When we think of herpes, we often think immediately of the scary photos our health teachers showed us in sex ed. Or maybe it was a concerned parent who thought showing you pictures of scary sexually transmitted infections (STIs) would prevent you from having sex. However herpes was first brought to your attention, it almost certainly was under the notion that it is very bad, very infectious, and extremely scary.
The thing is, when you look at the herpes virus, it isn’t the virus itself that is scary, it’s the shame and stigma in which it is shrouded. Who wouldn’t be crazy terrified of having pus-filled sores all over their genitals, right?
Well, here’s the thing. For all the hoopla around it, herpes is straight up just a skin infection. Let’s get the facts straight, shall we? Herpes is caused by two types of viruses: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).
HSV-1 is typically the strain that presents as oral infections (aka: cold sores), while HSV-2 typically shows up as genital infections. But the real kicker is that you can have oral herpes caused by HSV-2 or genital herpes caused by HSV-1. If you’re exposed to HSV-1 on your genitals—that is, if someone with a cold sore were to give you oral sex, you could get HSV-1 on your genitals.
We’re scared of herpes because of the visual aspect. You can physically see the sores, and therefore it is something we can classify as scary. We’re always more afraid when something has tangible symptoms.
The shame is super exhausting and, frankly, dated and boring. One thing we haven’t mentioned yet is that even though this STI is extremely common and can be controlled, it isn’t on the list of STIs you’re tested for when you go to the doctor for a screening. Yes, that’s right. When you go in to get an STI panel, herpes will not be included.
As a certified sex educator, I can count on this fact to drop many a jaw when I’m getting extra evangelical with my sex education knowledge. We can’t end stigma around herpes without understanding it. This means knowing why it isn’t on a regular STI panel—and why that’s actually a good thing.
1. A Lot of People Have It Already
Sorry to be the one to tell you this, but a lot of people have herpes and just don’t know that they do. According to the World Health Organization, 67% of the population under the age of 50 has HSV-1. That’s 3.7 billion people, people!
Meanwhile, the Centers for Disease Control and Prevention (CDC) estimates, about one in six people between 14 and 49 years old in the U.S. currently has genital herpes. While we’ve been systematically trained to believe having herpes means being covered in sores for life, this is not the case for the vast majority of people. In fact, it’s estimated that up to 90% of people with HSV-2 are never diagnosed. They simply never wind up having an outbreak.
Something important to note is that even if you don’t have symptoms, you can still spread HSV. Herpes is most infectious during an active breakout (when sores are present), but it can still be spread when there are no sores—medically known as “shedding” the virus.
2. Condoms Won’t Necessarily Protect You From HSV
While condoms are extremely important and are the most effective form of STI prevention we have at this time, they won’t always stop the spread of herpes. Even the best forms of protection are fallible, to some degree. Now, this doesn’t mean it’s a free-for-all and we should stop using condoms. Don’t get it twisted.
According to the CDC: “Condoms can reduce your risk of getting genital herpes if used the right way every single time you have sex. But a condom protects only the area of the body that it covers. Areas the condom doesn’t cover can become infected.”
OK, so what does that mean? Well, condoms for penises will protect you from sores that appear on the shaft of the penis, but not from those that appear on the perineum, buttocks, or scrotum. Likewise, using barrier methods on vulvas (aka: putting latex over a vulva) will only protect the areas covered by the latex.
3. Testing for It Could Cause Mass Hysteria
Here is the tea: The reason herpes isn’t on a routine STI screen is because it not only isn’t a big deal, testing for it would be a mess. 90% of people who have HSV-2 don’t even know they have it and never will. Testing for it is widely considered unnecessary.
Unlike STIs like human papillomavirus (HPV), which are known to cause cervical cancer, herpes doesn’t cause life-threatening conditions. The only time this is not the case is when a woman is pregnant: “In some obstetrics practices, pregnant women are routinely screened as part of prenatal care to plan for possible preventive therapy later in the pregnancy to decrease the chance of maternal-fetal transmission,” says Madeline Y. Sutton, M.D., M.P.H., a board-certified OB/GYN, medical epidemiologist, and sexual health expert.
There is widespread consensus among doctors that testing for HSV is not a great idea. “When professionally recognized groups of scientists and doctors have met to review all available evidence regarding routinely screening for genital herpes (HSV-1 and HSV-2) in asymptomatic adolescents and adults, including pregnant women, they’ve found that the evidence isn’t strong enough to support routine screening,” explains Sutton.
Herpes is steeped in age-old stigma. Because we have an incredibly flawed sex ed system, people don’t have the facts they need to make informed decisions about STIs. All we’re told is that “herpes is bad” and if we have it we’ll become some kind of social pariah. “Given the detrimental effect the herpes diagnosis can have on a person, relying on an inaccurate test to diagnose a patient leads to confusion, mental health issues, and sometimes, no change in sexual behavior,” explains Sheila Loanzon, D.O., board-certified OB-GYN and author of Yes, I Have Herpes: A Gynecologist’s Perspective In and Out of the Stirrups. “It is best if there is a question regarding HSV to speak to your health care provider, who can identify the testing that would be best suited for the clinical situation.”
4. Current Methods for Testing Are Not That Great
As Loanzon mentioned, the testing we have for asymptomatic herpes (herpes without any sores present) is not great. Sutton says that testing for herpes regularly would cause undue stress on people and their relationships, when they may not even have the virus in the first place.
Kecia Gaither, M.D., M.P.H., FACOG, who is board-certified in OB-GYN and maternal fetal medicine and director of perinatal services at NYC Health + Hospitals/Lincoln, agrees, explaining, “Blood tests have a high rate of inaccuracy, [with] high false positive rates. This can cause unnecessary anxiety and disrupt relationships.”
Additionally, the test for the non-presenting herpes virus can tell you very little about the herpes you might actually have. “Serology, or blood testing, detects antibodies to the herpes virus. Unfortunately, it does not detect if the herpes virus present is HSV-1 or HSV-2 [or] its location (oral or genital) which is often what patients would like to know,” explains Loanzon.
5. Testing for Herpes on a Widespread Scale Probably Wouldn’t Curb the Spread
Nearly every medical health expert I spoke to agreed that testing for herpes likely wouldn’t do much to help curb the spread of the virus. “Given the complex nature of the virus (i.e., asymptomatic transmission, access to health care to get a genital culture, or fear of disclosing their positive status to their sexual partner), I don’t know if testing widely would curb the spread,” says Loanzon.
The only accurate test for herpes is a culture of an active sore or ulcer. So, if you don’t have active symptoms, you shouldn’t get tested. Herpes is spread by skin-to-skin contact. It’s highly contagious and simply not that big of a deal. Herpes-positive advocates like Loanzon are doing their best to help give people the information they need to protect themselves, but also to understand how common this virus really is. “Practice safe sex, have frank disclosures with your partner before engaging in sexual activity, and see a health care provider for further questions or concerns. If you do receive a positive herpes diagnosis, please know that you are not alone and there are many people who are thriving, love and are loved, and [are] living life with the virus successfully without missing anything in life,” she says.
Let’s end the stigma. Let’s fight for comprehensive sex education for all and stop scaring people with pictures of herpes sores. Stigma is tired—information is wired.