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Herpes vs. HIV: What’s the Difference?

Medically reviewed by Barry S. Zingman, M.D.
Posted on May 30, 2023

Herpes and HIV are two different sexually transmitted infections (STIs) caused by different viruses, but they share several symptoms and risk factors.

Herpes is caused by the herpes simplex virus (HSV), and it can result in painful blisters or sores on or around the genitals, anus, or mouth. HIV is caused by the human immunodeficiency virus (HIV) and it attacks the immune system, making it harder for the body to fight off infections and certain other diseases. If left untreated, HIV can lead to AIDS.

The open sores caused by a herpes outbreak may increase your risk of getting HIV or passing it to others during sexual contact. Additionally, the suppressed immune function of HIV may increase your risk of a herpes outbreak. It’s important to understand the difference between these two viruses and how each can be treated.

What Are the Symptoms?

Herpes and HIV can both cause flu-like symptoms in the first days or weeks after you’re infected. These can include:

  • Fever
  • Headache
  • Muscle aches
  • Swollen lymph nodes
  • Sore throat
  • Extreme tiredness
  • Mouth sores
  • Rashes

However, not everyone will have symptoms after infection. The only way to know for sure whether you have either virus is to get tested. Herpes and HIV also have other symptoms that differentiate the two infections.

Herpes Symptoms

There are two types of herpes viruses — herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). HSV-1 usually affects the mouth or face, while HSV-2 usually affects the genitals or anal area. However, it’s possible to have an HSV-1 infection on your genitals and an HSV-2 infection on your mouth or face.

Many people infected with HSV don’t know they have it. Rarely, people have severe symptoms, but more typically, there are only mild symptoms if any. If you have symptoms, they will usually start to appear within two to 12 days after you’re exposed.

HSV-1 commonly causes fluid-filled blisters around or inside your mouth, known as cold sores or fever blisters. The ulcers may be painful and itchy and may leave an open sore that oozes and then crusts over.

HSV-2 commonly causes genital herpes. Common symptoms of HSV-2 infection include:

  • Painful, itchy blisters or bumps on or around the genitals, anus, or mouth
  • Ulcers that ooze pus or blood
  • Pain while urinating
  • Vaginal or penile discharge

After the symptoms of your first outbreak get better, you may never have another outbreak again, or the symptoms may come back periodically. When the symptoms come back, it’s known as a recurrent herpes outbreak.

HIV Symptoms

Flu-like symptoms are the most common early HIV symptoms that people may notice. They usually appear in the first two to four weeks after exposure. Only about two-thirds of people experience any symptoms from a newly acquired HIV infection. If you think you may have been exposed, it’s important to get tested, even if you don’t have any symptoms.

If you have an HIV infection and don’t get treatment, you may progress to a later, more severe stage of infection called AIDS.

Symptoms of AIDS can include:

  • Fatigue
  • Swollen lymph glands
  • Weight loss
  • Night sweats
  • Prolonged bouts of diarrhea
  • Pneumonia
  • Rashes
  • Mouth pain, sores, or white coating
  • Memory loss
  • Other symptoms from specific infections or cancers that can develop

Many of the symptoms of AIDS come from opportunistic infections that take advantage of your weakened immune system and cause more severe or frequent symptoms than they would otherwise. The herpes virus is one example of a possible opportunistic infection in people with HIV.

How Can You Get Herpes or HIV?

You can get herpes or HIV from sexual contact with an infected person. However, there are important differences between herpes and HIV transmission you should know.

Herpes Transmission

Both HSV-1 and HSV-2 spread through contact with the skin, saliva, or genital secretions of a person who is infected. Transmission is more likely when sores or ulcers are present, but it can happen when an infected person doesn’t have any symptoms.

You can get HSV-1 through the following ways:

  • Touching the skin close to a person’s mouth
  • Sharing items that come into contact with saliva or blood, such as food utensils, lip balm, or razors
  • Kissing with a closed or open mouth
  • Receiving oral sex from a person with HSV-1

You can get HSV-2 through the following ways:

  • Giving or receiving oral sex
  • Having vaginal sex or anal sex
  • Touching an open sore
  • Engaging in skin-to-skin contact, even without ejaculation
  • Passing from mother to baby during childbirth

HIV Transmission

HIV is transmitted through certain body fluids of a person who is HIV-positive if their HIV is not under control. Fluids that contain HIV in someone with uncontrolled HIV disease include:

  • Blood
  • Vaginal fluids
  • Semen
  • Rectal fluids
  • Breast milk

The most common ways to come in contact with these fluids are through vaginal sex, anal sex, and sharing needles or other drug equipment. The ulcers of a herpes outbreak leave open wounds on the skin, which can make it easier to transmit and acquire HIV.

