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Herpes Simple vs Herpes Zoster

difference between herpes simplex vs herpes zoster

When someone tells you they have Herpes, it is important to clarify which type of Herpes. There are more than 100 known herpes viruses, with 8 of them known to routinely infect only humans.
Have you heard of Epstein-Barr? That’s a Herpes virus.
Or Kaposi’s sarcoma virus? That’s a Herpes virus.
In this article we will focus on distinguishing between Herpes Simplex and Herpes Zoster viruses. You will learn about both viruses, how to distinguish them and also how Chinese Medicine can help.

What is Herpes Simplex Virus?

Herpes simplex viruses can be categorized into two types: HSV 1 is oral herpes while HSV 2 is genital herpes.

When HSV flares up, you will usually see blisters in and around the affected areas. These affected areas are usually the edge of the mouth and lip (oral herpes) and the genitals/rectum (genital herpes). When the blisters break, the area feels tender and sore.

If you already have the HSV virus, outbreaks happen when the immune system is compromised. This could be during a time of physical or emotional stress. It could ambush you when you fall prey to an illness. Other occasions of lower immunity include before and during the menses, or when you are using immunosuppressant drugs.

Both HSV 1 and 2 can spread even if the sore are not noticeable. Diagnosis can be done with lab tests (DNA or PCR tests) and virus cultures.

What is Herpes Zoster Virus?

When a person contracts chickenpox, the varicella-zoster virus that causes chickenpox may lay dormant in the peripheral nerves exiting the spine. This inactive virus lays dormant and may activate during a time of compromised immune function.

Most people experience the onset of Herpes Zoster as a sensitive, tingling sensation or burning pain, usually on the ribs on one side of the body, but sometimes also on the face. Thereafter, a red rash occurs and groups of blisters start to appear.

During a Herpes Zoster outbreak, the rash is in the blister phase and the Varicella-Zoster virus is contagious. It is not contagious before the blisters appear, nor is it once the blisters erupt and are crusted.

While Herpes Zoster is very painful, it is post-herpetic neuralgia that one want to avoid. This is where the pain persists even after the outbreak is over, is why Herpes Zoster should be treated once it is diagnosed.

Difference between Herpes Simplex vs Herpes Zoster

Herpes simplex and herpes zoster are two distinct viral infections caused by different members of the Herpes Virus family. While they share some similarities, they also exhibit several key differences in terms of:

(1) Causes
(2) Clinical Presentation
(3) Transmission
(4) Prevention and Management
(5) Recurrence

(1) Causes:

Herpes Simplex is caused by the Herpes Simplex Virus (HSV), of which there are two types of HSV viruses, HSV-1 and HSV-2.

HSV-1 generally leads to oral herpes, including cold sores, while HSV-2 is mainly responsible for genital herpes.

Herpes Zoster, on the other hand, is caused by the varicella-zoster virus (VZV), which is the same virus that causes chickenpox. After a chickenpox infection, the virus can remain dormant in the body and later reactivate to cause Herpes Zoster, also known as Shingles.

(2) Clinical Presentation:

Herpes Simplex presents primarily as painful, fluid-filled blisters on or around the lips (oral herpes) or around the genitals or anus (genital herpes). These lesions may cause discomfort, itching, and burning sensations. Recurrences are common.

Herpes Zoster typically presents as a painful, unilateral rash with fluid-filled blisters. It follows a dermatomal distribution, affecting only one side of the body, usually appearing on the chest or back. Sometimes it appears in the head, and lesions close to the eyes are also common enough. In addition to the skin rash, patients often experience severe pain, known as Post-Herpetic Neuralgia (PHN), which can persist long after the rash has resolved.

(3) Transmission:

Herpes Simplex: HSV-1 is often transmitted through oral-to-oral contact, such as kissing, while HSV-2 is typically transmitted through sexual contact. Both types can also be transmitted through contact with infected lesions or via vertical transmission from mother to child during childbirth.

Herpes Zoster is not transmitted from person to person in the same way as primary chickenpox. Instead, it is a reactivation of the dormant VZV (Varicella-Zoster Virus) within an individual who had previously contracted chickenpox. Do note that direct contact with the shingles rash can lead to the transmission of VZV to someone who has not had chickenpox or been vaccinated against it, resulting in chickenpox, not shingles.

(4) Prevention and Management:

Herpes Simplex can be prevented by practicing safe sex, using barrier methods like condoms, and avoiding contact with active lesions. Antiviral medications can help manage and reduce the frequency of outbreaks.

Herpes Zoster is best prevented through vaccination with the varicella-zoster vaccine. This is one known way to prevent Herpes Zoster in individuals aged 50 and older. Antiviral medications can be prescribed to reduce the severity and duration of shingles if it occurs, while pain management is crucial for postherpetic neuralgia.

(5) Recurrence:

Herpes Simplex: Both HSV-1 and HSV-2 can establish latency in nerve cells and reactivate periodically, causing recurrent outbreaks. These recurrences can be triggered by factors like stress, illness, and hormonal changes.

Herpes Zoster is primarily a one-time occurrence, although rare cases of recurrence can happen. Most people who have had chickenpox will experience shingles only once in their lifetime. That said, for those who do not recover completely, Post-Herpetic Neuralgia is a chronic condition.


In summary, Herpes Simplex and Herpes Zoster are distinct viral infections caused by different Herpes Viruses, presenting with unique clinical features and modes of transmission.

Understanding these differences is essential for effective prevention, management and treatment of these two conditions.

Treat HSV with Chinese Medicine

Blisters around the mouth/lips during an HSV 1 outbreaks get very good results with Chinese herbal medicine. For HSV 2 outbreaks, we have seen a drop in frequency of outbreaks as well as intensity of the flare.

One herb that we always use in the treatment of HSV is Isatis. Isatis has the leaf component (Da Qing Ye) and the root component (Ban Lan Gen), and both herbs are used in the treatment of Herpes flares. For example, topical application of Ban Lan Gen water extract has been shown to effective against herpes infection of the skin (1989).

Another herb, Radix Lithospermi (Zi Cao) has been shown an inhibitory effect against the herpes simplex virus (1986). It is also used in certain cases of Herpes. Other herbs include Houttuynia, Plantago, Stephania and Moringa.

Treat Herpes Zoster with Chinese Medicine

Chinese Medicine adopts a strategy around clearing Damp Heat in the Liver and Gall Bladder. One way of clearing Liver and GB Damp Heat is through acupuncture. Acupuncture is able to reduce painful sensations so effectively that many patients return again to get  non-pharmaceutical of a very painful condition!

Chinese Herbal medicine is very helpful in treating Herpes Zoster, but it is often overlooked . We thoroughly recommend it, because it is crucial in the prevention of Post-Herpetic Neuralgia (PHN).

During the acute phase, herbs like Skullcap and Gardenia are used to drain pathogenic Damp Heat, while herbs like Lonicera and Bupleurum are effective antivirals that will bring down inflammation and pain.

The herbalist will create a different formulation depending on the blister size, how angry the lesions look (rubor, calor) as well as the tongue and pulse. For some, the herbs will hone in more on clearing Liver fire; for others, the focus may shift to draining damp in the Spleen.

If you have an outbreak on the face and near the eyes, we beseech you to use TCM herbs. The herbs are crucial in preventing Post-Herpetic Neuralgia by enhancing circulation and taking away nerve pain.

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