Cold Sores are Also Known as Oral Herpes or HSV-1

Girl with cold sore
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It surprises a lot of people, but cold sores are caused by a herpes virus. In fact, the viruses that cause genital and oral herpes are most often caused by viruses that differ in less than 17 percent of their genome. They can even be caused by the same virus!

Just about everyone knows someone plagued by cold sores. Unfortunately, few people realize that they are caused by the herpes virus HSV-1. Oral herpes, i.e. cold sores, is an extremely common infection.

There are estimates that approximately one in every two Americans is infected with HSV-1. The numbers could easily be substantially higher since so many cases are asymptomatic.

Many people with cold sores become infected with HSV-1 during childhood. The virus is easily passed from person to person, even in the absence of symptoms. Therefore, people may be exposed by casual affection between relatives during childhood. That is, in fact, thought to account for a significant percentage of oral herpes infections! However, oral herpes can also be an STD. It can be passed through sexual contact as well as through kissing.

The Stigma of Cold Sores Compared to Genital Herpes

If oral and genital herpes are so common, why are they perceived so very differently by the general public? Genital herpes, usually caused by HSV-2, is a scourge to frighten children. People with genital herpes are often mocked or harassed for their infections.

Having herpes is even synonymous with "dirty" in some genres of music.  In contrast, oral herpes, usually caused by HSV-1, is generally seen as just a fact of life.

How are they perceived so differently when HSV-1 and HSV-2 are barely different at all? In fact, the viruses are so similar that they are quite capable of jumping from one site to the other during oral sex.

It was believed for a long time that HSV-1 preferentially infects the mouth area and HSV-2 preferentially infects the genitals. That's true, but it's only a part of the picture. Several studies have found that, in recent years, at least half of all first outbreaks of genital herpes were actually caused by HSV-1 not HSV-2. In other words, the "cold sore virus" is responsible for an ever increasing number of genital  herpes infections!

So why is there such a strong social stigma associated with genital herpes, but not with oral herpes? Because Americans still associate shame with sex or feel dirty about their sexual activities. The herpes viruses HSV-1 and HSV-2, however, show quite clearly how arbitrary, and silly, such judgments are.

After all, why should you be judged for having one virus instead of another when the two do almost exactly the same thing?

Sources:
Garland SM, Steben M. Genital herpes. Best Pract Res Clin Obstet Gynaecol. 2014 Oct;28(7):1098-110. doi: 10.1016/j.bpobgyn.2014.07.015.

Gupta R, Warren T, Wald A. (2007) "Genital herpes." Lancet, 22;370(9605):2127-37

Smith JS, Robinson NJ. Age-specific prevalence of infection with herpes simplex virus types 2 and 1: a global review. J Infect Dis. 2002 Oct 15;186 Suppl 1:S3-28.

Tunbäck P, Bergström T, Claesson BA, Carlsson RM, Löwhagen GB. Early acquisition of herpes simplex virus type 1 antibodies in children--a longitudinal serological study. J Clin Virol. 2007 Sep;40(1):26-30.

Xu, F. et al. (2006) "Trends in Herpes Simplex Virus Type 1 and Type 2 Seroprevalence in the United States" JAMA, 296:964-973

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