When people think of sexually transmitted infections (STIs), herpes (herpes simplex virus – HSV) is usually one of the first things that comes to mind. The fear and shame associated with the infection have turned it into a monster with more power than it deserves. In reality, genital herpes symptoms are typically so mild that an estimated 87% of Americans with the virus don’t even know they’re infected. And that’s a lot of people, considering about 1 in 6 people in the US have genital herpes. There are a lot of herpes myths out there so we are here to clear up the facts.
What’s the difference between HSV-1 and HSV-2?
Let’s start with the basics: is a cold sore really the same thing as a blister on your privates? Well, that depends. Historically, HSV-1 was called “Oral Herpes” usually causing sores on the mouth. HSV-2 was called “Genital Herpes,” predominantly causing sores on the genitals. These two strains are different, but related, viruses. However, more recently, studies show about half of all genital herpes cases are caused by HSV-1. This major increase is likely due to a few factors, one of which is an increase in oral sex practices.
So essentially both viruses, HSV-1 and 2, can cause sores on either the mouth or genitals, but they have different courses and different recommended treatment. Genital HSV-1 is much less likely to cause recurrent outbreaks, with 40% of people never having one. Plus, people who do have delayed outbreaks usually only have one or two over a three year period. On the other hand, people with an initial symptomatic outbreak caused by HSV-2 will have on average four recurrent outbreaks per year. In addition to the more common outbreaks, HSV-2 is also more likely to be transmitted even when there are no active sores.
Because the viruses behave in different ways, they are treated differently. People with HSV-2 are more likely to benefit from suppressive antiretroviral therapy to prevent outbreaks and protect sexual contacts.
How common is herpes?
How do you get Herpes?
Lots of ways – vaginal sex, oral sex, anal sex, and just skin-to-skin contact! You can even get herpes from touching symptom-free skin. Most often, people get genital herpes from genital contact with someone who has the virus. However, increasingly people are getting genital herpes from oral sex.
And because most cases of HSV 1 or 2 don’t show any symptoms, people usually catch the virus from someone who doesn’t have any sores. All it takes is one sexual contact to get herpes so everyone who is sexually active is at risk.
Would I know if I had Herpes?
Probably not. Most people with genital herpes have not received a diagnosis and do not know they’re infected. About 87% of people with HSV-2 do not know they’re infected. The main reason for this shocking statistic is that most cases herpes have few or no symptoms. In addition to a lack of symptoms, routine testing for people without herpes symptoms poses challenges of its own.
There are a couple of different ways to test for herpes simplex virus. Navigating them all is a bit complicated which is why herpes testing is often harder to access.
The first type of herpes testing is a direct test for the virus in symptomatic people – meaning people that have active herpes sores. This can be done with a herpes culture, which is a test done on a sample from the actual sore. Cultures are not clinically sensitive, which means that they report a large number of false negatives. A more sensitive way to test lesions is through DNA testing, which can also tell which type of herpes simplex virus is causing the infection.
The second type of testing is called serological testing. This type of test looks for antibodies in the blood which can show up regardless of whether or not there is an active sore. The body can take several weeks to develop antibodies which means that there is a delay between infection and an accurate serological test result. But once the body has the antibodies, it will likely always test positive for the virus. That means there’s no effective way to determine when somebody was infected.
Also, HSV serological tests have a high false positive rate, meaning that they often report an infection when there isn’t one. Due to the stigma surrounding a herpes diagnosis, a false positive herpes test can have intense negative psychological health effects on a patient. Often, this causes more harm than good.
It is because of this delay in antibody development and high false positive rate that the Center for Disease Control does not recommend herpes screening. These clinical recommendations are what make herpes testing more difficult to access for people without symptoms.
What does a herpes sore look like and where can you have herpes sores?
Most people with herpes simplex virus either have no symptoms, or have symptoms so mild that their lesions can be easily mistaken for other skin conditions like ingrown hairs. If you do have an outbreak, it is usually a cluster of blisters around the genitals, anus, or mouth that appears about four days after you’ve been exposed to the virus. The little blisters break, leaving uncomfortable sores that take about three weeks to heal.
Once you get herpes in one location, you are protected from being infected by the same strain somewhere else on your body. For example, if someone has HSV-2 on their genitals, they create antibodies that protect them from getting the same infection around their mouth. However, this person can still get HSV-1 at any location on their body.
Is Herpes curable?
No, but it is treatable and it’s not dangerous. Once infected with HSV, your body will always carry the virus. That said, there are ways in which you can lower your risk of transmitting the virus or having an outbreak.
For starters, barrier methods such as condoms can be somewhat effective in protecting against transmission if used correctly during every sex act. However, if the condom doesn’t cover the infected area, there will be no protection from transmission. For that reason, and because sometimes condoms slip or break, condoms on average only reduce the likelihood of transmission by about half.
Reducing ones chances of acquiring herpes by 50% is a worthwhile effort, but don’t worry, there are also reinforcements. Antiviral therapy can also reduce the likelihood of HSV-2 transmission by about 50%. By using medication in conjunction with condoms and avoiding sex during an active outbreak, you can significantly lower the chances of passing the virus to a partner.
While herpes can be uncomfortable, it has no other negative health consequences. It cannot lead to infertility and thanks to effective medication, should not complicate childbirth.
Can I still have sex if I have herpes?
Yes! With proper preventative precautions, people with herpes can have healthy and happy sex lives. In people with HSV-2 that do not have active sores, HSV shedding (or passing the virus) only happens 10% of the time. When there is an active outbreak, HSV shedding occurs 20% of the time.
As mentioned above, using condoms and avoiding sex during an active outbreak are two of the most important ways to prevent transmission. Antivirals can reduce the length of outbreaks. Plus, daily suppressive medication can reduce the likelihood of transmitting the virus to a partner.
The point is: herpes does not need to be a scary monster. It is a common, and usually mild, infection that anyone who has sex is at risk of acquiring. That said, if you are having symptoms, be sure to see a clinician and get the care you may need. Click here to learn more about other infections that could be causing some burning down there.