The Sexiest Thing You Can Do Is Not Be a Jerk About Herpes

In a society where vestiges of Puritanism are evident and “purity culture” is alive and well, sexually transmitted infections (STIs) in general carry a stigma. However, herpes (or HSV)—despite being in most cases fairly innocuous for healthy and nonpregnant people —is, in particular, perceived as a kind of “Scarlett Letter.” 

Stigmatizing references to herpes in popular culture abound, from Romeo and Juliet to Inside Amy Schumer and Saturday Night Live. Whether it’s John Oliver comparing herpes to terrorism or a joke on Bob’s Burgers that implies getting herpes would be worse than being killed, the cultural messaging is clear: “herpes is the worst thing ever, and if you get it, so are you.” 

For folks who find out they’re HSV positive, carrying the burden of stigma and shame can make them less likely to disclose their status to sex partners and negatively impact their psychological health. There are over 1,000 posts on Reddit that contain the words herpes and devastated. 

The stigma surrounding STIs in general, and HSV specifically, is rooted in negative societal attitudes towards sex, misinformation, and fear. Destigmatizing HSV requires challenging misconceptions by providing accurate information and fostering empathy and understanding by promoting open and non-judgmental conversations about sexual health. 

In this blog, we aim to do just that. 

Read on to learn about herpes and what to do if you test positive. 

What is herpes? 

Herpes is a sexually transmitted infection caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). 

HSV-1 used to be called “oral herpes” (or cold sores) and HSV-2 “genital herpes.” However, we now know that people can catch both HSV-1 and HSV-2 in either the mouth area or genital area. Both forms of HSV are treatable but not curable. 

Herpes is more common than you think. 

In the United States, 50 – 80% of adults have HSV-1, with most people getting it from being kissed by an infected friend or a relative in childhood. 

Around 12% of people between the ages of 14 and 49 in the US have HSV-2, and 90% of them don’t know it. This is because their symptoms could be either so mild as to go unnoticed, or they could be completely asymptomatic. 

Symptoms of HSV 

Symptoms of both HSV-1 and HSV-2 include small blisters that fill with fluid, then break open and scab over before fading. The severity of symptoms can vary greatly from person to person. For some, the condition is painful. For others, symptoms are so mild that they’re mistaken for something else, like an ingrown hair, razor burn, or pimple. 

There’s an ‘incubation period’ between the virus being transmitted and first having symptoms. For most people it’s 2-12 days, but for some people it could be much longer. If you start to experience symptoms of herpes, it doesn’t necessarily mean you were infected recently—the infection could have happened years ago. 

When herpes is first transmitted, the infection travels through nerves and settles in the sensory nerve ganglia (either the ganglia adjacent to the spinal rope in the lower back, or the ganglia behind the cheek bone). 

A protein in our body called interferon gamma wraps around the virus and keeps it dormant. When the virus is in its dormant stage, it’s still detectable in the body through testing but it doesn’t present as the active disease or produce symptoms. 

However, sometimes the virus re-activates and travels away from the ganglia to the affected tissue (lips, genitals, etc.). This re-activation of the virus produces an outbreak or flare-up of symptoms. 

Symptoms are generally more severe during a first outbreak and may include a fever, body aches, swollen lymph nodes, or a headache because the body hasn’t yet developed an immune response to the virus. 

Some people have asymptomatic herpes, meaning the virus is present in their bodies but they’ve never experienced an outbreak. 

Scientists are still studying what causes the virus to reactivate. For some people, it never happens. For others it happens occasionally, and for some outbreaks occur more frequently (five times a year would be considered frequent). 

Some people who have HSV are able to identify certain patterns or triggers that are associated with more frequent flare-ups. These include sun exposure, stress, menstruation, other infections, or foods that are high in arginine (certain nuts and seeds, dairy, certain animal proteins, and chocolate). 

What are the recommendations for screening? 

Generally, the CDC and U.S. Preventative Service Task Force (USPSTF) do notrecommend universal herpes screening. Instead, they recommend herpes testing for people with active symptoms. 

Widespread screening isn’t recommended because HSV-2 is mostly asymptomatic and can’t be cured, and there’s a high probability for false positives. The lower someone’s risk of HSV infection, the higher their probability for a false positive test result. 

Since false positive test results generate unnecessary suffering, the overwhelming medical consensus is that the risk of stigmatizing people outweighs the potential benefits of generalized screening. 

Tests 

If you have symptoms that could be herpes (such as a blister or a sore), a provider will take a swab and perform either a culture or Nucleic Acid Amplification Testing (NAAT). 

NAAT is far more accurate, because a culture requires a large enough amount of the virus to be present, which may not be the case if the lesion is small or already healing. 

Blood tests can be used when a person has no visible symptoms but is concerned about having herpes. Blood tests, which look for herpes antibodies, include both IgM and IgG tests. 

