There’s quite a bit of misinformation when it comes to herpes.
Let’s clear some things up, shall we?
Myth: Herpes can only be transmitted during an active outbreak.
Herpes is much more contagious during an active outbreak, whether it’s a visible cold sore on the lip or one or more blisters around the pelvic region. But even in the absence of any visible or tangible signs and symptoms, herpes is still contagious.
Myth: Condoms reliably prevent the transmission of herpes.
This is perhaps the most common misconception I encounter among my teenage and college-attending patients. Condoms only reduce the transmission of HSV by 30-50%.
It’s still worth it to use condoms, as they do reduce the risk of spreading herpes – just not as much protection as many realize. Condoms also offer significant protection against gonorrhea, chlamydia, syphilis, HIV, and other sexually transmitted infections (STIs), as well as unwanted pregnancy.
If you have herpes type 2, it’s especially important to use condoms. People with HSV 2 are at a much greater risk of contracting HIV if exposed to it.
In addition to condoms, anti-viral therapy (drugs like acyclovir and valacyclovir) further reduce the risk of transmission by 48%.
Myth: HSV 1 only causes cold sores on the mouth, and HSV 2 only causes lesions on the genitals.
As the name implies, herpes simplex virus is a viral infection. Although it’s classified as a sexually transmitted infection (STI), oral herpes can also be spread through kissing or sharing eating utensils.
The two strains of HSV are type 1 and type 2. Although type 1 classically presents on the lips (in the form of cold sores) and type 2 on the sex organs, with the growing popularity of oral sex, either strain can be found in either location (and both strains can affect the same body part).
In other words, if you get cold sores and perform oral sex on your partner, you may be exposing her to genital herpes. Likewise, if you get genital herpes outbreaks and your partner pleasures you with his mouth, he may contract oral herpes.
Myth: If I have a fever and new lesion, that’s just a “fever blister.”
“Fever blister” is just another term for a herpetic lesion. An initial herpes outbreak is often accompanied by a fever and flu-like illness. If you have these symptoms, see your doctor. The sooner you get treated, the milder the outbreak will be, and the less likely you’ll have outbreaks in the future.
Myth: If I have a herpetic lesion on my thigh and I put a band-aid on it, I won’t spread it to my partner if we have sex.
Genital herpes affects the base of the nerves in the pelvis – known as the sacral ganglia. This is where the virus lives in those affected. For this reason, a herpes outbreak can occur anywhere in the “boxer shorts” region. No matter where the lesion is in this “neighborhood,” having sex during an outbreak – yes, even if it’s just one blister on your backside – increases your partner’s risk of contracting the virus.
Because herpes doesn’t always present itself on the genitalia, it’s sometimes misdiagnosed as herpes zoster (shingles), recurrent urinary tract infections, or unexplained vaginitis.
Myth: I went to Planned Parenthood for STI testing and asked them to test me for “everything.” They told me all my tests were normal, so I must not have herpes.
County health departments, Planned Parenthood, and most sexual health clinics do not test asymptomatic patients for herpes. These clinics typically only do herpes testing on patients with active outbreaks or on those with a high clinical likelihood of having the virus. Herpes testing is not part of the routine screening STI panel.
But why? It isn’t because they’re mean or negligent. Herpes testing is quite expensive to do on a routine basis. And many people have herpes, but will go through their entire lives without a single outbreak. As with any condition, being told you have herpes can be emotionally and psychologically disturbing, even if you never have a single outbreak – and thus some believe it does more harm than good to do the testing. For these reasons, you probably have not been tested for herpes if you’ve never had symptoms.
If you do get tested for herpes, be sure to ask your doctor to order the test to differentiate type 1 vs. type 2 – it is good to know which strain you have!
Myth: I can only get tested for herpes during an outbreak.
There are two common herpes tests: one is a blood test, which can be done whether or not a lesion is present. The other test is a viral culture, which entails using a special swab to rigorously rub the lesion, pop it open, collect the fluid inside, and assess the contents. So while the blood test can tell you whether or not you have herpes, it cannot tell you if the blister on your thigh is specifically caused by herpes, shingles, or something else entirely. Only a swab can do that, and because the swab sample is collected from a lesion, the swab test can only be performed when one or more blisters are present and fluid-filled. If you’ve already had a lesion swabbed and diagnosed as herpes before, then the only reason to do the blood test would be to determine if it’s herpes I or II that you have. (If you don’t have access to a healthcare provider who will order tests for you, scroll to the end of this post for information on how to order it for yourself.)
Myth: I had a mild herpes outbreak 10 years ago, with no symptoms or outbreaks since. I must have cleared the virus.
Unfortunately, herpes is a permanent viral infection. HSV is still there, and is still unfortunately contagious. That being said, working with an integrative physician to support the immune system will help reduce the frequency and severity of outbreaks.
Myth: If I have herpes, my sex life is over.
Not at all! It’s important to talk to your sexual partners about your status and discuss the methods you’ll use to reduce risk of transmission. It may be an uncomfortable topic to broach, but your partners will thank you for it. (Besides, they quite possibly already have HSV and don’t know how to bring it up.)
Including your healthcare provider can be helpful; I encourage patients to bring their partner to an office visit so we can answer everyone’s questions at once and come up with a practical, medically sound game plan.
Getting tested for HSV 1 and HSV 2 will also tell you which strain you have, which may come in handy when taking precautions with future partners.
Myth: If I have herpes, I can’t ever have babies.
Although it can be dangerous for a woman to deliver a child vaginally during an active outbreak, precautions can be taken to reduce the chances of an outbreak during delivery, and medications can also be prescribed. Absolute worst-case scenario is that a C-section would be performed if a woman went into labor during when she had an active herpes outbreak. But women with herpes can absolutely still have healthy babies.
Myth: I’m in this alone.
Getting diagnosed with herpes can be psychologically and emotionally intense. It takes some time to adjust to the news. Thankfully, studies show almost everyone adjusts to having herpes around 6 months after being diagnosed. If you’re angry, sad, ashamed, or in shock: hang in there. It can also help to talk to somebody, whether it’s a friend or a medical professional.
If you have herpes, you are not alone. It’s estimated that 56% of Americans have HSV 1 and 30% of women in their 30’s have HSV 2! Herpes is common. The more we talk about it, the more we learn. And the more we learn, the better we can protect others and ourselves.
Many thanks to Terri Warren, NP, who gave an excellent grand rounds presentation on this topic in October of 2011 at the National College of Natural Medicine, Portland, Ore. Much of the information and all of the statistics in this entry come from her lecture.
Have You Been Tested for Herpes?
Shop now for direct-to-consumer laboratory tests.*
This is a blood test that can be performed whether or not a current outbreak is occurring. This test can help those who have never had an outbreak know definitively whether or not they have the virus. This test can also help those with herpes learn whether they have Type I or Type II. BUY NOW
This test may help determine whether the fluid-filled “bump” currently on your body is herpes. This is not a blood draw, but a test performed during an active outbreak by opening up one of the blisters and sampling the fluid within. BUY NOW
Only order this test if you have a healthcare provider who has the appropriate swab collection kit and is willing to help collect the test sample. Note this test can only be performed on an active lesion, so time is of the essence.
This is a rather extensive panel that screens both the blood and the urine for sexually transmitted infections (STIs), including herpes. BUY NOW