Can One Virus Cause Genital Herpes and Oral Herpes at the Same Time?

herpes cold sore on face
Herpes Cold Sore on Face. Todd Keith/E+?Getty Images

Question: Can one virus cause oral herpes and genital herpes at the same time? 

Historically, HSV-2 was known as the genital herpes virus and HSV-1 as the oral herpes virus. However, the reality is not nearly that straightforward. Both types of herpes simplex virus can infect either the mouth or the genitals. The only significant difference between cold sores and genital herpes lesions is their location.

 

Despite knowing this, many people wonder if it's possible to be infected twice with the same type of herpes virus. They want to know if having a herpes oral infection caused by HSV-1 means they're protected from an HSV-1 herpes genital infections. Unfortunately, it doesn't. 

Answer: You can be infected with HSV-1 or HSV-2 at multiple sites. One infection does not protect against others. 

Common wisdom and some "experts" often say you can't be infected with herpes twice. However, research has shown that concurrent herpes infections are possible. Multiple studies have demonstrated that people can have oral herpes and genital herpes infections caused by the same type of herpes virus at the same time. 

In other words, cold sores aren't protection against a genital herpes infection. That's true whether both infections are caused by HSV-1, both infections are cause by HSV-2, or one infection is caused by each.

These are all possibilities that can occur. HSV-2 oral infections are considered to be relatively rare, but they have been documented. They are just less likely to have symptoms. In contrast, HSV-1 genital infections are becoming more and more common over time. 

Reducing The Risk of Concurrent Herpes Infections

What does this mean, from a practical perspective?

If you or your partner are infected with herpes, or think you might be, it's important to use barrier methods during sex. That's something that's as true for oral sex as it is for intercourse. If a person has cold sores on their lips, they can transmit them to their partner's mouth during kissing. They can also transmit them to their partner's genitals during oral sex. Similarly, a genital HSV-1 infection can be transmitted to a partner's genitals or their mouth. (HSV-2 oral infections are possible. However, it is somewhat less likely that a genital HSV-2 infection would be transmitted to the mouth. HSV-2 appears to prefer the genitals as a site of infection. HSV-1 is a far more equal opportunity virus.)

Herpes infections are spread from skin-to-skin. That means that barriers aren't 100% protective. However, condoms and other barriers can reduce the risk of transmitting herpes to a partner. In addition, if a person knows they are infected, there are other options to reduce risk. Suppressive therapy doesn't just reduce the frequency of outbreaks. It also reduces the likelihood of transmission during sex.Regular use of valacyclovir, and other herpes anti-viral medications has been shown to reduce viral shedding and the risk of herpes being passed to a partner.

 

A Word from Verywell

Herpes testing isn't a standard part of sexual health care. The stigma associated with herpes infection is severe enough that many doctors are reluctant to test people who do not have symptoms. They may also be concerned about false positive or false negative testing. 

However, if you are at risk for herpes infection and want to know your current status, you can always ask for a test. Type-specific herpes blood tests can be performed at most major medical laboratories. They're not 100 percent accurate, but they can still provide useful information in certain situations. 

Sources:

Bernstein DI, Bellamy AR, Hook EW 3rd, Levin MJ, Wald A, Ewell MG, Wolff PA, Deal CD, Heineman TC, Dubin G, Belshe RB. Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women. Clin Infect Dis. 2013 Feb;56(3):344-51. doi: 10.1093/cid/cis891.

Embil JA, Manuel FR, McFarlane ES. Concurrent oral and genital infection with an identical strain of herpes simplex virus type 1. Restriction endonuclease analysis. Sex Transm Dis. 1981 Apr-Jun;8(2):70-2.

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.

Kim HN, Meier A, Huang ML, Kuntz S, Selke S, Celum C, Corey L, Wald A. Oral herpes simplex virus type 2 reactivation in HIV-positive and -negative men. J Infect Dis. 2006 Aug 15;194(4):420-7.

Lafferty WE, Coombs RW, Benedetti J, Critchlow C, Corey L. Recurrences after oral and genital herpes simplex virus infection. Influence of site of infection and viral type. N Engl J Med. 1987 Jun 4;316(23):1444-9.

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