Herpes: You Probably Already Have It, and It's No Big Deal
Sexually transmitted infections (STI) are scary, and we’ve been trained to fear them quite like the literal plague from a young age. Just look at one of the best lines in Mean Girls: “If you touch each other, you will get chlamydia. And die.” It’s funny because it’s true, but the truth is hardly as humorous. Abstinence-only education is infamous for not only withholding important information, but also promoting inaccurate information, especially when it comes to STIs.[i] As of 2014, only 13 states required medially accurate and verifiable information, and only 2 abstinence-only programs were found to be medically correct.[ii]
I recall my AO ed quite vividly. My body-builder, overly-exuberant, completely under-qualified gym teacher plowed through textbook pages of human anatomy sketches complete with doodled pubic hair and showed us videos of talking cartoon penises and vaginas while she chuckled at her desk in the back. I could never forget the slew of graphic images of mangled, mutilated genitalia. The bloodied, blistered, bloated skin would scream out to the class, “See what sex does! Stay away! Don’t do it!” The images are still sharp in my mind, but the lesson surrounding them blurs between the photos. What was it I learned? It didn’t matter. The important part was that STIs are gross and if you get one, your private parts will swell up and no one will ever want to touch you again.
So naturally I responded with incorrigible sobs as I heard the doctor’s sweet voice from between my legs say, “Yup, this looks like classic herpes.”
As the word brushed the insides of my thighs, I thought I could feel my tiny not-yet-full-blown-blisters grow three times their size as my sinuses swelled in camaraderie. I was mangled. Unclean. Lesioned. Diseased. Blistered. Swollen. In pain. Contagious. Unworthy. Unattractive. Unlovable.
“Now I’m just going to take a few swabs of you to make absolutely sure, but I’m 90—99% sure that this is herpes,” the doctor said as she unwrapped the longest q-tip I’ve seen since my pap smear. “Oop, looks like you’ve got one up here too,” I heard after breathing hard through a few touches to some sore spots. I was sure they’d grown, now. “All done!”
I sat up oozing all kinds of face juice and her self-satisfied grin of a swab well done lowered into the one-sided smile designed for sympathy.
“I know, it’s hard,” she said slouching in her padded stool. “And then there’s the awkward conversations with your previous partners you don’t want to have…”
“No, it’s not that,” I finally squeaked. She pushed her eyebrows together and I answered, “I just…I mean I’m single and I plan on being single for a while so how do I …?”
She hesitated, but not out of awkwardness. She was thinking. After a second, “Now this is totally unprofessional and I probably shouldn’t tell you this, but I actually have the virus too. I had one nasty outbreak when I was 16, and I haven’t heard from it since. That’s actually not too uncommon, to have one outbreak in a lifetime. The thing is, regardless of outbreaks, you just have it forever. It’s been about 15 years since my last one, but it’s still in me. And seriously between you and me? I’ve had a few partners over the years that I never told. And I never gave it to anyone. The risk of sharing your herpes when you have absolutely no signs of an outbreak are insanely low. I can’t say zero, but it’s close.”
The tears kept falling from my eyes, but I had stopped crying. First of all, I’d never met with such gracious unprofessionalism in my life, and I couldn’t have been more thankful. Secondly, what? I may not have been able to remember details of my high school don’t-have-sex education, but I know I never learned that.
Before I left the clinic, I cornered another doctor and asked her the likelihood of transmitting during asymptomatic periods. “In terms of a clock,” I said. “Out of 60 minutes. Like, 59?”
“And counting.” Her exact words.
I was in disbelief. I literally didn’t believe them. The fact that two doctors had the exact same opinion without huddling beforehand did lend credit, but my gut couldn’t accept such a low transmission rate. After all, I had gotten it, and I was vigilant in my use of protection. They had to be wrong.
I spent the next week researching and meeting with doctors at Planned Parenthood, and what I discovered revealed a simultaneously calming and unsettling truth: Most of what we think we know about herpes and how it spreads is terribly, terribly incorrect, and those with symptomatic versions of the virus are unnecessarily suffering at the hands of a misinformed stigma.
First off, let’s evaluate what we mean when we say the word “herpes.” Images from my high school health class come to mind immediately: enflamed vulvas swollen closed with tiny puckering white bumps, buttocks bloodied with smears of popped blisters. I can’t be blamed for envisioning a lonely life filled with pain and rejection at the mention of the word. But these cases are extremes existing on a vast spectrum.
Most of us are aware that cold sores are a version of the herpes virus (HSV1) and that genital herpes are very much a thing (HSV2), but you know who else can call the herpes virus daddy? Shingles. Chicken pox. Mono.[iii] (Two versions of the herpes virus, 4 and 5, lay claim to this one.) And lastly, Roseola, a mild infection that causes high fever and rashes in children usually younger than 2 years old.[iv] It’s so common that most children have had it before they enter kindergarten.
So, now that we know how many different types of herpes there are, how many different names they have, why are we more terrified of “herpes” than we are of “chicken pox” or “cold sore” when they’re quite literally the same thing? Simple. It’s an issue of rhetoric. Our long history of AO education has lumped herpes into the same category as HIV/AIDS, and as a result, carriers of general herpes are treated as if they harbor an atomic bomb between their legs.
Most of the stigmatization can be traced back to an advertising campaign in the late 1970s.[v] Up until the mid-70s, both oral and genital herpes were treated as moderate skin conditions simply appearing in different places. Medical journals dedicated to STIs made no mention of the disease and textbooks barely touched it. Then, pharmaceutical company Burroughs-Wellcome’s new drug, Zovirax, promised to reduce the severity and frequency of outbreaks. People began thinking there was something wrong with them since there was now a pill to fix the little annoyance they’ve been dealing with fairly easily up until then. The campaign created its own market demand by focusing on transmission rates, thereby creating social anxiety around the incredibly common infection.
