes is a sexually transmitted infection that’s spread through vaginal, anal, or oral sex with someone who’s already infected with HSV-2. Condoms can help reduce your risk of genital herpes transmission during intercourse with a sexual partner, but they’re not foolproof since they only protect the area they’re covering, and a herpes infection is extremely contagious. It’s best to avoid sexual contact if you have any sores.

How do you test for cold sores vs. genital herpes?

Cold sores and genital herpes can be diagnosed by a doctor if blisters are present, but they’ll likely do testing for confirmation. 

Doctors can provide you with a herpes antibodies test for oral or genital herpes, but antibody tests have become increasingly rare and are prone to false positives. Instead, viral culture tests, where a sample of your sore is examined under a microscope, can find antigens in the infected cells. Antigen detection tests and polymerase chain reaction (PCR) tests for herpes sometimes return false negatives and are used only for rare cases. 

For genital herpes testing specifically, you may get a blood sample taken to detect HSV antibodies that have previously fought off the virus. As for how accurate the herpes blood test is, there’s the possibility of an incorrect test result too. So, if you’re not having an outbreak of herpes right now, rest easy. Testing and treatment aren’t typically recommended for asymptomatic HSV infections.

Preventing cold sores and HSV transmission

There are steps you can take to reduce your chances of transmitting the herpes simplex virus. If you’ve broken out with cold sores, avoid skin-to-skin contact with anyone else. That includes kissing, so sad news for any romantic partners.

Similarly, avoid sharing utensils, towels, lipstick, and lip balm while you have an outbreak of HSV-1 sores. You should also routinely wash your hands while you have cold sores. 

Treatment for cold sores vs. genital herpes

While it’s not possible to cure cold sores caused by HSV-1, there are several options to help manage symptoms of your cold sores. You may receive pain medication such as lidocaine as a topical treatment for reducing pain and irritation from a doctor. 

Wearing SPF 30 sunscreen on your lips can also help shield your cold sores from irritation and reduce burning sensations in the affected area. 

If you’re prone to chronic cold sore flare-ups, a doctor may recommend an antiviral medication such as valacyclovir or famciclovir.

For genital herpes, you can use ibuprofen or acetaminophen for pain. You can also apply lukewarm or cool cloths to the area, or take a lukewarm bath. Make sure you keep the area clean and dry afterwards and opt for cotton briefs and loose-fitting clothing. To treat genital herpes, however, you’d use antiviral medication — the same ones you’d use for cold sores. These help your body manage the infection, reduce the duration of the outbreak, decrease pain, itching, and also reduce genital herpes transmission.

As for how long it takes for treatment to work for cold sores vs. genital herpes, both antiviral medications listed above can be used for cold sores or genital herpes and their timeline is the same. They can take between seven to 10 days to work, but you may feel relief sooner than that. 

What are the possible complications of cold sores vs. genital herpes?

If left untreated, herpes complications can occur, but this is rare. Cold sore complications can include:

• Dehydration if the cold sore makes it difficult to drink
• Skin infections if the virus comes into contact with broken skin
• Herpetic whitlow — painful sores and blisters on the fingers
• Herpetic keratoconjunctivitis — inflammation of the eye and sores on the eyelids 
• Encephalitis — inflammation of the brain

Genital herpes complications can include:

• Meningitis — an infection of the protective membrane surrounding the brain and spinal cord
• Encephalitis 
• Inflammation of the lower spinal cord and surrounding nerves 
• Increased risk of other STIs, including an HIV infection

In the case of pregnancy, genital herpes complications can arise, but this is also rare. Herpes may be passed onto a newborn, which can cause brain damage, blindness, and even be life-threatening. However, newborns are more likely to become infected if their mother has an outbreak at the time of delivery. 

To help prevent this, women can talk to their doctor to check for signs of an outbreak before birth. If there are any, a Caesarian section is recommended.

There’s also less of a risk of infection if the mother contracted genital herpes before or at the beginning of pregnancy since her immune system has a chance to produce antibodies that can be passed onto the newborn.

Moms-to-be may also speak with a doctor and decide if they’d like to take an antiviral medication to help prevent an outbreak entirely. 

When to see a doctor for cold sores vs. genital herpes

Cold sores aren’t the same as genital herpes. However, they both belong to the herpesviridae family of DNA viruses, alongside chickenpox and shingles. Although herpes usually isn’t dangerous, both types of sores are uncomfortable and contagious. Seeing a doctor is helpful for diagnosing cold sores or genital herpes, getting outbreaks under control, helping your sores to heal sooner, and preventing them in the future.

If you’ve come into contact with someone who has herpes or think you’re having an outbreak and want testing or medication, you can connect with a Canadian-licensed doctor in minutes on Maple, 24/7. They can provide a diagnosis, medical advice, and treatment if needed. HSV is lifelong, but it doesn’t have to rule your life — get in touch today.

This blog was developed by our team and reviewed by a medical professional.