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“HSV-1 and HSV-2 are different but closely related viruses,” says Dr.Christine Johnston, MPH, who is the Associate Medical Director of the Virology Research Clinic at the University of Washington.
Johnston explains that both are transmitted through close mucosal or skin contact with infected secretions.
HSV-1 primarily causes oral outbreaks, also known as cold sores, and HSV-2 usually causes genital outbreaks.
A 2004 study in the New England Journal of Medicine found that suppressive therapy decreases the risk of HSV-2 transmission from symptomatic, infected partners to uninfected partners by 48%.
So “the risk of transmission is significantly reduced, but cannot be eliminated even with suppressive therapy,” Johnston explains, and she stresses that the virus can be passed along even without signs or symptoms.
But HSV-1 can also cause genital outbreaks through oral-to-genital contact, according to the CDC.
According to Johnston, genital HSV-1 is less likely to recur than HSV-2, and there’s less asymptomatic shedding (transmitting the virus without realizing it) with HSV-1 than with HSV-2.“With your first episode, you can have fever, fatigue, and flu-like symptoms,” says Cullins. Johnston notes that “there can be false positive test results with Herpe Select ELISA (the most commonly used test), particularly with low index values, so the CDC now recommends confirming low index values with a second test.”All this means that if you are concerned about herpes, you will need to talk to a doctor and request the test yourself.Options for testing include taking a culture if you have outbreak symptoms, like a lesion, blister, or ulceration, or a blood test if you don’t, which will detect any antibodies.According to Melissa King, a psychotherapist who runs a support group for women with herpes in New York City, when someone finds out they’ve gotten herpes from a partner, there’s often immediately an assumption that the partner knew that they had it and lied, or that they were cheating.“But the reality is that in a lot of cases, people don’t know that they have it,” King tells Buzz Feed.According to Cullins, “Pregnancy is the time period when [a provider] really wants to know whether or not the person has had herpes in the past,” so they can protect the pregnant person and their infant from a herpes infection.