Cold sores vs herpes—what the difference is and why they happen

Medical experts shed some light on cold sores vs herpes—and explain why it’s time to destigmatize this common virus

woman looking at mouth in mirror
(Image credit: Future)

Cold sores vs herpes—both are common infections that are often misunderstood. With the help of experts we break down the differences and why it's time to get rid of the stigma surrounding both health issues once and for all. 

There’s no doubt about it—cold sores are physically uncomfortable. They’re itchy and oozy, and often to blame for mouth, gum, or throat irritation and tongue pain. But there’s another type of discomfort they can cause—embarrassment and feelings of shame due to the stigma surrounding them. Yes, cold sores are a type of herpes. But, most people haven’t been educated about the difference between run-of-the-mill cold sores that can be cleared up with creams and products like jojoba oil at home, and the sexually transmitted disease (STD) herpes. 

Whether you struggle with cold sores flaring up, a genital infection or a new partner just told you they have herpes, it can be tough to carry on with your life without worrying about the health implications—or what others might think. Although they’re both common infections, oral herpes and genital herpes are most often caused by different viruses. It's time to understand the differences between cold sores vs herpes.

What are the differences between cold sores vs herpes?

“Both genital herpes and cold sores (known as oral herpes) are caused by a herpes virus but are transmittable in different methods,” explains Dr Sandra El Hajj, a specialist in preventive and global health and writer for MyMSTeam. Although they’re often confused, here’s what separates these two viruses.

Cold sores (oral herpes)

The herpes virus (HSV-1) causes cold sores

“Cold sores are extremely common and typically associated with the herpes simplex type 1 virus (HSV-1)," according to Dr Barry Goldman of Goldman Dermatology. He’s not kidding about cold sores being common: The World Health Organization (WHO) estimates two-thirds of the global population has HSV-1, although some people may have never experienced an outbreak.

“Unfortunately, cold sores are highly contagious until the lesions scab over and disappear,” says Dr Lawrence L. Ressler of Ressler Dental. “Antiviral medications may help reduce the severity or length of an outbreak, and in some cases can prevent outbreaks from occurring in the first place,” he adds. And some home remedies for cold sores can alleviate the discomfort, too.

Cold sores can flare up on your lips and inside your mouth or on your lips, throat, or gums, but they can also spread to your face and nose if you’re infected with the HSV-1 virus. And, unfortunately, there is no cure or vaccine for HSV-1.

Cold sores can be triggered by:

  • Stress
  • Cold, flu, or fever
  • Trauma to the mouth
  • Hormonal changes
  • Weakened immune system (see our guide to immunity supplements if you need a boost)
  • Too much sun exposure

Genital Herpes

A different herpes virus (HSV-2) most often causes genital herpes

“Most people, when they hear ‘herpes,’ think of genital herpes, which is typically herpes simplex virus type 2 (HSV-2) and spreads from genital to genital,” notes Dr Goldman, adding that this is also a pretty common virus. According to statistics from the Centers for Disease Control (CDC) and Prevention, about 12% of people have it, but nearly 9 in 10 people infected with the virus haven’t been clinically diagnosed.

However, the symptoms of an outbreak would be hard to ignore. As Dr El Hajj explains, “Cracked, raw, and red areas appear on the genitals that can be itchy, tingly, and cause pain during urination. Headaches and backaches are also common in genital herpes.” 

These herpetic lesions are also highly contagious and, since the condition is incurable, future outbreaks are likely.

Can you get genital herpes from oral herpes? 

It sounds like cold sores should have nothing to do with the STD version of herpes, right? Well, not exactly. Things get murky because, as the Mayo Clinic explains it, “either type can spread to the face or genitals through close contact, such as kissing or oral sex.”

In other words, you can get cold sores from someone with genital herpes—or you can pass genital herpes onto someone because of contagious cold sores. Unfortunately, this is where the stigma sets in.

Let's break the cold sores vs herpes stigma

“Herpes is looked at as a taboo topic,” says Dr El Hajj. For some members of society, it represents “sexual negligence that is not acceptable among women”. According to the CDC, more women have HSV-2 than men, likely due to the fact the infection passes more readily from men to women during sex.

“Society tends to have a say in who to have sexual contact with. When the act itself is coupled with a non-treatable infection, an insinuation of dirty promiscuous practices occurs,” Dr El Hajj adds. “Every time herpes is mentioned, it's automatically linked to high sexual activity, unhealthy sexual practices, and multiple partners, and it can tend to have a heavy psychological burden on the person who has it.

“Women may feel particularly stigmatized as ‘damaged goods’ with an incurable infection. There may be fear of passing on to a future partner or a baby while giving birth,” says Dr Goldman. While these may be legitimate health concerns, there should be no blame assigned to those with herpes. This snap judgment from society doesn’t take into account how most cold sores are actually contracted—and how they happen. In fact, the CDC says HSV-1 is usually acquired during childhood. “We think kids often get it sharing toys and mouthing them, as well as being kissed by relatives,” says Dr Goldman. 

But, whether cold sores or herpes start with a childhood toy, develop in your teens, or are a result of your most recent sexual partner, they need to be destigmatized—they are incredibly common and there should be no shame surrounding these easily transmitted viruses, or any virus.

w& thanks Dr Sandra El Hajj of MyMSTeam, Dr Barry Goldman of Goldman Dermatology, and Dr Lawrence L. Ressler of Ressler Dental for their time and expertise.

Ciara McGinley

Ciara McGinley is a meditation practitioner and health journalist. She qualified as a meditation teacher with the British School of Meditation in 2020 and is the founder of Finding Quiet, a series of classes, workshops and retreats that combine meditation practices and mindfulness techniques to make mindful living realistic in an always-switched-on modern world. She is all about bettering that mind-body connection but believes wellness looks different to everyone.

Ciara is also the former Health Channel Editor at woman&home and has covered all things health and wellbeing for years, from fitness to sleep to relationships.