Photo credit: Vratislav Darmek

Did you know that the Herpes Simplex Virus (HSV) is so common that many health professionals believe people should assume everyone has herpes and act accordingly?

Yet, as common as Herpes is, it is surprising that most of us remain misinformed about how the infection spreads and how it can be prevented. One prevalent myth is that there is a “good” type and a “bad” type of herpes, the latter being consider a result of irresponsible and careless sex. The truth is that there is little difference between the two strains. Having HSV of either type is not shameful, nor is it indicative of your worth as a sexual being.  As demonstrated in the article below, Herpes is at its core simply a skin condition.

If you are concerned that you’ve recently been exposed to Herpes Simplex Virus (HSV), this article by the CSPH (the Center for Sexual Pleasure and Health) will help you navigate what are the next best steps to take.

Here is a summary of important facts everyone should know about HSV today: 

• While there is no cure for Herpes, it is considered a minor, yet reoccurring skin condition.
• There are antiviral medications that may help manage outbreaks and treat or relieve symptoms.
• HSV-1 is the most common form of Herpes and many people contract it through non-sexual contact. The majority of individuals affected HSV-1 contract it during childhood.
• Like Human Papillomavirus (HPV), HSV can be transmitted even when condoms are used due to exposed skin at the site of contact.
• Two thirds of people with HSV have no symptoms.  Furthermore, HSV may be transmitted even when there are no symptoms and between outbreaks. Check out this article for more about when different STIs are transmittable and when is the best time to get tested.
• You can protect yourself from HSV by using barrier methods (condoms and dams) consistently and correctly, washing after sex with soap and water, and using lubricants during sexual activity to help prevent microtears (tissue damage that increase the risk of HSV transmission and triggering an outbreak).
• Specifically ask for an HSV test when get STI testing. Most doctors will not test for herpes if no symptoms are present. Testing is crucial to prevention, especially considering that an estimated 80% of people with Herpes are undiagnosed.
• For more information about living a healthy and fulfilling sex life with herpes, check out the resources at the bottom of this post.

This article was originally published on the CSPH.

BY THE CSPH | theCSPH.org

Image from the CSPH

So I received oral sex from someone yesterday. Today that person has a cold sore. My understanding is that oral and genital herpes are caused by different strains, hsv-1 and hsv-2, and there’s also a strain that can cause both. So if it’s just hsv-1, I probs won’t get genital herpes, and if it’s the evil one that causes both, I could. This is clearly something that I should talk to my doctor about, but I was hoping you could give me some more info/tell me whether my info is at all factual. Thnx!

Herpes Simplex Virus (HSV) is one of the most common sexually transmitted infections, with HSV-1 infecting some 50 to 80% of people and HSV-2 affecting a projected 30% of adults.  Despite its prevalence, however, many misconceptions about this STI exist, and I hope my response will address most of these.  One herpes myth in particular that I hope to debunk is the idea that people are sexually and romantically “ruined” following HSV, which resources such as Love in the Time of Herpes help disprove.  For more information on living and loving with herpes, you refer to the resource list at the bottom of this Q&A.

If you’ve had a recent hook-up and are now concerned about having contracted HSV, feel free to skip to the final section of this article.

What is the Herpes Simplex Virus (HSV)?

Herpes Simplex is a category of sexually transmitted viruses that oftentimes results in infections of the skin and mucous membranes, manifesting itself in blisters/sores.  Following infection, HSV will establish latency within the nervous system, meaning the virus will attach itself to the cells of one’s sensory nerves, making it one of the few STIs for which there is no cure.  Despite this, HSV is in fact a relatively minor infection; it is literally a simple, yet recurring skin condition.

There are two strains of herpes: HSV-1, also known as “oral herpes” and “cold sores,” and HSV-2, which most often affects the genital and anal region.  Despite this colloquial distinction, it is in fact entirely possible for both strains to affect both the mouth and genitals, as well as other parts of the body such as eyes, fingers, and thighs.  Vulva-owners may also experience sores on the inside of their vaginal canal and on their cervix.  HSV-1 in particular is also associated with potential complications such as oracular herpes and conjunctivitis (pink eye).

Is There a Good/Bad Herpes?

While many people are under the impression that there is a “good” herpes and “evil” herpes, the distinction is minor: both varieties of HSV may be contracted both orally and genitally, and while HSV-1 in particular is known as “oral herpes,” it is quite frequently transmitted to the genitals.  However, it’s less common for HSV-2 to be transmitted to the mouth.

Furthermore, under the microscope, both strains are almost identical.  HSV-1 and HSV-2 also manifest themselves similarly and, following infection, becomes latent in the nervous system. Neither type of herpes is curable.

