February 03, 2020 at 08:00PM by CWC
You probably have thoughts about herpes. Some may be accurate, but others may be born more of stigma (and jokes, of which herpes is often the punchline) than any actual truth about the virus.
My personal understanding of herpes—a common, sexually-transmitted virus that can cause sores, but generally no other poor health outcomes—has evolved over the years as I’ve watched friends receive diagnoses under a variety of circumstances. One got herpes from her first love, who transmitted it to her via oral sex. One got it from her husband, who to this day has never had an outbreak. One doesn’t know where or how he got it, only that it showed up unexpectedly when he was sleeping with someone who was not positive for the virus. And so on.
Watching this wide variety of scenarios unfold has led me to question what I once thought I knew about herpes: that it was a “gross STD,” that only irresponsible people contracted, that if someone gave it to you, they were “bad,” and that if you got it, your life was “ruined.”
What I’ve realized in the process is that herpes is not what society’s painted it to be. To help remedy the rampant misconceptions associated with the STI, I asked experts to debunk the most common herpes myths they hear.
Myth #1: You get tested for it every time you ask for an STI check
In the midst of reporting this piece, I happened to see my OB/GYN. Regarding herpes, he told me, and I quote, “We can land a man on the moon but we can’t figure out herpes diagnosis.”
So, here’s the thing: The Center for Disease Control and Prevention (CDC) doesn’t recommend routine herpes testing, which means that unless you specifically ask for it, you’re not getting tested for it. This might seem like a massive oversight, but there are a number of good reasons for this.
“When you do blood testing for herpes, it’s very difficult to interpret,” says NYC-based gynecologist Alyssa Dweck, MD. “It might tell you you’ve been exposed at one point at your life, but it won’t tell you when that happened or who you got it from—so the usual STD screen doesn’t test for herpes in the blood unless people ask for it.” Even then, a positive result will mean you’ll be told you’ve been exposed to herpes, which isn’t quite the same thing as being told you have it. (False positives are also common, too.) Plus, per the CDC, diagnosing someone without symptoms via a blood test has not shown to change their sexual behavior or stop the spread of the virus.
For these reasons, Merissa Hawkins, MPH, clinical strategy manager for birth control and at-home STD testing company Nurx, tells me that blood tests are usually only used as a secondary form of diagnosis to confirm the cause of a visible outbreak. In this scenario, a doctor would see a herpes outbreak on a patient, then work to get more accurate diagnosis by swabbing the lesion for a culture.
“The best way to diagnose herpes is through a visual exam and swab test so you can look specifically for the virus under a microscope,” says Hawkins. Even that isn’t a perfect system. “Testing for herpes does have a lot higher false negative rate across the board because it’s kind of finicky,” she says. “So though swab testing is better than a blood test, it’s still not as accurate as other STI testing.”
Myth #2: Herpes outbreaks are always obvious
According to the CDC, “most people with genital herpes infection do not know they have it.” This isn’t just an issue with testing; it’s because herpes can often be more subtle and complex than how it was presented in high school health class.
I have a friend who knew he had herpes immediately, because he had “hundreds” of sores. I have another friend who was shocked to be diagnosed off of one paper-cut like lesion she had suspected was yeast-related. These two anecdotes illustrate how differently herpes can present in each individual. “Everybody is unique and has a unique immune system,” says Hawkins. “[An outbreak] could be incredibly mild, where someone thinks it’s a blemish or ingrown hair, and it could be really apocalyptic, where someone feels the need to go in and see a medical provider and get access to medication.”
Myth #3: You can’t contract herpes if you always practice safe sex
Condoms only cover part of the area in which herpes can manifest, says Dr. Dweck, which means that they don’t fully protect you from catching the virus.
For this reason, there is one way to practice mostly safe sex with respect to herpes. In other words, you can’t protect yourself from getting it, but someone with herpes can protect you by taking what Dr. Dweck calls “prophylactic antiviral medication,” e.g. Valtrex, every day, whether there’s an outbreak or not. “I have a lot of patients who are in a discordant couple, meaning that one person has herpes and the other doesn’t and they want to prevent transmission,” says Dr. Dweck. “The person who has it can take Valtrex to help prevent transmission.”
Myth #4: You can only contract herpes from someone who has symptoms
Hawkins tells me there’s a phenomenon in herpes called “asymptomatic shedding,” where an infected individual can transmit the virus without having an active outbreak. What makes this even trickier is that some people with herpes never have noticeable symptoms and yet they may still be contagious. “It’s actually a really interesting virus, because you can transmit herpes even though you don’t have any symptoms or outbreaks,” says Hawkins.
