Herpes Simplex Virus (HSV)

What You Actually Need to Know About HSV

Herpes simplex virus comes in two main strains, HSV-1 and HSV-2. Most people have heard the outdated terms “oral herpes” and “genital herpes,” but these labels are no longer accurate. Either strain can infect the mouth, the genitals or the anus. Both strains can be transmitted through oral sex, kissing, skin-to-skin contact and, in rare cases, during childbirth.

Understanding HSV matters because it is one of the most common viral infections in the world, yet also one of the most misunderstood.

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Incubation Period

Symptoms may appear four to seven days after exposure, but the window can extend up to two weeks. A large percentage of people never develop noticeable symptoms at all, which is why HSV often goes undiagnosed for years.

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Symptoms When They Occur

HSV symptoms vary widely:

• Oral HSV can cause cold sores around the lips or inside the mouth.
• Genital HSV may cause blisters, itching, burning, tingling or small ulcers.
• Recurrent outbreaks tend to be milder and heal faster than the first episode.

Many people with HSV-1 or HSV-2 never develop symptoms. For them, the only sign of infection is a positive blood test.

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Complications if Untreated

For most adults, HSV is manageable and does not cause long-term health problems. Rare complications include:

• Neonatal herpes, which is a medical emergency
• Ocular herpes, which can affect vision
• HSV meningitis or encephalitis (very rare)

The greater burden of HSV is emotional rather than medical, due to fear and stigma rather than health danger.

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The Changing Landscape of HSV-1 and HSV-2

The way herpes spreads is changing. HSV-1 used to be a childhood infection primarily spread non-sexually. But pediatric HSV-1 has dropped by more than 30 percent over the past few decades. Children who do not get HSV-1 early are far more likely to acquire it genitally later through oral sex.

This has transformed the epidemiology of genital herpes in the United States.

In the 1990s, only about 31 percent of new genital herpes cases were caused by HSV-1.

By 2001, the number rose to 78 percent.

More recent studies show nearly 60 percent of new genital herpes today is HSV-1. Source

In other words, HSV-1 is now the leading cause of new genital herpes infections.

This is why clearer terminology matters. Someone who has genital HSV-1 (GHSV-1) does not pose a transmission risk to someone who already has oral HSV-1 (OHSV-1). You cannot acquire the same strain twice.

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Understanding HSV Blood Testing

Herpes testing is not like other STI testing. The HSV IgG blood tests detect antibodies, not active virus. This means they cannot tell:

• When the infection occurred
• Where the infection is located
• Whether someone is currently contagious
• Whether symptoms will ever appear

Testing is fundamentally different from testing for chlamydia, gonorrhea or HIV.

Why Routine HSV Testing Is Not Recommended

The U.S. Preventive Services Task Force gives routine HSV-2 screening for people without symptoms a “D” rating. A “D” rating means the harms outweigh the benefits.

The reason is accuracy. IgG tests have:

High sensitivity

They rarely miss true infections.

Lower specificity

They can produce false positives, especially in people at low risk.

A simple example

Imagine 100 people are tested.

Five truly have HSV-2.

Two others receive false positives.

The test reports seven positives, but only five are real.

That means nearly one in three positive results is wrong.

This is why a single positive HSV test should never be interpreted as a final diagnosis. Follow-up testing is essential, especially when someone has no symptoms.

Interpreting Results

• A negative HSV-2 IgG result is generally reliable unless the exposure was recent.
• A positive result should be viewed as a starting point, not a conclusion. Retesting several weeks later can help clarify whether the initial result was accurate.

Emotional Impact

HSV creates disproportionate anxiety compared to its actual medical significance. Many people test positive and never have a single outbreak. Many never transmit the virus to anyone. The stigma is often more harmful than the infection itself.

Clear information helps replace fear with understanding.

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HSV-1 vs HSV-2: Why It Matters

Because HSV-1 is now a major cause of genital herpes, understanding strain type provides more accurate risk information. Someone with HSV-1 already cannot catch HSV-1 again. Strain-specific labels like GHSV-1 or OHSV-1 are more honest and more helpful than the vague term “genital herpes.”

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Treatment

Antiviral medications such as valacyclovir reduce outbreak severity, shorten healing time and significantly reduce transmission risk. Many cases of HSV transmission could be avoided if individuals with known outbreaks used suppressive or episodic therapy.

Shameless Care clinicians prescribe and ship valacyclovir directly to your home.

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How Common HSV Really Is

HSV-1 infects billions of people worldwide. In the United States, HSV-1 incidence has remained steady at around 2.8 million new infections per year for decades. HSV-2 prevalence has been slowly declining but remains common enough that positive tests need careful interpretation.

Because so many infections are silent, most people with HSV never know they have it.

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Contagiousness and Testing Timelines

Most HSV transmission occurs when people have no symptoms. Blood tests take several weeks to months after exposure to become positive. For the most accurate results, testing should be timed based on known exposures and interpreted in context.

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The Bottom Line

Herpes is common, manageable and medically low-risk for most adults. The primary challenges are emotional, not clinical. When testing is done, it must be interpreted with nuance, follow-up and education.

If you experience symptoms such as sores or blisters, test during the outbreak.

If you need treatment, medications like valacyclovir are highly effective.

If you want support and clear guidance, Shameless Care is here to help.

Shameless Care provides evidence-based testing, thoughtful interpretation and prescription antiviral therapy delivered directly to your door. Our clinicians can help you understand your results, reduce your transmission risk and manage HSV confidently and without stigma.