Last year, in my Anatomy & Physiology class, the subject of herpes came up, which launched a few people into mini-tirades laced with judgmental language, describing it as “disgusting” and “gross.” My classmates might have been more sensitive, as statistically speaking, there were probably several people in that very room who were living with herpes. Given that most of my fellow students were pursuing careers in the health-care field, it was especially disheartening. Yet despite being relatively widespread, herpes is often stigmatized and misunderstood.
Herpes is caused by herpes simplex virus (HSV), which comes in two strains: HSV-1 and HSV-2. HSV-1 is most often associated with oral herpes, while HSV-2 is most often associated with genital herpes, though by no means is this association exclusive. For example, HSV-1 can cause genital herpes when the site of infection is the genitals. It is estimated that only 10 to 15 percent of those with herpes exhibit symptoms, and that millions of people unknowingly carry the virus. After infection, the virus enters a latent state in nerve cells, where it will remain for the rest of the host’s life — the same is true for other viruses in the Herpesviridae family, such as the virus that causes chickenpox.
Oral herpes is incredibly common — about 60 to 90 percent of U.S. adults have been infected with HSV-1, and most of them caught it as infants or children through nonsexual transmission. HSV causing oral herpes remains latent in the trigeminal nerve ganglia in the face. Cold sores, which appear on the outer margin of the lips, appear when the virus has been activated and it moves along the pathway of nerves from the ganglia to the surface of the skin. They can be triggered by sunburn, stress, or even menstruation.
Genital herpes is also common. According to the CDC, about 1 out of 6 people between the ages of 14 to 49 has genital HSV-2 infection; other sources give numbers as high as 1 in 4 Americans over the age of 30. Additionally, genital HSV-1 infections, often acquired via oral-genital contact, are increasingly common and account for half of the cases of genital herpes in the United States. Although it is common not to exhibit any symptoms, a clue that one may have been infected is a cluster of sores in the genital region. During the first outbreak, which usually occurs within two to 20 days after exposure (but can sometimes take years), symptoms can include swollen lymph nodes, chills, and a flu-like feeling. This initial outbreak can take two to four weeks to subside. Symptoms of subsequent outbreaks might include a burning sensation if the sores come in contact with urine, as well as itching and pain. Flare-ups usually subside in 10 to 14 days. HSV causing genital herpes remains latent in the sacral nerve ganglia, which is found near the base of the spine. As with oral herpes, when an outbreak is triggered the virus will move from the ganglia to the skin’s surface, where it manifests as sores.
Herpes can be transmitted by skin-to-skin contact inherent to most sexual activities, as well as through kissing and touching. Rarely, it can be transmitted from mother to infant during vaginal childbirth. Anyone experiencing a herpes outbreak should abstain from sex — even with a barrier such as a condom — until the outbreak has subsided. If you have a cold sore on your mouth, abstain from kissing or performing oral sex. If you or your sexual partner are infected with herpes, avoid contact with the sores and wash with soap and water if you do come in contact with them. Between outbreaks, barrier methods should be used during any sexual activity to reduce risk of transmission.
Herpes cannot be cured, but it can be treated with medications that can shorten or prevent outbreaks and reduce risk of transmission. People infected with herpes are able to lead normal lives, but must be more careful about practicing safer-sex methods because having herpes doubles the risk of contracting HIV, and to prevent transmission to a sexual partner.
You can find more information about herpes at Planned Parenthood’s website. If you are concerned that you might have herpes, you can get tested at a Planned Parenthood health center, as well as other clinics, private health-care providers, and health departments. The test for herpes involves a physical exam and either a blood test (if one is asymptomatic) or a test of fluid taken from a suspected herpes sore.
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Anna, thanks for the informative post – you always do a great job of making technical info more accessible.
I thought it was interesting that menstruation can trigger a herpes outbreak. Thanks for all the little tidbits – I’m sure these will come in handy at the next sex ed trivia night! 🙂
Thank you so much, Serena, that is a huge compliment!
Hey – I just wanted to point out a couple things, from the perspective of someone with herpes.
First, you concentrate mostly on the experience of people who regularly get outbreaks. A huge percentage of people don’t, and don’t have adequate awareness of what that means for transmission and safer sex practices. Indeed, the medical industrial complex doesn’t really have any good answers around transmission rates for people who are asymptomatic. Basically, barrier methods that prevent skin-to-skin are recommended in most cases, but herpes can still be transmitted without actually having penetrative sex, so it’s a bit of a gray area.
Also, you said that “people infected with herpes are able to lead normal lives.” I find the use of “normal life” to be….really judgey and arbitrary here. What’s a normal life?
Hi Katie, thanks for your comments.
I pointed out upfront, in the second paragraph, that the majority of people with herpes are asymptomatic and therefore could be unknowingly infected. There’s not much more to say than that, other than to stress the importance of getting regularly screened for STIs and to make it known that the virus can still be shed regardless of whether or not someone is having an outbreak. I said that barrier methods need to be used regardless of whether or not someone is having an outbreak, and I didn’t limit this discussion to penetrative sex — though I could have more explicitly stated that by “sexual activity” I was talking about sexual activity as a whole, not just penetration. Maybe these are points that bear repeating, since (1) so many people associate herpes with the outbreaks, (2) so many people are unaware that herpes can be shed at any time, and (3) so many people associate “sex” with penetration. But I did cover all of these points; perhaps I could have really hammered it home through repetition.
Your point about the language of “normal lives” is taken. I was not 100 percent happy with it either, but even though it nagged at me a little I obviously wasn’t bothered enough to reword it. My thinking behind including that statement was that I wanted to help destigmatize herpes. Not that I think any STI should be stigmatized, but the more I learn about herpes the more surprised I am by how heavily stigmatized it is. I wanted to express that a herpes infection is not the end of the world for anyone diagnosed with it. “Normal” was a shorthand for that (I guess “not the end of the world” is also shorthand) — though I do agree with you that the whole concept of normalcy is problematic. I also understand how you can see my use of it as “judgey,” even though I don’t agree that I was coming at it with judgmental intentions.
Thanks for this! Even in online sexual health communities that I frequent (which, I’d guess, are more knowledgeable and more accepting than is the general population), there tends to be increased misinformation and fear surrounding HSV. (And yeah, I think that misinformation is a direct contributor to fear.) It’s good to have a source that succinctly lays out some facts.
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