How Do You Prevent Spreading Herpes?

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In this week's Sex IDK column, Emma McGowan, certified sex educator and writer, answers your questions about how to prevent the spread of herpes simplex virus (HSV).

Q: How do you prevent spreading HSV?

I'm so glad you asked! Herpes is a really common — and really misunderstood — infection. While it's always important to take care of our own sexual health and that of our partners, the big question here has to do more with preventing the stigma — since so many people already have HSV.

The herpes simplex virus (HSV) is a super common virus that can sometimes cause a skin rash. It’s not curable, but it's extremely treatable. HSV comes in two forms: HSV-1 and HSV-2. Because it likes to hang out in the cells behind the cheek, HSV-1 most commonly shows symptoms around the mouth, if it shows symptoms at all. (It can also spread to the genitals, usually through oral sex with a person who is having an outbreak.) When people do have symptoms, it shows up as patches of broken skin, usually around the mouth, called “cold sores.” According to the Center for Disease Control (CDC), just under half of all Americans have HSV-1.

HSV-2, on the other hand, likes to live in the nerve roots at the base of the spine, which is the only real difference between HSV-1 and HSV-2. So when people have symptoms of HSV-2, it’s usually in the genital area. It’s what we generally call “genital herpes” and the CDC estimates that a little under 12% of Americans have it.

Most people don’t show any symptoms of HSV-1 or HSV-2 at all — or the symptoms are so minor that they mistake them for something else. As a result, it’s really, really easy to spread HSV. After all, how can you take precautions around spreading an infection that you don’t even know that you have?

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But if you do know you have HSV — like you’ve had a rash and had it tested and the doctor was like, yup, that’s herpes — then there are certainly steps you can take to prevent spreading it.

First: If you have an active rash — meaning sores on your mouth or in your genital area — hold off on intimate contact until they’re gone. That means no kissing, rubbing, penetration — nada. The virus is highly contagious when those sores are visible, so just masturbate for a while if you don’t want to spread it. (Be sure to wash your hands and/or toys afterward — if you touch a sore and then touch someone else, you can spread the virus from your hands.) You can also get a prescription from your doctor for an antiviral medication that can be taken at the first sign of a rash or sore, in order to reduce the length of your symptoms by a couple of days.

If you want to greatly reduce the likelihood that you’ll have any symptoms at all — and reduce the likelihood that you can spread the virus during “subclinical shedding,” which is when you’re contagious even though you don’t have any symptoms — those same medications can be taken continuously, in what’s called “suppressive therapy.” According to the American Sexual Health Association, suppressive therapy has been shown to reduce the number of outbreaks a person has by 75% and to reduce subclinical shedding by 94%.

Finally, barrier methods — like condoms and dental dams — provide some protection from spreading HSV. People with vulvas are less likely to get the infection from a partner who is carrying it if they use condoms during intercourse. But people with penises aren’t offered any extra protection from using condoms, according to the Guttmacher Institute.

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Being careful about your health and the health of those around you is always the right thing to do, but I need to insert a word of caution here. Herpes is perhaps the most over-exaggerated viral infection that humans share with each other. And, fortunately, the reality of carrying the virus very rarely lives up to the hype.

As I mentioned earlier, most people who have the virus don’t even know that they’re carrying it, because it has no effect on their health. Literally none! No sores; no pain; no itching; no rash; nothing. Of course, that’s not the case for everyone, and people with suppressed immune symptoms are particularly prone to more serious symptoms such as sores and rashes that are very painful and itchy. But it’s generally true that herpes is a very minor irritant at worst for the majority of people who have it.

So why does HSV have the reputation that it does? According to Slate, our over-dramatic and not-science-based response to the herpes simplex virus is rooted in the cultural backlash to the “free love” movement of the 1960s.

“In the period in between the discovery of penicillin (which cured chlamydia, gonorrhea, and syphilis) and the first reported cases of HIV/AIDS in 1981, Americans had no reason to think they were at much risk from casual sex — but they were deeply ambivalent about the idea of having multiple sex partners for fun,” author L.V. Anderson writes. “An incurable, easy-to-spread sexually transmitted infection that (sometimes) produced visible marks on the body and (very rarely) killed babies really did feel to some people like divine punishment for having sex.”

Anderson’s article describes a sort of hysterical back and forth between the public and the media that started in the 1970s and continues through to today. Headlines that referred to herpes as “sexual leprosy” and a made-for-TV movie with the title Intimate Agony about a town where everyone has herpes are just the tip of the herpes scare history that Anderson uncovers. It wasn’t until the AIDs epidemic in the late ‘80s and early ‘90s that herpes stopped being the primary "sexual boogeyman" and people started focusing on a virus that did actual harm.

But, unfortunately, so much of that stigma still persists today. While the headlines are generally less alarmist than in decades past, and herpes activists now speak out about the reality of living with the virus, many people still think herpes is a terrifying illness that’s going to make their genitals fall off. Preventing the spread is important, but so is preventing the stigma. While you’re working on spreading the virus, why not also spread the truth about what it is — and what it isn’t? Because herpes simplex virus isn’t going anywhere. But the stigma certainly should.

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