Is Herpes As Big A Deal As You've Been Made To Believe?

News flash: most people with herpes don't even know they have it.

To a lot of us, herpes is just a mystery and a punchline. Something to be ridiculed and feared, even though we barely understand anything about it. Maintaining that ignorance just makes life worse for people who are facing a herpes diagnosis, which could be any one of us down the path. 

For the sake of our own sexual health, and the mental health of people who are dealing with having herpes, let’s admit how little we actually know and get informed. The reality is wildly disparate from the myths.

In reality the majority of people carry herpes simplex type 1. In reality the physical consequences of herpes are usually mild or nothing. In reality the majority of people with herpes don’t even know they have it.

So to verify facts from fiction, we chatted to an expert on episode two of GOAT’s sex education podcast, Thinking Between The Thighs. Dr Shailendra Sawleshwarkar is a physician working in sexual health, and a senior lecturer and clinical academic at the University of Sydney. He has provided some truth to cut through the over-hyped panic that surrounds herpes.

“The stigma of herpes is real and the stress is also real, but it is out of proportion to physical symptoms that it does cause.” Dr. Sawleshwarkar confirmed. 

Somehow knowing next to nothing about herpes is the norm, but it shouldn’t be. So let’s straighten some things out ASAP.

What Is Herpes?

Herpes is the colloquial term used to refer to the herpes simplex virus (HSV) type 1 and 2, though they belong to a wider family of herpes viruses which will not be discussed here. HSV-1 is responsible for cold sores but has been increasingly associated with genital herpes and HSV-2 is responsible for genital herpes, which can be passed on through skin-to-skin contact during sexual intercourse, so they are classified as sexually transmitted infections (STIs).

With both types of herpes simplex, once you have it you will always carry the virus. Although that doesn’t mean you always have physical symptoms. A lot of people with herpes will experience symptoms only once or never at all. HSV lives in your body and may occasionally cause outbreaks on the skin in the form of blisters or ulcers on the oral, genital and anal areas. 

Symptoms of genital herpes might include a tingling, itching sensation on the skin, small red ulcers or blisters around the genitals that may be painful, and potentially some flu-like symptoms (tiredness, fever, headache) in the first outbreak. 

The first herpes outbreak tends to be the most intense, and sometimes the only outbreak you ever experience.

“That’s a really common misconception that once you get herpes it will always keep on coming back.” Dr. Sawleshwarkar told GOAT on Thinking Between The Thighs. “It does come back in a significant number of people, but not everyone.”

There can be further complications from HSV, thought they are very rare. Complications are more likely for people who are pregnant or immunocompromised, and HSV and HIV have been shown to influence each other.

What’s The Difference Between Type 1 And Type 2?

There are a lot of false notions of a hierarchy of the herpes simplex viruses. But you can’t divide HSV into a ‘good type’ and ‘bad type’, as the physical reality and implications of both can overlap.

HSV-1 is mostly associated with oro-labial herpes, which can include symptoms we know as ‘cold sores’ around the mouth. A large proportion of us contract herpes type 1 in our childhood. HSV-2 is a sexually transmitted infection that causes genital herpes.

However, HSV-1 can actually appear as genital outbreaks, and an increasing number of genital herpes cases are caused by HSV-1. One person can get both herpes type 1 and type 2, though it’s very unlikely for outbreaks from the same type to appear in multiple places. Wherever the first outbreak of that herpes type occurs, you tend to not get it anywhere else.

So, for example, if you’ve had cold sores, you won’t get an HSV-1 outbreak on your genitals, but you could have an HSV-2 outbreak on your genitals. If you’ve never had cold sores, and you receive oral sex from a partner that has, you may be at risk of an HSV-1 genital outbreak. 

How Common Is Herpes?

Studies show that about 1 in 8 Australian adults carry herpes type 2 antibodies (which means they have been exposed to the virus), and around 75% carry herpes type 1 antibodies. Globally, the World Health Organization estimates that 67% of people under 50 have HSV-1, and 11% of people aged 15-49 have HSV-2. That’s billions of people with type 1, and hundreds of millions of people with type 2.

So the short version is that herpes is VERY common.

How Do You Know If You Have It?

A huge misconception is that you will absolutely know if you have herpes, because how could you miss that? Right? 

Wrong! The majority of people with HSV never experience any symptoms at all. That means that there are millions to billions of people who honestly do not know that they are carrying the herpes virus. 

Most people actually don’t show symptoms for months, or years, or at all, or they are so mild they go unrecognised. So knowing that you have herpes and pinning down exactly how and when you got it isn’t as easy as myth would have you believe. 

A sexual health check in Australia will currently screen you for chlamydia, as well as gonorrhoea, syphilis, HIV and a few others depending on whether you’re considered to be in an ‘at risk’ category. But there’s no screening for the herpes simplex viruses in a standard sexual health check. So, just because you have a check that comes back clean, that doesn’t necessarily mean you don’t carry the herpes virus.

The way that people tend to confirm a herpes diagnosis is by going to the doctor when experiencing some form of genital symptoms, and a swab test of those lesions will confirm whether it is HSV-1, HSV-2, or neither.

In the absence of symptoms, no other tests are generally recommended to verify your herpes status – including blood tests.

