What do you know about genital herpes? Would you run a mile if a potential partner disclosed that they had it, afraid that you'd open yourself up to painful symptoms? Slow down. Genital herpes has quite a lot of myths attached to it, many of which are not founded on accurate science. It's also phenomenally widespread: herpes simplex 2, the herpes virus predominantly defined as "genital," currently infects around 1 in 6 of all American adults between 14 and 49 — and many of them have no idea. That's the thing about genital herpes: it's not as obvious as you might think it is.
Here are a few basic facts about herpes in general to get us started: It's spread almost exclusively by skin-to-skin contact (no, you cannot contract it from a toilet seat), though in isolated cases it can be spread by sex toys if they're being used by both partners in quick succession; herpes virus cells can't actually survive for very long in the air. It generally spreads through the moist mucus membranes of the mouth or the genital-anal area, but it can very occasionally spread through breaks in non-mucus skin; don't give a hand job to somebody showing herpes symptoms, for instance, if you have an open cut on your hand. HSV-2, as it's called, has its own special features, though: for one, it has a unique effect on pregnancies.
If you yourself contract genital herpes, or if a partner has it, don't panic and get on a ship to Madagascar; it's an extremely common disease, and antiviral medications and good use of sexual protection can reduce the risk of transferral almost entirely. Here are nine facts to know about genital herpes.
1. There Are Two Types, Both Of Which Can Be "Genital"
Technically speaking, there are two types of herpes simplex virus: herpes simplex 1, and herpes simplex 2. They're distinguished by their most common areas of infection: HSV-1, as it's called, is mostly oral (around the mouth), giving you blisters ("cold sores") on your gums, lips, throat, or mouth surface in general, while HSV-2 is almost exclusively genital, showing those symptoms around the genitals, bottom, or tops of the thighs.
2. Oral Herpes Can Be Transmitted To The Genitals
There's something key to know, though: the World Health Organization explains that HSV-1 can actually be transmitted to the genitals. This is why you should never give anybody unprotected oral sex while you're suffering from a cold sore, as HSV-1 can actually transfer to the skin of the genitalia. This is more common than you might think; statistics estimate that between 30 and 50 percent of all herpes signs on the genitals are actually due to HSV-1. HSV-1 can be transmitted from the mouth to the genitals at any point where you're experiencing symptoms (a blister or tingling), and at a rate of around five percent the rest of the time. (We'll discover later why transferral from genitals to mouth isn't as straightforward.)
3. ... But It's Unlikely Genital Herpes Will Spread To The Mouth
This is an interesting one: we know that HSV-1 can be transferred from its normal home (mouth) to the genitals via oral sex, but at the moment, science seems to indicate that the return journey — HSV-2 going from the genitals to the mouth — is actually extremely rare. "[Genital] herpes transmission to the mouth is uncommon," comments the New Zealand Herpes Foundation; but to understand why, we need to look at the science.
According to a study in the Scandinavian Journal of Infectious Diseases Supplement back in 1990, almost 100 percent of HSV-2 occurs in the genitals. Part of the reason may be that many people also have HSV-1 from childhood; Dr. Peter Leone at the New York Times says that having HSV-1 "offers only partial immunity" to HSV-2. We're not entirely sure how much, but that might be enough to make oral transmission very rare. But here's the thing: a study in 2004 found that viral "reactivation" of HSV-2 in the mouth (reactivation means shedding) was very, very rare, showing up in about 0.08 percent of patients. So you may get HSV-2 in your mouth, but you're very unlikely to show symptoms or spread it anywhere else.
4. Infection Is Possible Even When There Are No Symptoms
Big lesson about genital herpes: many carriers have no idea they've got it, as it's often largely asymptomatic and flare-ups can be rare or non-existent. There's the distinct possibility, though, that you can actually catch genital herpes from the skin surface of a sufferer at certain times, even if they're not showing any overt symptoms (like blisters or flu-like symptoms). HSV-1 and HSV-2 exist long-term in the body's nerve cells, without providing any exterior symptoms; but every so often they travel to the skin's surface to "shed," and this can either produce symptoms or not. If it doesn't, it's called "asymptomatic shedding," and means that the virus cells are present on the skin even when there's no other symptoms, no tingling, no nothing. I know, it's very unhelpful.