Myth #5: You can’t get herpes if you’re not sexually active
Herpes can be passed from skin-to-skin contact that isn’t sexual in nature, Hawkins tells me. “If you look at the leotards that wrestlers wear, if you have upper thigh genital herpes in an area that’s low enough that it shows under the leotard, someone [who comes in contact with that area] can get it, too,” Hawkins tells me.
With that said, Hawkins tells me you don’t need to worry about getting it from trying on a swimsuit or sharing a towel, because the virus doesn’t live outside of the body for long. “Now if you’re trying on bathing suits without any underwear underneath, there are plenty of wonderful infections that you can get even if herpes is not one of them,” she says. “People are still strongly advised to make sure they’re using proper hygienic options.”
Myth #6: There are two types: genital and oral herpes
Buckle up, because this is where things get really confusing. There are two types of herpes, HSV-1 and HSV-2. (The HSV in both stands for “herpes simplex virus.”) HSV-1 is typically oral, meaning it causes cold sores on the mouth. More than half the population has been exposed to this virus, and often from childhood. HSV-2 is typically genital, and most usually is transmitted through sexual contact.
With that said, Dr. Dweck says that herpes type 1 can be spread to the genitals via oral contact (read: oral sex). So you might have type 1 that only presents orally, or you might have type 1 that only presents genitally. Herpes type 2 can also be spread in the reverse fashion, from the genitals of one individual to the mouth of the other (though this cross transmission is less common for type 2 than for type 1).
Myth #7: You can “cure” herpes holistically
Both experts tell me, unequivocally, that herpes cannot be cured. “Unfortunately, I think some herbal remedies take advantage of the misconception that they can cure herpes, but what’s really happening in these scenarios is that your outbreak is going away,” Hawkins says. Outbreaks tend to lessen naturally over time, BTW, whether or not you invest in supplements and holistic remedies. “There is no cure for herpes; it is with a person for life,” she says.
Myth #8: Herpes can affect your fertility
Herpes has no impact on fertility, says Hawkins; however, people may be confused because there can be an issue with herpes when it comes to pregnancy. “If someone is pregnant and gets an outbreak close to when she’s going to deliver a baby, that could be problematic,” she says. In very rare cases, the outbreak can be transmitted to the baby during birth; this is called neonatal herpes and the condition is potentially deadly. In such a situation, doctors may recommend a cesarean to protect the baby from infection.
Myth #9: If someone has herpes, they’re probably promiscuous
“One of my ‘favorite’ myths is that only promiscuous or ‘slutty’ people get herpes—I just want to shout from the rooftops that this is absolutely not the case,” says Hawkins. “Herpes is something that’s super easily transmitted.” This is especially true of type 1 oral herpes, as you may have contracted it from, say, your grandmother as a kid. If this is the case, 15 years later you could perform oral sex on your partner and accidentally transmit your type 1 to his or her genitals—it’s that easy.
For this and all the reasons outlined above—the fact that it’s difficult to test for, most people don’t know they have it, it can be contracted non-sexually, etc—you can catch genital herpes from your first love, your long-term partner, someone who has been STD tested and shows you a clean bill of health, etc. Your number of sexual partners and your sexual proclivities are irrelevant.
Myth #10: Herpes is a really big deal
This one is my favorite, having watched a number of friends be traumatized by diagnoses, only to later realize that ultimately, herpes is not that big of a deal.
For starters, Dr. Dweck tells me that one-third of the sexually-active population has been exposed to herpes. Hawkins offers more specific, but equally staggering, numbers as well; she says that one-half of the population has oral herpes and one-sixth of the population aged 14 to 49 has genital herpes.
What’s more, my OB/GYN points out that the virus is more so inconvenient than it is nefarious, meaning that while outbreaks, especially your first, can be painful, they’re not doing you any health harm overall. And if you do have significant recurrent outbreaks, there’s a medication for that.
For all of these reasons, pros tend to agree that the outsized stigma around herpes is unwarranted and often, it’s the worst part of being infected. In reality, there’s no reason herpes should make someone feel like a social pariah or that it should remain such a closeted, shameful condition.
“The fact that so many people are living with this and having the same experiences but we don’t talk about it, it’s really a shame because we could definitely support each other in ways we’re currently not doing,” says Hawkins. “Herpes is, of course, not something people would want, but it’s not as big of a deal as people make it out to be.”
Hawkins’ company NURX doesn’t offer herpes testing for the above reasons, but they do offer other at-home STI screening and over-the-internet STI medications (including herpes meds). Plus, here’s how to have a fulfilling (and safe) sex life post-diagnosis.