Herpes: What it is, how it’s spread, and how to manage it
Of all the STIs, herpes might be the most misunderstood. From dire warnings and photos of serious infections in high school sex ed to jokes made on sitcoms to passing comments from friends, we’re constantly getting the message that getting herpes is the worst thing that could ever happen to a person. But that’s more about STI stigma than it is about the reality of living with herpes.
In reality, herpes is: 1. Much more common than most people realize. 2. Manageable, (though not curable, because no viruses are curable). 3. Often symptomless or causing only minor symptoms.
So here are some common questions and the actual facts—without the scare tactics—about herpes.
What is herpes and what is the difference between the types of herpes?
Herpes is a virus that’s in the same family as shingles or chickenpox. (In fact, if an adult gets shingles, they’ll often be prescribed the same medication that’s prescribed for managing herpes!)
There are actually two types (called strains) of the herpes virus: HSV-1 and HSV-2. As for the difference between the two strains, nurse practitioner and certified nurse-midwife Robin Watkins says there really isn’t one. “Most herpes infections on and around the mouth, like cold sores, are caused by the HSV-1 virus. HSV-1 can also cause eye infections, though this is rare. Infections in and around genital areas, like your vagina, vulva, penis, scrotum, inner thighs or anus are typically caused by HSV-2. However, you can get an HSV-1 infection on your genitals and an HSV-2 infection in your mouth or elsewhere on your face,” she says. It’s also possible to have both strains at the same time.
“Both strains are treated by a provider in the same way based on where the infection is, not what strain of herpes you have,” says Watkins.
“Something I’ve come to realize is that people who have HSV-1—which typically causes cold sores—they almost are like, ‘Well, I have HSV-1 so, it’s okay,’” says Emily DePasse, sexologist and herpes awareness activist. “It’s like there’s this good and bad herpes, which is not the case.” There is no “bad” or “good” herpes—just herpes.
What are the symptoms of herpes?
Both strains can cause blisters or open sores, called ulcers. They can also cause pain, itching, and burning. With both types of herpes, you can get flare-ups of symptoms multiple times over the course of your life. That’s because once you have it, the virus stays in your body for life, even when you don’t have symptoms.
According to Watkins, “The big difference between having HSV-1 and HSV-2 is the pattern of how often you get outbreaks and how likely you are to be able to pass the infection on to a partner when you don’t have an outbreak. For both HSV-1 and HSV-2, the first outbreak is usually the worst. Some patients may even have flu-like symptoms, like body aches. Overall, HSV-2 infections are more likely to be symptomless and go without being diagnosed. HSV-2 infections are also more likely to be spread even when you don’t have symptoms of an outbreak, like blisters.”
One thing people are often misinformed about is what herpes actually looks like. The images people find on Google and the ones they’re shown in high school sex ed are often very advanced cases of herpes in people having very strong reactions to the virus. Many people who have herpes either don’t have any symptoms at all or they’ve only had one flare-up and it was so small that they didn’t realize it was herpes. That initial flare-up can look like a pimple or an ingrown hair or even just a small cut. That’s why so many people who have herpes aren’t even aware they have it.
How do you get herpes?
Herpes is spread through contact with: a herpes sore, the saliva of a person who has an herpes infection in their mouth (caused by HSV-1 or HSV-2), the genital fluids of a person with a herpes infection on their genitals (caused by HSV-1 or HSV-2), or the skin of a person who has herpes (this is called skin-to-skin contact).
Skin-to-skin contact doesn’t mean it can spread to any part of your body by touching any part of a person who is carrying the herpes virus. The herpes virus needs to come into contact with an opening, like a tiny cut or a mucous membrane (like the delicate skin inside your mouth), in order to get into your body. That’s why we see it so often near our mouths and our genitals—those are areas with mucous membranes.
Using condoms and dental dams can reduce the likelihood of spreading herpes, but it doesn’t totally eliminate the possibility. That’s because sores can happen in places that condoms and dental dams don’t cover and because even skin that doesn’t have a sore on it can spread the virus.
There are ways to reduce the likelihood of passing herpes to a partner, including by taking medication to prevent flare-ups (described below). Preventing flare-ups reduces the likelihood that you’ll transmit herpes. But it’s important to know that you can still pass herpes to a partner when you’re not having a flare-up and have no symptoms of herpes at all.
When should you be tested for herpes?
Health care providers don’t routinely test for herpes, so it’s important to let them know if you have a partner who has been diagnosed with herpes or if you think you’ve been exposed. You should also be tested for herpes if you have any of the symptoms of herpes.
If you have sores, a provider may be able to diagnose herpes just by looking at them. They may also take samples from the sores and have them tested to see if they contain the herpes virus. There is also a blood test for herpes that can let you know if you’ve been exposed at any point in your life. But Watkins notes, “It can’t tell you when you were exposed or where on your body, so a positive result doesn’t mean you’ll have outbreaks or be able to pass the herpes virus to a partner.”
While it’s a good idea in general to get screened for STIs once a year, even if you don’t have any symptoms, and anytime you’ve had sex with a new partner, if you don’t have symptoms of a herpes infection your provider isn’t going to test for it. Check out our clinic finder to look for a place to get tested in person or read up on how to get tested for STIs via telehealth.
How is herpes managed?
Herpes isn’t curable—no viruses are. But there are medications to manage it and steps people can take to reduce the risk of spreading it to a partner or partners.
There are three medications that are FDA-approved for managing herpes: acyclovir, valacyclovir, and famciclovir. These medications can be used either as episodic therapy, meaning they’re taken at the first sign of a flare-up for a specified amount of time, or as suppressive therapy, meaning they’re taken daily in order to reduce the likelihood of a flare-up. Research has shown that taking the medication daily can reduce the number of flare-ups by at least 75 percent or even eliminate them all together. And suppressive therapy reduces the risk of passing herpes to others.
Additionally, people with herpes can use condoms and dental dams to further reduce the risk of passing on the virus to their partner or partners. And while using those barrier methods don’t eliminate the risk, it does greatly reduce it.
How not to freak out if you’re diagnosed with herpes
When a person is diagnosed with herpes, it’s unfortunately really common for them to go into a shame spiral. That’s because many of us have been exposed to stigmatizing messages around herpes, and that we may have deeply absorbed those messages.
“You’re still you,” says Emily. “A lot of people lose their identity to what they think herpes means and they start to associate themselves with all of these societal negatives. You’re still you, before diagnosis and after diagnosis.”
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