But the Herpes Viruses Association has a few points that make things look better. For one, asymptomatic shedding seems to decline with time; and for another, it's infrequent in people who have very rare shows of symptoms. Also, these are the only situations in which HSV carriers are infectious, and generally they're only shedding (visibly or not) around 10 percent of the time. WedMD also points out that it takes a certain level of virus to be present on the skin for a partner to become infected. So if you've got genital herpes, don't view your body as a bomb perpetually about to go off in your partner's face (or underpants).
5. The First Outbreak Is Usually The Worst
Here's an intriguing fact: not all cases of genital herpes are recurring. The Center for Disease Control points out that a whopping 87.4 percent of all people with HSV-1 or HSV-2 show no symptoms at all, and that while it's more common to have herpes that keeps coming back if you've got HSV-2, it's by no means guaranteed. And they also explain something pretty comforting about recurrent cases of genital herpes: they get a lot easier after the first occurrence. Your first bout of symptoms, if you get any, will likely be kind of unpleasant, with more likelihood of headaches, flu-like sensations, and lesions and cold sores that take longer to heal. From there, you may never get another bout, or you'll encounter another recurrence, but it will likely be much less severe.
6. It Doesn't Affect Fertility, But Can Impact Pregnancies
There's no evidence at all that genital herpes can cause any impediment to fertility in either men or women; if you do have it, you can conceive just as easily as you would otherwise. You're also not particularly at risk if you had HSV-2 before you actually got pregnant, as the National Health Service explains, because your body will still be capable of transferring the relevant antibodies to the fetus to protect it during the last trimester. (You may still need to take antiviral medications, though.)
It's catching the HSV-2 virus while you're pregnant, particularly later in the pregnancy, that might cause issues; it's very rare that herpes is passed on to fetuses, but it's more likely if the mother contracts it within the third trimester.
7. Outbreaks Seem To Reduce As You Age
We're not entirely sure why this is, but it seems that reactivation (the prompting of the virus to cause symptoms and come up to the skin to "shed") becomes rarer as we get older. Both HSV-1 and HSV-2 can spend years in "latency," basically hanging around dormant in our nerves doing absolutely nothing. Then they flare up again and cause an outbreak. We're only just understanding what prompts flare-ups, but new research in 2012 revealed that outbreaks are likely tied to immune systems becoming "distracted" by other things, like other viruses. (This is probably why high stress levels are linked to herpes outbreaks, as stress can depress the immune system.)
Perhaps our immune systems get more used to the HSV-2 system over time; we're just not sure. A 2011 study in the Journal of Infectious Diseases, though, pointed out that while rates of shedding decrease over the course of ten years after your first HSV-2 infection, they still exist, so you can't get to a decade (or two) and imagine that you no longer need to warn sexual partners.
8. "Passing Back And Forth" Is Not A Thing
As myths go, the capacity of the human body to "pass herpes back and forth" like a tennis ball is a pretty weird one. And it's not true. If you and your partner both have HSV-2, you don't need to continue to have protected sex so that you avoid "passing" it; you can't make HSV-2 worse by repeated exposure to it, and it's very rare to catch it again in another part of the body. If you're monogamous, the British Association for Sexual Health and HIV assures us, there's no reason for two HSV-2 partners to stay protected against transferral, though you still need to be wary of other STDs and pregnancy.
9. There's No Cure — But There Is Treatment
If you do have HSV-2, it's common for treatment to be maintenance-based, as there is currently no cure. Depending on the frequency of your flare-ups, your doctor will prescribe you antivirals either on an intermittent basis (taken whenever you start noticing itchiness or sores), or on a suppressive basis, where you take them daily. Suppressive therapy can often mean no outbreaks at all, and radically reduces the risk of spreading the virus to a sexual partner, but it's still recommended that all sexual encounters involve condoms or dental dams.
And of course, if you find you do have genital herpes, disclosure isn't necessarily easy — but it is always necessary. Here's how to do it.
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