Herpes Simplex Virus (HSV) is one of the most feared and least understood sexually transmitted infections (STIs). The infection itself is uncomfortable, but manageable. The real problem with HSV, however, is the shame that surrounds it. The social stigma associated with HSV causes more harm than the infection itself. The fear of being rejected, and thought of as “dirty” or “slutty,” by possible sexual partners has caused many sufferers to be depressed, anxious and isolated.
In reality, HSV is the ugly cousin of Herpes Zoster (Shingles), otherwise known as Chickenpox, and it can cause sores on your mouth or genitals. Shingles/Chickenpox and HSV are both Herpes viruses. Once you have been exposed to a virus, whether you get the illness or not, you will ALWAYS have that virus inside of you. Yes, every cold and flu virus you have ever had still is inside of you. Your body builds up its defenses against it, which are called antibodies, and as long as your immune system is strong, these antibodies work to prevent the illness from happening. The difference is that unlike the flu and cold virus, HSV hangs out (latency) and can take it’s time to become active. HSV exists in two forms: Type 1 which occurs mainly on the mouth but can spread to the genitals, and Type 2 which occurs on the genitals. But sometimes, these antibodies are not strong enough, especially if your immune system is weakened by illness, stress, chemotherapy or an immune deficiency such as HIV. When this occurs, Herpes Simplex can express itself with flu-like symptoms, burning pain in the mouth if one has HSV 1, or genitals with HSV 2. It can also occur outside of mucous membranes, affecting buttocks, fingers, and face. The pain and flu-like illness then progresses to a lesion that is painful and becomes a blister. During this whole period, the virus is shedding and contagious. Once the lesion scabs over and dries, then virus is basically in remission. With people who break out, these incidents can occur 1-2 times year or less. Many people only have it once in their lifetime. There are medications available called “anti-virals” that help suppress the virus from being active. You need to take them on a daily basis for them to work that way. These same medications are used during a Shingles infection and HSV infection to shorten the life of the illness if caught early on. Most people know when they have an outbreak and do not have sexual contact during an outbreak, yet feel contagious all the time. The problem is that sometimes shedding can happen without the illness. Some people may never have an outbreak, yet may have the been exposed to the virus. The natural course of the infection show a relatively short asymptomatic period (studies suggest that up to 85% of asymptomatic individuals diagnosed with HSV-2 become symptomatic within 6 months of testing). Use of antivirals during this asymptomatic period may not change the course of transmission and disease, but more studies may need to be done to confirm that. Genital HSV infection affects about 15.5% of the US population between ages 14 to 49 years (about one in six people), according to estimates from the Centers for Disease Control and Prevention (CDC) . In the general population, 20% of women and 11.5% of men are infected. More women are infected because of the increase in mucosal surface which the virus lives on. Among single women between the ages of 45-50 the prevalence rate is a whopping 50 to 70% Asymptomatic transmission may be the central way herpes is spread since most people are not having sex while they have genital pain and an open lesion. Even if you have never actually had a lesion, you can “shed” the virus without knowing it. HSV does not need intercourse to spread; mere skin to skin contact is enough. So even if you use a condom, and have never had an outbreak, you can be transmitting herpes. It can lie dormant for years and then come out in a monogamous relationship. And yet, HSV-1 (which practically everyone has been exposed to) and HSV-2 antibodies are not routinely tested for. It is no longer recommend that antibody testing be done due to high false positives and unclear benefit of treatment with anti-virals. It is only recommended routinely for people who are HIV positive. The USPSTF concludes with “moderate certainty” that the harms outweigh the benefits of screening for genital HSV infection in asymptomatic adolescents and adults, including pregnant women. How this pertains to high risk populations such as sex workers and nonmonogamous people, is yet to be determined For far too long, the stigma of having this virus (that may occur only once in one’s life) has created a disproportionate and unnecessary amount of shame and stress. If we are better able to face the fact that many more people are already positive, that it is not life altering (except in people with HIV or who are immune-suppressed), and that the outbreaks can be managed by anti-viral medication, maybe we can overcome the fears surrounding this virus. It is an infection, much like other viral infections, which lies within us forever, but the name and fear permeate the lives of those living with it far more than it should. By spreading the word that HSV is only one of the many things life exposes us to, you can help to stop spreading the shame.