Are All Cold Sores Herpes? Oral vs. Genital Infection

“Cold sores are just a skin manifestation of the herpes virus,” Dr. Rodney adds. “There’s a stigma when people hear ‘herpes,’ and they think it’s terrible, but it’s usually caused by the HSV-1 virus. It’s so terribly common. There’s nothing to be ashamed of.”

Sometimes, people even ask for a swab test that tells them which type of herpes they have because they wonder how they got it, says Dr. Abdur-Rahman. But as he explains, “testing positive for type 2 just means the herpes is caused by the virus that usually causes genital herpes, it doesn’t mean that you didn’t get it from kissing someone.” People usually get cold sores through close contact, like kissing and oral sex, but herpes is not always sexually transmitted: Sharing eating utensils, razors, and towels can spread the virus as well, the Mayo Clinic notes.

The distinction doesn’t matter much in the practical sense—wherever your herpes shows up is where it shows up, independent of which strain brought it about or how you got it. But it’s key to know that if you have herpes, you can give it to someone else through kissing or oral sex, no matter which strain you have. Cold sores are contagious, particularly if you’re currently going through a flare and have an oozing blister, according to the Mayo Clinic.

What are common cold sore symptoms to be aware of?

People can confuse a cold sore for a canker sore, an angry noncontagious lesion that isn’t linked with herpes, or an exceptionally painful pimple, at least in the beginning before the blister opens up. In general, per the Mayo Clinic, you can expect the following cold sore symptoms:

• Tingling, itching, burning around the lips
• A small, hard painful spot
• Small, fluid-filled blisters along the border of your lips
• Oozing and crusting

“One key sign is that sometimes you may feel pain and tingling in the area before the cold sore actually appears,” Dr. Rodney says. Cold sores also tend to show up in the same spot or region every time. “If you usually get cold sores on your right upper lip, it will usually appear in that same spot again in the future,” Dr. Rodney says.

Cold sore symptoms can be slightly different during the first outbreak, though. The AAD says this initial infection typically happens during childhood and can lead to the following symptoms in addition to the ones above:

• Fever
• Headache
• Muscle aches
• Swollen lymph nodes
• Nausea
• Sore throat
• Pain when swallowing

Why do some cold sores come out of nowhere?

Here’s the weird thing about cold sores: You can be infected with HSV-1 or HSV-2 and not have visible symptoms for years. In fact, some people can have several cold sores a year or only one or two in their lifetime—it really just depends on your body.

“I’ve had a lot of patients who wonder if their partner cheated on them because they suddenly developed a cold sore,” Dr. Rodney says. “But that’s not the case—they just had their first visible outbreak later in life.”

That’s because the virus lies dormant in your skin’s nerve cells, only to rear its head when it’s triggered to do so. These recurrences can be set off by a slew of different things, like a viral infection or fever, hormonal changes, stress, fatigue, exposure to sunlight and wind, changes in your immune system, or a skin injury, the Mayo Clinic notes. So, if you have a cold sore, it likely won’t be visible forever.

Can you have herpes with no symptoms at all?

Most people with herpes have it without knowing it. About two thirds of the global population under age 50 has HSV-1, according to the World Health Organization, and around one in every six people in the U.S. between ages 14 and 49 has genital herpes, according to the CDC. In fact, because it’s so common, doctors often don’t even test for herpes in the usual STI workup.