In rare cases, HIV can be transmitted through oral sex. You may be more likely to get HIV from oral sex if you have another STI, such as herpes, and if there is semen in the mouth with bleeding gums, oral ulcers, or ulcers on the genitals. A herpes infection can make it more likely that you will have oral or genital ulcers.

Although it is possible to get HIV from the following activities, it is very rare:

  • Deep open-mouth kissing (not closed-mouth kissing)
  • Biting
  • Spitting
  • Touching body fluids
  • Getting a tattoo or body piercing
  • Having a blood transfusion

How Can You Prevent Herpes and HIV?

Most sexual activity carries some level of risk for STIs, including HIV and herpes. The safest options are to abstain from sexual activities that involve skin-to-skin contact and bodily fluids or to consider forming a monogamous sexual relationship with someone after you’ve both tested negative for STIs. Proper and consistent use of latex condoms every time you have sex can also minimize the risk of both herpes and HIV.

Antiviral medication can reduce the risk of transmission from an infected sexual partner to an uninfected partner. People with herpes can take valacyclovir (Valtrex) to help prevent passing the infection to a partner, as well as avoiding sexual contact during an active herpes outbreak.

People who are HIV-negative can take preexposure prophylaxis (PrEP) with emtricitabine/tenofovir (Truvada or Descovy) or cabotegravir (Apretude) to reduce the risk of HIV infection.

If your partner is HIV-positive, ask whether they are taking their HIV medicines consistently and whether their viral load is undetectable. Consider asking them to share their viral load results with you so you can be sure. Encourage them to take their meds and control their HIV, both for their health and to lower your risk. If you are unsure about their HIV being under control, always use condoms.

How Common Are Herpes and HIV?

Herpes is very common. Genital herpes affects nearly 17 percent of people in the U.S. between the ages of 14 and 49. More than half of American adults have oral herpes. Most people with herpes don’t know they have it.

HIV is less common in the U.S. — about 1.2 million people in the U.S. are HIV-positive. Most people with HIV know they have it. The Centers for Disease Control and Prevention (CDC) estimates that only about 13 percent of people with HIV in the U.S. are unaware of their status.

People of any age, sex, race, or sexual orientation can be infected with herpes or HIV. According to the CDC, certain risk factors can increase the likelihood of contracting herpes or HIV, such as:

  • Engaging in sexual contact without protection, like condoms or dental dams
  • Having sex with multiple partners
  • Having sex with an infected partner who is not receiving treatment
  • Being a man or transgender woman who has sex with other men
  • Having a history of other STIs

How Are Herpes and HIV Diagnosed?

A health care provider might be able to diagnose herpes by looking at the sores on your skin. They might also take a sample directly from the sore to analyze in a lab. If you don’t have a visible herpes outbreak, your health care provider may use a blood test to check for HSV antibodies. Antibodies are your body’s natural response to an infection. This test may be able to tell you if you have been exposed to HSV in the past, but it is not fully accurate.

The only way to know if you have an HIV infection is to get tested. HIV can be diagnosed using a sample of blood or saliva. There are three types of HIV tests:

  • Antibody tests — These look for HIV antibodies in your blood or saliva.
  • Antigen/antibody tests — These look for HIV antibodies and parts of the virus itself (antigens) in the blood.
  • Nucleic acid tests (NATs) — These look for the virus itself in the blood.

These tests require some time after exposure before they can detect HIV. Ask your health care provider when and how often you should be tested.

How Are Herpes and HIV Treated?

There is currently no cure for herpes or HIV. However, antiviral medications can help treat these infections.

People who rarely have herpes outbreaks may choose not to have any treatment. Oral or topical (applied to skin) antiviral treatment during a herpes outbreak can decrease symptom severity and speed up your recovery time. Antiviral medications can also be taken orally daily to prevent herpes outbreaks.

Treatment options for herpes — available as generics and under brand names — include:

  • Acyclovir (Sitavig and Zovirax)
  • Famciclovir (Famvir)
  • Valacyclovir (Valtrex)

For people with HIV, antiretroviral therapy (ART) can help keep the virus levels in your blood low, help the body to heal from prior damage, and prevent complications. ART always includes at least two medications that work against the virus in different ways. There are many combinations of treatment options for HIV. Talk to your health care provider about which one is best for you.

Talk to your HIV care team about your risk of herpes. If you’ve already been diagnosed with herpes or you’ve noticed an increase in herpes outbreaks, your doctor can help you with a treatment plan that complements your HIV treatment.

Talk With Others Who Understand

On myHIVteam, the social network for people with HIV and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with HIV.

Have you been diagnosed with herpes? Do you have any tips for managing the symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on May 30, 2023
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    Barry S. Zingman, M.D. specializes in HIV/AIDS medicine and general infectious disease. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Amanda Jacot, PharmD earned a Bachelor of Science in biology from the University of Texas at Austin in 2009 and a Doctor of Pharmacy from the University of Texas College of Pharmacy in 2014. Learn more about her here.

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