So, if the strains are so similar, why is there the misconception that there is a “good” virus and a “bad” one?  The stigma likely lies in the sheer prevalence of HSV-1, which the majority of affected individuals contract during childhood.  Due to the fact that a majority of individuals have HSV-1, it’s easy to write off the STI as “only a cold sore,” whereas the much less common genital herpes is vilified as a “sexually transmitted infection.”

What are HSV Symptoms?

Upon initial infection, HSV may cause small, painful blisters or sores at the site of infection, enlarged lymph nodes of the neck or groin, decreased appetite, muscle aches, general malaise, burning while urinating, and fever.  The first outbreak generally occurs within two days to two weeks after transmission or contact with infected areas, and symptoms can be quite severe should they occur at all.

A second outbreak may occur weeks to months following the first.  Subsequent outbreaks are often less painful and disruptive, and symptoms may grow more mild over time.  Some individuals, particularly those with HSV-1, may not experience outbreaks for months or years at a time.  The average rate of outbreaks for HSV-2 is four times a year.

With that said, not all people who have contracted HSV experience symptoms.  Indeed, estimates suggest that two thirds of people with HSV have no symptoms or mild enough symptoms that the infection goes unnoticed.  Furthermore, HSV may be transmitted even when there are no symptoms and between outbreaks; one study shows that more than half of asymptomatic HSV-2 carriers exhibit viral shedding.  Viral shedding is how HSV is transmitted through skin-to-skin contact even without contact with open sores or bodily fluids.

Finally, symptoms of an oncoming outbreak include fatigue and itching, tingling, and discomfort at the site of the outbreak.  HSV outbreaks can be triggered by a number of sources, including but not limited to: physical and emotional stress, sun exposure, injury, a compromised immune system, surgery, hormone changes such as those that occur during the menstrual cycle, and even the common cold.

How is HSV Contracted?

Herpes Simplex is transmitted through direct contact with a lesion, or from the body fluid of or skin-to-skin contact with an individual with HSV.  Unlike most other STIs, HSV may be contracted through kissing and even sharing drinks; it’s this reason that half of children under the age of six are infected with HSV-1.  Furthermore, like Human Papillomavirus(HPV), HSV can be transmitted even when condoms are used due to exposed skin at the site of contact.

As I previously discussed, many people who come in contact with HSV do not, in fact, show symptoms, or otherwise have symptoms so mild they go unnoticed.  However, whether the individual is asymptomatic or between outbreaks, there is still a risk of transmission.  Indeed, it is suggested that up to 70% of HSV-2 transmissions occur in the absence of symptoms.

It is also important to remember that while HSV-1 and HSV-2 are technically two distinct viruses, oral herpes may be contracted from the genitals, and genitals may contract oral herpes. Research suggests that HSV-1 in particular is commonly transmitted through unprotected oral sex, with up to half of all new cases of genital herpes occurring as a result of HSV-1.

Finally, it should be noted that vagina-owners more easily contract genital HSV than penis-owners.  Studies also suggest that HSV increases the risk of HIV transmission, due to the existence of open sores.

How Can I Prevent HSV Contraction/Transmission?

There are three main ways people can help prevent the contraction and transmission of HSV: use barrier methods during sexual activity; know your status and communicate it with sexual partners; and if you’ve already contracted HSV, consider managing future outbreaks through antiviral medication.

Other ways to help limit the possibility of HSV-2 contraction and transmission include sexual abstinence, washing after sex with soap and water, and using lubricants during sexual activity to help prevent microtears (tissue damage that increase the risk of HSV transmission and triggering an outbreak).

Unfortunately, due to the prevalence of HSV-1, it can be incredibly difficult to prevent transmission.  However, if you are concerned about contracting or spreading oral herpes, you can avoid kissing people as well as avoid sharing items like kitchen utensils and lip balms, namely when a cold sore is present or you feel one forming.  With that said, I understand that kissing for many people is an important component to sexual activity, but not kissing doesn’t have to be unsexy or awkward.  Whether you’re in a monogamous relationship or the type to hook-up casually and participate in orgies, you can sexualize preventative measures by incorporating an intentional “no kissing on the mouth” policy in your play, which may encourage some creative measures, or even using gags.

For both HSV-1 and HSV-2, contact with the sites of outbreak and/or kissing should be stopped as soon as individuals feel the warning signs of an outbreak.  You shouldn’t touch a sore; doing so runs the risk of transmitting the infection to another body part.  If you do touch the sore, wash your hands with soap and water.  Wait until seven days after the sore heals before resuming contact with the mouth, genitals, or anus.