The fact is that this unfortunate handful of people who have experienced a genital herpes outbreak make up only a tiny percentage of those who actually carry the virus. The herpes virus—and everything that derives from it—is a latent infection, meaning it’s alive in the host for as long as the host is alive. So, if you had chicken pox as a kid, you’ve got it. If you had even just one cold sore in your life, you’ve got it. So, most likely, you’ve got it and you are contagious. Right now.
Check out the numbers:
Adults who carry HSV1 or HSV2 (somewhere on the body) 75-80%
Adults who carry HSV1 orally, exclusively 80%
Adults who have genital herpes (either HSV1 or HSV2) 16.2%
Adults who have genital herpes who don’t know they have it 80%
That’s a lot of herpes walking around. And most of it is just hangin’ out in our nervous system, unacknowledged, shedding silently.
What’s shedding, you ask? Good question! Viral shedding is the reason people transmit herpes when they’re showing no signs of an outbreak. The disease lies dormant in your nervous system, and occasionally, it’ll make its way through your nerves up to your skin in such trace amounts that don’t provoke a visible reaction. If uninfected skin makes contact with shedding skin, the herpes transmits. There’s no way to tell exactly when asymptomatic shedding occurs.
Originally it was thought that shedding operated like a light switch—either it was happening or it wasn’t. However, recent studies have suggested that shedding episodes resemble sporadic fireworks rather than a constant light. One study concluded that genital shedding of the HSV2 virus occurs on ~20% of days with a median duration of 13 hours.[vii] That’s a good chunk of time, but it’s impossible to tell when the shedding is occurring unless you’re conducting expensive medical testing multiple times a day.
So, considering the vast majority of people carry some version of HSV, and most of those who are infected with genital herpes don’t even know it and are asymptotically shedding who knows when, there’s a very high possibility that if you’re active in today’s hookup culture, you’ve probably slept with someone who has HSV without knowing it, and you still probably had it in the first place anyway.
That’s how herpes gets around—very quietly—and it’s incredibly difficult to trace its origins. I have no idea who gave me mine, and I most likely never will. Herpes has roughly a two-week incubation period, meaning that the earliest symptoms show up will be two weeks after transmission, if they even decide to show up upon earliest transmission. Latent infections can be insidious and rest in your body for weeks, months, or even years before making their debut. Any inhibitor to your immune system can potentially trigger an outbreak, be it surgery, a cold, or even the simple presence of stress.[viii] Hormonal changes can trigger outbreaks as well, especially those that occur during the menstrual cycle. (Great. Wonderful. Perfect.)
Those of us who experience the symptoms of our HSV are not dirtier or sluttier or more contagious than anyone else. We’re simply unlucky. But our unfortunate circumstances actually end up working in our favor—or yours, really. People who experience symptoms of genital herpes are actually less likely to transmit to a partner if they take all the necessary precautions, keep themselves healthy, and avoid sexual intercourse during active outbreaks. (Which we’re obviously going to do, this shit is painful to even sit down on.)
How’s that even possible? Because we know we have it and we’re taking steps to minimize our risk of transmission. I don’t have numbers on this one, but I’m fairly certain that unless we’re talking about a sadistic asshole, known carriers of HSV will use condoms more often to decrease the risk of transmission in addition to taking daily viral suppressants, which significantly lower the risk of transmission. Meanwhile, undiagnosed, asymptomatic carriers are behaving as if everything is right as rain.
The Risks [ix]
Male to Female Female to Male
No condoms or medication 10% No condoms or medication 4%
Use of condoms or medication 5% Condoms or medication 2%
Condoms and medication 2.5% Condoms and medication 1%
People don’t always use condoms when they have sex, whether in a monogamous relationship or not. Even if they do, they run a higher risk of transmission than those “marked ones” who are on medication. So, considering that most people have the virus and most don’t know that they do, it’s the ignorant population that’s doing most of the spreading, not those of us in the know.
And you know what? That’s still pretty okay. Because even if you’re (somehow) not a carrier and you enjoy the pleasures of casual sex, there’s an 80% chance that if you do pick up herpes, you won’t experience any symptoms at all!v And if you do? Well that’s not the end of the world either. The first outbreaks tend to be the absolute worst, as your body doesn’t have Life-of-pix-legs-Sarah-babineaua reserve of antibodies ready to fight the virus off.
Over time, the frequency and intensity of outbreaks decreases, and in a handful of cases, the first outbreak is the only one, just like how it was for my first doctor.viii Asymptomatic shedding also decreases with time and use of daily antivirals. More good news: If you’ve been prone to cold sores your whole life, there’s a relatively 0% chance of the virus migrating south once it’s found its home in your mouth. And there’s no need to worry about washing your sheets every day; HSV can only live outside the body, or off of the skin, for around 10 seconds.[x] Keep up that hand washing, though!
In sum: no sex is safe sex, and herpes really isn’t the lesionary Apocalypse Now you were taught it was. Sure, there’s some major discomfort for a short amount of time, but who hasn’t had the flu, or a UTI, or a yeast infection, or jock itch? It’s no worse than those, people, I can personally promise you that.
As a parting note, one of my doctors told me with a heavy sigh, “Herpes is a social problem, not a medical one.” Our proclivity to turn fear into facts then cling to those facts with a religious fanaticism only serves to isolate a group of people who are no different from most others apart from one thing: knowledge. And those of us with that knowledge are using it to protect everyone else. So if someone has the courage to open up to you about their herpes, give them a hug, ask if they’re actively broken out, and if not, go to town. You’ll be fine.