Herpes simplex virus (HSV) is known for its painful ulcers in or around the mouth and genital region. However, the two types, or complexes, of HSV come with various spreading methods and affect different body parts. The following sections will explore the two main herpes complexes, their symptoms, transmission methods, treatment options, and prevention.

What Are the Two Main Types of Herpes Complexes?

What is the difference between herpes complexes? There are two main herpes complexes, Type 1 (HSV-1) and Type 2 (HSV-2).

• Type 1, or HSV-1, affects the area around the mouth and the genitals in the form of cold sores, also known as oral herpes.
• Type 2, or HSV-2, is specific to genital herpes. Sores, or lesions, can be found in and around the genital area, such as the anus, penis, and vagina.

What Are the Symptoms of Each Type of Herpes Complex?

The general symptoms for HSV-1 and HSV-2 are similar, as individuals may experience fever and muscle aches before the outbreak. Symptoms of the initial outbreak occur two to twenty days after exposure to an infected person. Within the two days before the first outbreak, you may experience tingling, itching, or burning. After that, collections of painful, fluid-filled blisters, called cold sores, develop. They then break open, ooze fluid, and form a crust before they finally heal.

HSV-1 symptoms typically occur around the mouth but can spread to any body part, including the genitals. Below are the common symptoms:

• Cold sores on the tongue, inside the mouth, lips, or on the face that can spread to any part of the body
• Swollen lymph nodes in the neck if experiencing an oral outbreak or groin if experiencing a genital outbreak
• Outbreaks usually last two to three weeks

Symptoms of HSV-2 include the following:

• Lesions on the buttocks, anus, penis, or inside and outside of the vagina 
• Women with HSV-2 often experience urinary symptoms, such as difficulty initiating and burning when urinating due to the location of the sores
• Swollen lymph nodes near the groin with the genital area affected
• Outbreaks usually last two to six weeks.

After you are infected, the virus never leaves the body. It moves from the skin cells to the nerve cells and will live in the nerve cells forever. People frequently live their lives without ever experiencing a second outbreak, as the virus lives dormant, or inactive, in the nerve cells. However, triggers such as emotional stress, illness or surgery, fever, sunburn, and menstruation can cause an outbreak.

HSV also has complications, such as HSV keratitis and herpes meningoencephalitis. Both of these conditions are medical emergencies. You should call your healthcare provider immediately for diagnosis and medical management if you experience symptoms of either of these complications of the herpes simplex virus. 

• HSV keratitis is an infection located in the cornea of the eye that can lead to scarring of the cornea and blindness. The symptoms of HSV keratitis include redness and pain in the eye, blurred vision, discharge, and sensitivity to light (photosensitivity). It is treated with oral antiviral medications and eye drops.
• Herpes meningoencephalitis is inflammation of the brain (encephalitis) and inflammation of the meninges (meningitis), caused by the herpes simplex virus. Symptoms include headache, fever, nausea, confusion, and seizures. Medical management involves intravenous antivirals such as acyclovir.

How Is Herpes Complex Transmitted?

People typically contract HSV-1 during infancy or childhood after contact with an adult carrier of the disease, but that isn't the only way it is transmitted. Here are some ways transmission can occur:

• Skin-to-skin contact with an adult carrier (someone who has the virus but is without symptoms, or is asymptomatic)
• Sharing objects that were used on or near the mouth, such as silverware or lip cosmetics
• Oral sex, or transmission from mouth to the genital area, which makes sores on the penis one of the HSV-1 symptoms in males

HSV-2 is transmitted through sexual contact, and females are more likely to be infected. Characteristics of those most at risk include the following:

• High-risk sexual behavior, including those who have had multiple sexual partners and whose first time having sex was at a young age
• Those who have or have had another sexually transmitted infection (STI)
• Those with a weakened immune system or who are immunocompromised, either due to disease or immune suppressant medications
• Pregnant women can transmit to their baby during the childbirth process

What Are the Treatment Options for Herpes Complex?

There is no cure for herpes simplex virus. You can take antiviral medications by mouth or through an intravenous line to shorten the duration of an outbreak. Antiviral creams applied to the affected area can relieve the burning, itching, tingling, and pain related to the lesions. When applying the creams, use a cotton swab instead of your finger to apply the ointment to prevent the lesions from spreading. Fortunately, the first outbreak is usually the most severe, and some people may never experience another outbreak again. However, if recurrence occurs, it will likely happen within the first year of having HSV.

What Can Be Done to Prevent the Spread of Herpes Complex?

The best way to protect you and your loved ones from becoming infected with HSV is to prevent it from happening. Educate adolescents regarding high-risk sexual behavior in their relationships and encourage condom use. Here are some guidelines to prevent the transmission of HSV-1 and HSV-2.

To prevent the spread of HSV-1, avoid the following:

• Kissing or having oral sex if you are experiencing an outbreak
• Sharing your silverware, facial cosmetics, drinks, or towels
• Touching the sores or letting them touch other people

With HSV-1, you can prevent the spread to other body parts by washing your hands after touching a sore and using a cotton swab to apply medications to the site.

To prevent the spread of HSV-2, mind the following guidelines:

• If you have lesions on your genitalia, don't have sex
• Always use a condom, but keep in mind that using a condom does not fully prevent the spread of HSV

Tell your healthcare provider if you or your partner have HSV-2 and become pregnant. You will need to take medications at the end of your pregnancy to prevent transmission to your baby during childbirth.

Herpes simplex virus is associated with cold sores in and around the mouth and genitalia. The two different complexes of HSV are Type-1 and Type-2. Type-1 is passed to others orally and mainly affects the mouth, but it can spread to the genitals through oral sex. Type-2 is transmitted through sexual contact and affects the genital region. There is no cure for HSV, but you can alleviate symptoms with antiviral medications like creams and oral and intravenous formulas. Reduction in high-risk sexual behavior and due diligence by those infected can prevent the spread of HSV to others. Fortunately, those living with HSV frequently have a single occurrence of symptoms and then live asymptomatic for the rest of their lives. 

References 

American Academy of Dermatology Association. (2023). Herpes simplex: overview. https://www.aad.org/public/diseases/a-z/herpes-simplex-overview

Centers for Disease Control and Prevention. (2022, November 30). Basics of HSV (herpes simplex virus) keratitis. https://www.cdc.gov/contactlenses/viral-keratitis.html

Kumar AK, A., & Mendez, M.D. (2023, January 31). Herpes simplex encephalitis. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK557643/ 

World Health Organization. (2023, April 5). Herpes simplex virus. 

https://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus#:~:text=Type%201%20(HSV%2D1)%20mostly%20spreads%20by%20oral%20contact,contact%20and%20causes%20genital%20herpes.

Kirsten Gonzalez MSN, APRN, ACNPC-AG has worked in the nursing profession for ten years caring for critically ill patients. Currently writes blog posts and articles for medical topics as well as practicing as an Acute Care Nurse Practitioner in the inpatient setting. She enjoys spending time with her kids, husband, and dog and loves traveling to explore new places and trying out the local foods.