Barrier Methods

While the unfortunate truth is that even condoms do not completely protect against HSV transmission, studies show that condoms do, in fact, provide considerable protection, in particular to susceptible vagina-owners.  For this reason, barrier methods are an incredibly important component of limiting the possibility of contractions and transmission of HSV.

In addition to external condoms, internal condoms are a great alternative barrier method.  Internal condoms potentially provide greater protection from HSV transmission, as they also provide coverage for the vulva and outer anus, thereby reducing the amount of skin-to-skin contact.

Due to the nature of HSV, barrier methods should be used during not only penetrative sexual activity, but also any sexual activity that engages with the mouth, genitals, and anal region.  This includes skin-to-skin frottage, also known as dry-humping; stimulation with one’s hands, during which latex gloves can be used; and oral sex.  Safer oral sex consists of using condoms over penises and dental dams over the vulva and anus.

Know Your Status

As with all sexually transmitted diseases, one of the best things you can do to prevent contraction and transmission is to know your status.  This can happen by being tested at a local medical care provider.  With that said, while providers consistently test for STIs such as gonorrhea and chlamydia, HSV is rarely tested for unless the individual is exhibiting signs of an outbreak.  For this reason, you’ll likely have to explicitly request an HSV test, which I will discuss later.

In addition to being aware of your STI status, it’s important to use that knowledge to empower you in your relationships by discussing STI testing and your status with sexual partners.  Not only is your status important, theirs is too!  Although this can be an intimidating conversation to initiate, I nevertheless strongly recommend that you do so; this shouldn’t be understood as a sign of distrust, but rather an important step in keeping you and your partner healthy.  This is especially important considering an estimated 80% of people with herpes are undiagnosed.

Consider Antiviral Medications

It’s important to note that while there is no cure for either type of HSV, there are antiviral medications that may help manage outbreaks and treat or relieve symptoms.  If, following an outbreak and/or testing, you learn that you have HSV-2 in particular, you may want to consider such medications.

There are currently three kinds of herpes antiviral drugs, all of which are available in pill form and can be taken for two purposes: treatment for outbreaks (to shorten duration and severity of symptoms), and suppressive therapy (to reduce the likelihood of outbreaks).

I’m Worried I Contracted HSV – What Now?

When it’s all said and done, it’s understandable that you may be worried about your hook-up’s cold sore.  For this reason, regardless of if you start showing symptoms of HSV, I suggest that you contact your medical care provider to discuss your situation and to get a professional opinion on the matter.

With that said, standard STI testing often does not include testing for HSV unless the patient has a blister.  This is because the Centers for Disease Control & Prevention does not currently recommend routine HSV testing for those in the general population who don’t exhibit symptoms.  If you are exhibiting sores, however, you should visit your healthcare provider as soon as possible as the test is an easy viral culture swab.  Unfortunately, false negatives are very common with this method.

If you are not exhibiting symptoms, you can still get tested.  Serologic, or blood, exams will allow your medical care provider to test for HSV.  There are two ways blood can be tested for HSV: polymerase chain reaction (PCR) tests and antibody tests.  The PCR test is the most accurate, and can type which strain of HSV you have.  Antibody tests are less reliable and may yield false positives, so this may be a topic you want to discuss with your healthcare provider when being tested.

Finally, I want to stress that having herpes isn’t the end of the world. Figures suggest that some 50 million people in the United States alone have HSV-2, with even more people having HSV-1.  Considering how common it is, it is unlikely that you will be the only person you know with HSV, and many health professionals are of the opinion that people should assume that everyone has herpes and act accordingly.

Furthermore, people with herpes continue to have healthy, fulfilling sex lives and happy relationships.  In the greater scheme of things, herpes is merely a minor convenience for most couples.  Having HSV of either sort is not shameful, nor is it indicative of your worth as a person or sexual being.  Herpes is at its core simply a skin condition.

If you have any other questions about HSV, you can call the National Herpes Hotline at 919.361.8488.  In addition, you can contact the Herpes Resource Center at 1.800.230.6039.
For more information on leading healthy, fulfilling (sex) lives with herpes, you can visit the following websites:

HC Support Network: the largest and most active support website for people with herpes

(H)Life: a community forum that seeks to serve as a roadmap and guide for living and loving with herpes

How to Have a Sex Life Despite Having Herpes, by Dr. Laura Berman

Genital Herpes Sex Advice and Suggestions

The CENTER for SEXUAL PLEASURE and HEALTH (The CSPH) is designed to provide adults with a safe, physical space to learn about sexual pleasure, health, and advocacy issues. Led by highly respected founder and director, Megan Andelloux, The CSPH is a sexuality training and education organization that works to reduce sexual shame, fight misinformation, & advance the sexuality field.