You’re in middle school. Acne and Axe body spray abound. Out of nowhere, you overhear someone sneer, “You know cold sores are herpes, right?” This may have been surprising the first time you heard it.

Many of us have been subjected to this not-so-fun fact on more than one occasion. For anyone who hasn’t heard this before, allow me to cut to the chase: yes, cold sores are a manifestation of herpes infection. Let’s talk about it.

Herpes is a common infection caused by Herpes Simplex Virus (HSV)-1 and HSV-2. HSV-1 is the cause of cold sores, or oral herpes. Genital herpes can be caused by either HSV-1 or HSV-2. Sores caused by these viruses are painful wounds that tend to heal within a week, and usually, these outbreaks do not have serious health complications. The World Health Organization reports that up to 80 percent of people in the world have HSV-1 or 2.

Many people contract the virus as children and never develop lesions. Some people experience only one outbreak. There are antiviral medications available to reduce symptoms in those with recurrent outbreaks. As always, if you choose to be sexually active, utilizing barrier protection such as condoms lowers your risk of getting sexually transmitted infections (STIs), including herpes.

In contrast, canker sores are not caused by a herpes virus and are not contagious. They are painful ulcers, or shallow wounds, that appear on the inside of the mouth, as opposed to cold sores that occur outside the mouth, on, or near the lips. Canker sores occur for a multitude of reasons including injury, stress, vitamin deficiencies, and irritating foods.

While genital herpes is considered an STI because it is transmitted through sexual contact, there is disagreement on whether cold sores should be classified as an STI. Oral herpes can occasionally be spread to the genitals through oral sex. At the end of the day, “STI” is a functional category that describes infections spread a certain way.

This categorization helps healthcare providers organize our thought processes during evaluation, diagnosis, and patient education. It is important to remember that sexual contact is not the only way HSV is spread nor is it the most common mode of transmission. Furthermore, a diagnosis of cold sores or any STI is never a reflection of a person’s value, cleanliness, or morality.

The Centers for Disease Control and Prevention do not recommend testing individuals without symptoms. A blood test is available, but for HSV-1 it cannot distinguish between an oral and genital infection. If you have active symptoms, a healthcare provider can confirm the diagnosis by swabbing the lesion and testing the sample for the virus.

Herpes is incredibly common. Stigmatizing, shaming, or insinuating a person has herpes to put them down is unkind and is not an effective tactic to promote safe sex practices. Instead of relying on fear and shame, we can use nonjudgmental dialogue to discuss STIs, educate each other, and destigmatize herpes.

-Erin Sullivan, Third-year Year Medical Student, Class of 2023