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Gone Viral: 6 things you should know about herpes

Think you know everything about herpes? You might be surprised…

by Ina Park, MD, MS

Genital herpes is one of the most feared and misunderstood sexually transmitted infections (STIs, a.k.a. STDs). Here are 6 things you probably didn’t know about this virus (but should) in honor of STD Awareness Month.

1. You’re having sex on the tip of an enormous iceberg.

You might ask a prospective sex partner whether they’ve had STIs (like herpes) before you have sex. (We highly recommend doing this!) Maybe one of your partners has even told you they had genital herpes. But people who actually know they have herpes are just the tip of the iceberg of everyone who has the virus. In fact, of the 50 million men and women estimated to have genital herpes in the United States, over 80% are not aware that they have it.

That means if you are dealing with a new herpes diagnosis, you may not have any idea where it came from. This doesn’t mean one of your partners is lying to you; most people just don’t realize that they were ever infected. So even if your inner detective wants to hunt down the partner who gave you herpes, if you’ve had more than 1 or 2 partners, chances are you just won’t be able to be 100% sure. Regardless of whether or not you find the source, it’s important for you to tell your partners about it so they can get tested and protect themselves.

2. The iceberg is melting.

Unlike other STIs (gonorrhea, chlamydia, syphilis) which continue to increase, genital herpes is actually not becoming more common. Twenty five years ago, 1 in 5 people had genital herpes; now fewer than 1 in 6 people are infected.

3. In the world of herpes, we are not all created equal.

Your likelihood of having herpes depends largely on your age, gender, and the gender of your sex partners. Since herpes is a lifelong infection, people over 40 years of age are more likely to have a positive blood test for herpes (1 in 4 people) than a teenager who hasn’t had as much time to become infected (1 in 100 teens). Like with many other STIs, women get the short end of the stick: 1 in 5 of us will be infected with herpes before age 50, while for men overall it’s about 1 in 9. For men who have sex with men it’s about 1 in 3.

4. It takes two.

Did you know there are actually two viruses that can cause genital herpes? One is called herpes simplex virus type 2 (HSV-2), and the other is herpes simplex virus type 1 (HSV-1). You may have heard of HSV-1 because it typically causes cold sores on the mouth, but it can easily cause the same types of sores on your genitals or anus too. One major difference: HSV-1 can easily infect you above and below the belt, while HSV-2 is almost exclusively confined to the genitals and anus.

5. The culprit behind genital herpes is changing, and this may actually be good news.

For those of us hoping for an effective vaccine, the failure of multiple herpes vaccine studies has been heartbreaking. An upside is that one of these studies revealed a surprising shift in the cause of genital herpes in young women. The study found that HSV-1 (the virus that usually causes oral herpes) was twice as likely to cause genital outbreaks as HSV-2. This information backs up another study among college-age women, which demonstrated that nearly 80% of genital herpes outbreaks were caused by HSV-1, not HSV-2.

Although having a genital herpes outbreak isn’t fun for anyone, if the outbreak is caused by genital HSV-1, then it’s more likely to be a one-and-done situation. People who have a genital outbreak caused by HSV-1 are less likely to have multiple outbreaks, less likely to shed virus that could infect others, and actually get some protection against catching HSV-2 in their genitals in the future. There’s your silver lining.

6. Herpes is not exactly forever.

People always label herpes as the “incurable” STI. While technically this is true, most people who have herpes outbreaks do not suffer with them for the rest of their life. For people who get genital herpes (e.g., from HSV-2) outbreaks will usually be most frequent for the first two years after diagnosis, as is the chance of passing it on to someone else. After two years, most people are only shedding herpes virus on 2% of the days in a given year. (That’s only 7 days out of 365.) You don’t know when those days will be, so condoms are still a good idea. Plus, there are multiple treatments that your health care provider can prescribe that can help prevent spreading herpes to someone else.

The bottom line: While you can’t completely avoid herpes and other STIs, there’s a lot you can do to reduce your risk. First, get informed, get tested, then get out there and have fun!

Ina Park, MD, MS has dressed up as a giant condom more than once to encourage awareness of STIs and safer sex. She’s currently the Medical Director for the California STD/HIV Prevention Training Center and an Associate Professor at the University of California San Francisco-School of Medicine. She’s also raising two rambunctious sons whom she refers to as the “future STI transmitters of America.” When she’s not at work or with her family, she’s practicing yoga and eating as much as she can.

read more about: stis, health, provider perspective, herpes

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