Last Updated on June 4, 2020 by Shuvani Sanyal, MD
If genital herpes is usually so minor, should we even test for it?
This is a debate that I often have with my colleagues. The medical community does not agree on the answer to this question. If someone has a painful genital sore, we all agree that testing is appropriate. It also makes sense if someone reports periodic genital sores to confirm the diagnosis, so a person can talk to their current or future partners about safer sex.
But, if we’re instructing everyone to practice safer sex (condoms, regular STD testing, limiting the number of partners and practicing monogamy), is herpes testing really important? I believe people should know their herpes status, but I respect that there are other opinions.
We know that if a person has genital herpes, they are at greater risk of acquiring HIV (and other STDs), if exposed – particularly during an outbreak. We also know that if a person and their partner are aware of their herpes status, they can delay the time until the uninfected partner becomes infected. In other words, now that Susan is aware that her periodic genital sores are from herpes, she can avoid sex at the first sign of discomfort, and can be more diligent with condom use, thereby protecting her partner and lowering his chances of getting genital herpes.
So, just how contagious is genital herpes?
That’s a common question. I explained to Susan that if she has regular, unprotected sex with her partner over the course of a year, and avoids sex at any hint of an outbreak, the risk of her spreading genital herpes to that partner is around 4%. Let me repeat that. The risk of Susan spreading genital herpes during a year of regular unprotected sex is 4%. Now let’s say it’s a man who is infected and his female partner doesn’t have herpes. In that case, in a year of unprotected sex, the risk of spreading herpes to the woman is 10%.
People are often relieved to know that it’s common to not spread herpes to others, especially when condoms are used.
The risk of herpes transmission can be reduced by at least half with regular use of condoms. This is important, because we believe that most herpes is spread between outbreaks. If your partner has a genital sore, you’re both going to know to avoid sex. If, however, your partner isn’t having an outbreak, you may not realize that the virus can still be spread.
The moral here? Although the numbers are reassuring, and not everyone with an infected partner will get herpes, using condoms is smart and recommended.
What about treatment or management of herpes?
Well, there are lots of options for management, but herpes cannot be cured. Let’s go back to Susan and find out what she did for management of her herpes. In her case, Susan wasn’t actively dating anyone at the time she was diagnosed with genital herpes. Given that, medication to treat her herpes was optional. I asked her if the occasional symptoms she had were bothersome enough that she’d want to take medication when it flared up, and she said no. With that in mind, she didn’t take a prescription for treatment, but I reminded her that when she did become sexually active again, she would need to inform her partner, her partner should be tested (remember, 90% of people with herpes don’t know they have it), she should use condoms, and she should consider prescription options to lower the risk of transmission.
About six months later, I got an email from Susan asking about how to protect her partner. She had been dating someone, and they had ‘the big talk.’ Susan told him about her diagnosis of genital herpes, and like most of my readers, she had the good fortune to be with someone who was understanding and supportive. It wasn’t a deal breaker, in other words.
He was going to get a type-specific herpes antibody test to see if he was positive, but in the meantime, they wanted to know their safer sex options, in addition to condom use. I told her that taking daily antiviral medication to suppress the herpes virus can further reduce the risk of transmission.
Ultimately, Susan and her partner decided to practice safer sex with condoms, and to avoid sex during any hint of an outbreak. She didn’t elect to take daily medication, as the risk of transmission was very low with condom use. Her partner understood that there was still some risk of transmission, and he was willing to take that risk. Two years later, they’re still together, and things are going well.
Susan’s experience is not unusual.
She found something that I’ve heard echoed by other readers. When you start a relationship dealing with a serious topic like an STD, it actually separates the wheat from the chaff. She wouldn’t have had ‘the talk’ with someone unless she was fairly confident that he would be thoughtful and respectful of her. She was also less likely to hop in bed on the first date, not knowing if it would turn into a relationship.
Susan found that she gained insight into her partner’s character by the respectful way he educated himself before making a commitment to be her partner and to sleep together in a responsible way. All in all, while Susan wasn’t happy about her diagnosis of genital herpes, it paved the way for a more solid relationship.
Now what about you? Have you been tested? Do you talk about STDs and condom use with a partner before getting into an intimate situation? In this day and age, it makes sense to be smart about your sexual health and to be ‘planful’ when dating.
Herpes is definitely not the Scarlet Letter H, but it is something to test for, something to talk about, and most importantly, you don’t need to run if you meet someone fantastic who tells you that he or she has genital herpes.
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Are you living with herpes and frustrated by all of the fear, stigma, and overreaction? Did this article change your perspective about someone you know with HSV or about your own infection? Share your thoughts in the comments section below!