“[A blood test for herpes] might tell you the previous exposure to the virus, but it doesn’t tell you whether you are going to get symptoms because of this infection or not. Most people don’t. It does tell you that you are carrying a virus, and then it opens up the questions that we can’t really answer.” Dr. Sawleshwarkar told GOAT on Thinking Between The Thighs.

“The other challenge we have is that the tests are not phenomenally great. We don’t have an absolute, kind of, fantastic test that we’ll start recommending, saying it’s 100% that you have it or you don’t have it. So the tests are not that good yet, and so that’s why it’s not a routine recommendation to go and get checked for blood test.”

“If you have outbreak though, if you have ulcers and genital lesions, by all means you should go and see your physician or GP and get a swab for herpes.”

How Can You Avoid Transmission Of Herpes?

HSV-1 is mostly passed on through kissing and oral sex, though it’s also recommended to avoid sharing objects that have contact with saliva during an outbreak. HSV-2 is mostly transmitted during sex that involves contact with genital and anal surfaces – including skin, sores or fluids of someone who carries the virus. 

A common misconception is that herpes only spreads to other people if you’re having an outbreak. But people with no visible outbreaks, and people that don’t even know they have herpes, can still transmit it through something called ‘asymptomatic viral shedding’. 

Both herpes simplex viruses are more likely to be transmitted during an outbreak, so abstaining from sex and contact with active symptoms will reduce the chances of spreading to a partner. Some doctors prescribe antiviral medication, which can reduce the severity and frequency of symptoms, but cannot cure the infection. You can also use condoms to give yourself some protection from herpes transmission.

“It’s important to remember, condoms protect you not just from one STI but from most STIs.” Dr. Sawleshwarkar told GOAT on Thinking Between The Thighs. “So if you use a condom every time you have sex, especially when your herpes lesions are on the area covered by the condom, you are much less likely to either spread it to your partner or acquire it from your partner. And so condoms do work in that context. They’re not 100%, in most STIs they’re not 100%. But having said that if you use them every time you have sex, the chance of acquiring these STIs, including herpes, is reduced significantly.” He said.

What’s The Protocol On Dating With Herpes?

The stress caused by herpes has little to do with the physical symptoms, and a lot to do with the fear of rejection by potential partners. The worst part of HSV is the stigma. But we can help to dismantle that by being rational and informed, whether we are on the giving or receiving end of an “I have herpes” chat. 

If you have been diagnosed with genital herpes, the protocol is to tell a potential new sexual partner before engaging in any sexual activity that could risk transmission. Whether that’s a chat you have in person, on the phone or via text, telling people can be intimidating. But according to the wide world of herpes-positive people, the response from new partners is very rarely, if ever, the worst case scenario you might be imagining.

Telling someone you carry the herpes virus is something that could be discussed in the broader context of sexual health, which is ostensibly a chat we should be having with all potential sexual partners.

“Put it in the context of sexual health, saying ‘let’s talk about sexual health. I’ve had the check ups, have you had the check ups or not?’” advised Dr. Sawleshwarkar. “And then talking about it, so how important it is to have a good sexual health. And yes I’ve got this viral infection, yes it’s going to stay and potentially you may be infected if you don’t have it. And those are the sorts of things.”

As an alternative, there’s actually a huge world of dating sites and tinder-like apps specifically for people with herpes and other STIs. That can alleviate some of the pressure of dating with herpes, because everyone’s pretty much in the same boat. But ideally, there will be less of a demand for those isolated services as the stigma around herpes is dismantled.

Considering the actual numbers of people who have herpes, and especially the number of people who have herpes and have no idea, dating with herpes shouldn’t be such a big deal. That depends on us being informed, accepting, and letting go of what we thought we knew about herpes. 

So Why Are We So Afraid Of Herpes?

If herpes is so common, and so mild, where was the panic born?

Unfortunately, herpes has been used as a punchline in TV, movies and our general banter for a long time. It’s been the biggest joke of the STI family, used to both mark someone as ‘dirty’ and strip them of their sexual appeal.

If we had more thorough sexual education programmes in school, that kind of rampant misinformation would not be as successful. But as it stands, we are relatively clueless about herpes, likely until encountering it.

“The stigma is from two things.” Dr. Sawleshwarkar explained on Thinking Between The Thighs. “One is obviously it comes from sex, and that stigma is with every sexually transmitted infection…The additional stigma in herpes comes from the fact that you don’t have a cure…‘oh I’ll always carry this’ kind of stigma.”

When we think of herpes we often think of the worst possible picture, the stigma imprinted through pop culture, and a general sense of embarrassment. But those connotations are all derived from a lack of actual knowledge about herpes, and it’s our responsibility to change that.

Herpes is a common infection, a mild condition, and sometimes even a silent condition. So hold your judgment and try not to stress.

What Have We Learned?

That was a whole lot of information, so let’s just go over some of the most important takeaways.

  • Herpes is extremely common. Globally, the World Health Organization estimates that 67% of people under 50 have HSV-1, and 11% of people aged 15-49 have HSV-2.
  • Most people who have herpes don’t even know that they have it.
  • Herpes symptoms don’t always recur, or occur at all. The first outbreak is usually the worst, if you have an outbreak at all. 
  • Currently, there is no need for a test to check if you have herpes for most people unless you are showing symptoms.
  • Herpes can be transmitted when there is no visible outbreak, which is called ‘asymptomatic viral shedding’.
  • Herpes is not as big a deal as you think it is.