HSV-1 is the most common of the two, and it's generally responsible for oral herpes, showing up as blisters (“cold sores” or “fever blisters”) around the lips and in the mouth.
HSV-2 is the one that causes genital herpes – the condition we usually refer to when we use the term “herpes”.
However, both the herpes simplex viruses can infect both oral and genital areas, if there is contact of these areas with the virus. In fact as more infected people are engaging in oral sex (sometimes in the hope of avoiding herpes infection) we are finding HSV-1 is becoming more common infecting the genital area, and HSV-2 is increasingly found in oral herpes infections.
The only way to distinguish between these two forms of herpes simplex is a blood test, as the symptoms are similar and they appear identical under the microscope.
The herpes simplex virus is generally transmitted by intimate contact with an infected person, by sexual contact or kissing, or sometimes just by skin contact. It's a myth that you can only get infected by a person if he or she currently suffers from an outbreak – it is still possible, though much less likely, that an infected person without an active outbreak can infect another person.
The risk of transmission is increased if a person makes direct contact with a lesion or if they have small cuts or abrasions on the skin area involved in contact. Herpes can also be spread through contact with the saliva of an infected person, through kissing or sharing drinks or toothbrushes.
Once a person is infected, the virus rapidly replicates within the epithelial cells. This causes death of the epithelial cells – the characteristic blisters – and the virus then establishes itself in the long fibres in nerve cells, where it is almost impossible for the body's defence mechanisms to get at it.
After the primary infection, there is a risk of recurrence and symptom outbreak in the future, especially in immunosuppressed people such as those with HIV or those who are receiving immunosuppressive therapy.
Symptoms of herpes simplex infection
With HSV-2 (genital herpes) some people experience only very mild genital herpes symptoms or no symptoms at all. Frequently, people infected with the virus don't even know they have it. However, when it causes symptoms, it can be extremely painful. This is especially true for the first outbreak, which is often the worst. Outbreaks are described as aches or pains in or around the genital area or burning, pain, or difficulty urinating. Some people experience discharge from the vagina or penis.
Oral herpes lesions (cold sores) usually cause tingling and burning just prior to the breakout of the blisters. The blisters themselves can also be painful.
Medication can decrease the pain related to an outbreak and can shorten healing time, as well as reducing the frequency of outbreaks. Pharaceutical drugs used to treat herpes include including Famvir, Zovirax, and Valtrex.
There are also natural remedies which can be effective in stopping or reducing the severity of an outbreak, and other little known treatments which attack herpes simplex virus directly.