Clearing the confusion over herpes types 1 and 2

Originally Published: June 25, 2004
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Dear Alice,

You say that others quite possibly might have antibodies built up from childhood exposure to Herpes Simplex 1. Is that true regardless of where you have the virus (genitals, face)? I had it on my face often as a kid, and now genitally... Am I less likely to give it to someone, genitally, who has had it on their face at one time or other, because of a build up of antibodies?

Scared and depressed in Oregon

Dear Scared and depressed in Oregon,

HSV-1 is more likely to appear on the face than on the genitals; however, either virus can create outbreaks on the mouth and/or genitals. When people are exposed to or infected with viruses, their bodies' immune systems respond by developing antibodies to fight off the particular virus(es) infecting their bodies. Antibodies to HSV-1 and/or HSV-2 form regardless of the site of the symptoms (i.e., lips/mouth or genitals), which is often where the virus first entered the body. Since herpes is a lifelong virus once it is contracted, circulating antibodies help fight future infections, a.k.a. episodes, so that over time, these outbreaks become less severe and happen less often.

Many people who are infected with either type of herpes virus are unaware of their infection because they may be asymptomatic and never have sores, or may have mild signs that they don't notice. The signs and symptoms of both types of herpes virus can vary.

If someone knows for sure that s/he has, or has had, HSV-1 on the mouth, then her/his body will have antibodies for HSV-1. When lesions appear genitally, it is unclear as to whether these lesions are caused by HSV-1 or HSV-2, unless a person had a HSV-2 antibody blood test or a culture with typing. (Testing for asymptomatic herpes is often not recommended unless someone has been at risk for exposure, as no screening tests for STIs are 100 percent accurate, and most asymptomatic people do not have an STI. For more information, read Why is testing of asymptomatic STIs not routine? in Alice's Sexual Health archive.) So to address your second question, if strictly talking about being infected with one type of herpes and not the other — that is, if you know for sure that you have only HSV-1 — and both you and your partner have antibodies to HSV-1, then transmitting HSV-1 is not a concern, since both people already have it. The symptoms may be non-existent or intermittent, but both people still have the virus. However, if you have both HSV-1 and HSV-2, and your partner only has one type of herpes, then you could transmit the other to her/him.

More importantly, to minimize the risk of herpes transmission, regularly use protection, such as condoms; take good care of yourself when you have an episode; avoid sexual contact until the blisters heal completely; and, keep your partner informed of your herpes status. For more detailed information about herpes, read the herpes section of Alice's Sexual Health archive.

A final note: your signature. You are not alone with how you feel about having herpes. Many people feel scared and depressed at first. They are afraid of never finding someone to love them, or they believe that their time and opportunities for sexual expression are over. Fortunately, their fear is rarely the reality. After time and perhaps treatment with medication, the symptoms of each herpes episode become less intense.

If it helps to know, unlike other viral STIs, herpes does not place those who have it at risk for any debilitating or life-threatening conditions. The primary concern is the active episodes, if one has noticeable symptoms, causing irritation/discomfort during that time and the higher likelihood of passing on the virus to others. Being more educated about herpes and how to manage it can be helpful in learning to live and love with herpes. If you would like to talk with someone for support and/or get more information about herpes, you can call the American Social Health Association's National Herpes Hotline at 1.919.361.8488 [9am - 6pm (EST), M - F]. Another resource you might find helpful is Charles Ebel's book, Managing Herpes: How to Live and Love with a Chronic STD.

Alice