IS HSV-1 an STD? What Cold Sores Mean

What’s a cold sore? Chances are that you’ve heard them called a dozen names. Cold sores are alternately described as fever blisters, lesions, open sores and ulcers, but aside from the occasional pimple near your lip most of these sores fall under the umbrella of the herpes simplex virus.

But does that make cold sores, called herpes simplex virus type 1 (HSV-1), a type of sexually transmitted disease (STD)? Well, that’s where things get murky. Generally, if HSV-1 is contained away from the genitals, it’s not considered an STD. But if it spreads to the genitals, it is. We know — it’s confusing.

Below, we’ve explained the different types of herpes that are sometimes referred to as cold sores, and what it means when someone has a herpes infection or herpes outbreak. We’ve also shared some important information on how to manage, treat and suppress cold sores if you’re struggling with them.

Cold sores are a common health issue that affects the majority of people. Based on statistics from the World Health Organization, over 65 percent of all people under the age of 50 have HSV-1, the variation of the herpes virus that can cause cold sores to develop. 

Because cold sores are caused by the herpes virus, many people associate them with sexually transmitted viruses like genital herpes. While they share some key similarities, they also share some key differences.

There are two major types of the herpes virus: HSV-1 and HSV-2. Before we get into the things that differentiate an HSV-1 and HSV-2 infection, let’s just establish some things they have in common:

• Both infections are a form of herpes.

• Both HSV-1 and HSV-2 can spread to another part of your body besides where it’s known for — finding symptoms of herpes around your mouth does not necessarily mean they are HSV-1, and genital herpes does not necessarily mean they are HSV-2.

• Herpes outbreaks occur more commonly in people with a compromised immune system such as in an HIV infection, where reduced antibodies allow for recurrent outbreaks.

• Beyond the telltale herpes sores, herpes can lead to flu-like symptoms, body aches, swollen lymph nodes and other less than mild symptoms.

Now, here’s how they compare.

HSV-1

The first, HSV-1, is the strain that typically causes cold sores to develop during an oral herpes outbreak. This virus affects the majority of people, although most people rarely if ever experience any cold sore symptoms.

Most people catch HSV-1 (the strain of herpes that causes cold sores) through kissing or other forms of direct contact with other people. The virus is found in the saliva and surfaces in or around the mouth, making it easy to transmit an HSV-1 infection to your partner or partners (or receive it from your sex partners) when you kiss, through a process that’s called viral shedding. 

Combined with the huge number of people that have HSV-1, this makes it very easy to acquire HSV-1, often without ever realizing it.

HSV-2

The second major type of the herpes virus is HSV-2. This is the strain of the herpes virus that’s most commonly associated with genital herpes. 

While the HSV-1 virus can spread even if a person doesn’t have a cold sore, HSV-2 spreads almost exclusively through sex or other direct genital contact, and only rarely affects the lips and mouth.

So, is herpes type 1 an STD? The answer is a bit complicated. HSV-1 is typically spread through oral contact, but it can also be spread through oral, vaginal and anal sex. So although HSV-1 isn’t technically an STD, you can potentially catch the virus through sexual contact.

Oral sex has become very much a part of the sexual mainstream in less than a generation, and so science is still in some ways hustling to keep pace with the phenomenon of oral herpes being passed to genitals, and genital herpes being passed to oral surfaces.

When you acquire HSV-1 through receiving oral sex, it leads to genital herpes rather than cold sores. Just like with oral HSV-1 transmission, you can acquire HSV-1 from receiving oral sex even if the person infected with the virus doesn’t have any visible cold sores or other signs of infection.

Our guide to sex with herpes covers the cold sore stages, what cold sore symptoms to look for, how to prevent transmission and everything else you need to know about living a fulfilling sex life with the virus.

Knowing what we know, we suppose the real question to ask is: "Does it matter?"

In the event that you’re infected with HSV-1, whether from sexual or non-sexual contact, there’s no need to panic. Although HSV-1 and HSV-2 are different viruses, they belong to the same family of viruses and are treated using similar medications.

A wide range of safe, effective treatments are available for HSV-1 cold sores or genital herpes, including FDA-approved antiviral medication like valacyclovir.

While topical medications are only effective on a single area where they’re applied, using them can speed up the healing process. Over-the-counter topicals like docosanol can provide relief and potentially shorten the two-week duration of the average cold sore.

Meanwhile, antiviral medications can help you prevent those herpes outbreaks, or shorten a outbreak by preventing the virus from replicating within your tissues.

Antiviral medications like valacyclovir (Valtrex®), acyclovir and famciclovir reduce healing time. Our guide to valacyclovir goes into more detail about how antiviral medications work to stop cold sores from developing and speed up the healing process, as well as things like common dosage instructions, potential side effects and the amount of time required for valacyclovir to work.

So, is a cold sore an STD? On its own, a cold sore isn’t technically an STD. There are plenty of common ways to get cold sores that have nothing to do with sexual contact. But if that cold sore spreads to the genitals, it technically is considered an STD.

Regardless, cold sores are extremely manageable with the right knowledge: 

• While sexually transmitted infections of HSV-1 and outbreaks in the genital area are less common, they are still possible.

• The vast majority of HSV-1 occur through non-sexual activity through skin contact alone.

• Simple, everyday actions like kissing your partner or a parent kissing a child are enough to spread the virus from one person to another, potentially causing the newly infected person to develop cold sores.

• HSV-1 can also be transmitted to the genitals through sex, meaning that it can also be considered an STD if it leads to genital herpes.

• A healthcare provider can walk you through managing your first outbreak and help you confirm which type you have through a blood test.

Currently, there are no vaccines for herpes, but treatment is available. If you think you’re experiencing an outbreak for the first time, reach out today.