Should Polyamorous People Get Tested for Herpes?

Let’s start with a quick herpes refresher

Herpes is a contagious viral infection caused by the herpes simplex virus, there are two types, HSV-1 and HSV-2. We used to refer to HSV-1 as “oral” herpes and HSV-2 as “genital” but we know that you can get infected with either strain in either place, and we’re seeing an uptick in HSV-1 infections in the genitals, likely due to an increase in oral sex (yay!).

Herpes is transmitted through skin-to-skin contact, when a contagious area comes into contact with a tiny break in the skin on the mouth or genitals. Most people will have their first herpes outbreak somewhere between two and twenty-one days after exposure. The first outbreak is usually the most severe, and then the virus goes dormant, hanging out in the nerve root. Some people never have another outbreak, whereas others have multiple outbreaks a year. We are still learning more about what triggers outbreaks and what might help keep the virus dormant.   

It's estimated that more than 50% of the population have HSV-1, and about 12% (one in eight) people ages 14-49 have HSV-2. Many people have herpes and don’t know they have it, usually because the signs are so mild they are mistaken for another condition (like an ingrown hair, jock itch, or a pimple).

Herpes is not curable, but it is treatable.  Antiviral medications like acyclovir, famciclovir, and valacyclovir can be taken at the first sign of an outbreak to reduce the severity, and some folks choose to take antivirals every day for “suppressive therapy” to reduce the likelihood of future outbreaks and decrease the likelihood of transmitting the infection to serodiscordant (partners who do not have HSV) partners.

Why is this a hot button issue for polyamorous folks?

There’s a debate about whether or not polyamorous folks are at increased risk for sexually transmitted infections. On the one hand, more sexual partners means more opportunities for infection. On the other hand, polyamorous folks may implement more careful safer sex and testing practices that mitigate this risk. 

So how do safer sex and testing practices apply to herpes?

Currently, the CDC does not recommend asymptomatic testing for HSV. This means it will not be including in a standard STI testing panel (which tests for chlamydia, gonorrhea, syphilis, HIV, hepatitis C, and trichomoniasis).

If HSV is highly contagious and sexually transmissible, why not get tested for it?

First, the risk of a false positive is much higher for HSV than it is for other STIs. The U.S. Prevention Task Force estimates that 50% of positive test results diagnosed by the IgG test are false positives. Second, herpes isn’t associated with serious health outcomes, it is essentially a pesky skin condition. One of the main reasons we do asymptomatic testing for other STIs is that, if left untreated, they can lead to serious health consequences like pelvic inflammatory disease or infertility. 

So why might someone still choose to get tested?   

We hear from lots of non-monogamous folks across the state of Massachusetts who choose to get tested for HSV, even if they are asymptomatic. We like the expression “risk aware sex” (as opposed to safe sex) to describe the goal of being aware of the specific risks that sex with you and your partners and their partners entails. Proponents of risk aware sex might argue in favor of testing even though the health consequences of herpes are minor and the risk of asymptomatic transmission is low.

So what should you do?

We encourage everyone to ask a lot of questions about what their partners’ safer sex practices entail. Don’t end the conversation when someone says, “I get tested for STIs regularly and I use condoms”. Here are some questions we love to ask:

1.)   How often do you get tested for STIs?

2.)  Which STIs do you get tested for?

3.)  Do you get cite specific testing? If someone is having oral or anal sex, cite specific testing involves swabbing the anus and back of the throat in addition to a urine and blood test. This is because STIS like chlamydia and gonorrhea absolutely love colonizing the back of your throat. If you do a urine test only, you might still have an asymptomatic case present only in the back of your throat, which means you are able to transmit it during oral sex.

4.)  Do you use barrier methods when you have oral sex? In our practice, we find when someone says they “use condoms all the time” they usually mean they use condoms when they have penetrative sex. STIs are still transmissible during oral sex. We’re not in the business of telling our patients what safer sex practices to follow, but we want your sex to be risk aware!

5.)  How much information do you feel like you have about the safer sex practices of your partners other partners and their partners? It’s helpful to know if this is information freely exchanged, or if folks assume but don’t know.

At The Pomegranate Institute, we believe anyone who wants to get tested for HSV should get tested! It’s not for us to say people “should” get tested but we do think non-monogamous folks should be able to explain their perspective on why or why not. We think a transparent conversation about risk-aware sex is one of the greenest flags there is. If you want to learn more about HSV, check out our article The Sexiest Thing You Can Do Is Not Be a Jerk About Herpes, and if you’re in Massachusetts and you want to talk to someone about your safer sex practices, reach out!