There are two ways to distinguish between cold sores and herpes. One definition is based on the strain of the responsible virus while another definition is based on the location of the lesion. Cold sores and herpes have many things in common and can seem nearly the same, but significant differences do exist.
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According to the American Academy of Dermatology, cold sores, sometimes known as fever blisters, result from the virus called herpes simplex 1, or HSV1, and herpes results from the virus called herpes simplex 2, or HSV2.
Both cold sores and herpes are especially drawn to mucous membranes. Both can appear anywhere on a person’s body, but cold sores show up with the most frequency on the face and herpes lesions show up with the most frequency in the genital area.
The American Academy of Dermatology notes that cold sores are typically spread through casual contact such as kissing, using the same silverware, or using the same linens as someone with HSV1 while herpes is most commonly spread through sexual contact with someone infected with HSV2.
Terri Warren, author of “The Good News about the Bad News Herpes: Everything You Need to Know,” states that 20 percent of Americans aged 15 and older have herpes and 56 percent of Americans aged 15 and older are infected with cold sores. Warren says that 17 percent of the population as a whole has herpes. In her book “Sexually Transmitted Diseases: A Physician Tells You What You Need to Know”; Dr. Lisa Marr maintains that about 7 out of every 10 people have contracted cold sores by the time they reach their 40th birthday.
Age of Acquisition
The American Academy of Dermatology reports that most people infected with cold sores contracted the infection before they reached puberty. Herpes, which in the vast majority of cases is transmitted through sexual contact, is typically contracted at an older age.
Causes of Recurrence
Cold sore recurrences are more likely following the onset of a cold or other illness, after injuries to the mouth, and following time spent in the sun. Herpes recurrence is more likely during times of stress, poor diet, and lack of sleep.
Outbreaks and Symptoms
Overall, cold sore outbreaks occur less often and with milder symptoms than herpes outbreaks.
In her book, Warren explains that people with cold sores shed the virus in from mouth in between 6 percent and 33 percent of the days measured and people with herpes gave off the virus from their mouth in only 1 percent of the days that were measured. She further notes that people with cold sores gave off the virus from their genitals in 5 percent of the days measured and people with herpes gave off the virus from their genitals in between 15 percent and 25 percent of the days measured.