IgM tests are generally not recommended because they don’t distinguish between HSV-1 and HSV-2 and can cross-react with other viruses in the same family, giving those false-positive results that we discussed above. 

While IgG tests are more accurate, it takes time for the antibodies to reach detectable levels in the body, so it’s generally recommended to wait 12-16 weeks after potential exposure for a more accurate test. 

If you Test Positive 

First thing’s first: double check which test was performed. 

Researchers from the University of Washington in Seattle and the Westover Heights Clinic in Portland found that patients with low positive HSV-2 results on commercial EIAs (enzyme immunoassays) frequently tested negative with the more sensitive Western Blot. The recommendation from the lead author was to get a confirmatory Western Blot test. 

Keep in mind that testing positive doesn’t necessarily mean you were recently exposed to herpes. You could have been asymptomatic and having your first outbreak months or years after the initial infection. 

Treatment 

For many people, the diagnosis is the most traumatic part of herpes-- the actual symptoms themselves are usually mild and respond well to treatment. 

Treatment includes antiviral medication (such as Acyclovir, Valacyclovir, or Famciclovir). Antivirals might be taken at the start of an outbreak to help reduce severity of symptoms, or every day (called suppressive therapy) to reduce both the risk of a future outbreak and the likelihood of transmission to partners. 

Antiviral medication is most effective if you take it continuously as suppressive therapy, or if you start taking it during the prodromal phase (when you feel a little “off” or feel a tingling sensation in places you would normally get a sore, but don’t yet see one). It’s less effective if you start taking it when you already have symptoms, though it can still help shorten the duration and severity of an outbreak. 

Other things that you can do to reduce discomfort during an outbreak include: 

• Wearing loose fitting cotton clothing. 
• Remembering to wear sunscreen every day. 
• Sitting in a warm bath (without soap). 
• Applying a cold compress. 
• Using a device like the Frida Mom Upside Down Peri Bottle or a bidet to squirt warm water during urination to reduce the discomfort of urine touching a lesion. 
• Some people find it’s helpful to eat foods high in lysine and low in arginine. 

Sex With Herpes 

People with herpes can absolutely have great sex and great relationships. 

Open communication with your partner about safer sex practices and steps to reduce the risk of transmission are key. Remember, your partner may already have antibodies for herpes without knowing it, and you may want to discuss the risks and benefits of them getting antibody testing. 

Barrier methods can reduce risk of transmission, but it’s important to remember that both transmission from lesions and asymptomatic shedding can occur on places not covered by barriers like condoms or dental dams. 

You should never have sex when lesions are present, healing, or when you feel prodromal symptoms that indicate an outbreak is coming (some people get a strong tingling sensation in the days prior to an outbreak). 

Transmission via asymptomatic shedding of the virus is still possible, though much less likely. Asymptomatic shedding can greatly be reduced by suppressive therapy (taking anti-viral medication every day). 

Support 

Remember, herpes is actually very common, and there’s a lot of support out there. 

Here are some organizations that offer support and community for people navigating a positive diagnosis and living with herpes: 

• Something Positive for Positive People 
• Herpesite 
• The American Herpes Foundation National Herpes Hotline: (919) 361-8488 

There are several content creators who produce hilarious, relatable, and supportive content about living with herpes. Some of them include: 

• Suzanna Elzbieta 
• Chase Cramer 
• Christopher Pickering 
• Ella Dawson 
• Courtney Brame 
• Adrial Dale 
• Jenelle Marie Price 

Here are a few articles that share first person accounts of navigating life after diagnosis: 

• Living With Herpes - What I Wish I’d Known Before My Diagnosis 
• Both Sides of a Breakup: He Couldn’t Get Past the Herpes 
• I Have Herpes HSV-1 - This Is How I Date & Disclose It 
• The Truth About Dating with Herpes, Women Tell All 
• 23 Women Reveal How They Tell Someone They Have Herpes 

There are also several dating websites and apps geared towards folks that are HSV-positive, however, there’s some legitimate concern that they might actually reinforce stigma. 

Conclusion 

STIs are very common. In fact, they’re a natural aspect of being human. 

Barry Marguiles, a biology professor at Towson University, likes to tell his students that herpes viruses are “extremely common pathogens that have actually sort of evolved a fabulous coexistence with us [since] in most cases, nobody ever knows they have them.” 

As William A. Knaus wrote in 1976 for the New York Times Magazine, “herpes viruses are part of our individual and collective ecosystems—like bacteria and pollution. We cannot get rid of them without getting rid of ourselves.” 

It’s 100% possible to be HSV positive and live a fulfilling life, both in terms of sex and dating, and everything else. It just may require learning some new skills and behaviors to make sure you’re taking the best possible care of yourself and others. 

If you or your partner have recently been diagnosed and you’re struggling, schedule a complimentary consultation with The Pomegranate Institute, we’re here to help!