Last Updated on June 4, 2020 by Shuvani Sanyal, MD
Let’s talk about Susan. She is a 38 year old professional female – single, dating, fit, goes out a lot with friends on the weekend. Susan is a hard-working, terrific woman who seems to have mapped out a great life for herself. Susan is also what I would consider a ‘serial monogamist.’ She dates a bit, meets someone who seems like a good fit, and maybe that relationship will last 6 months, a year, or a couple of years, but she has never been married or had a relationship that lasts more than a few years.
A few years ago, during a routine pap smear, Susan mentioned that she had occasional discomfort on her vagina, which she attributed to her underwear rubbing against her when she exercised. It would sometimes get a little raw, but would heal up within a week or so, without any specific treatment. It only happened a few times a year; so, she said she wouldn’t have mentioned it if they hadn’t asked about genital sores during her exam. They decided to perform a herpes blood test. Her results on a type-specific herpes antibody test were positive. They asked her to come in the next time she had a sore spot and she did. A culture confirmed that the sores were caused by the type 2 herpes virus they had found via her blood work.
So, what does that mean?
According to the Centers for Disease Control and Prevention, approximately 776,000 new genital herpes infections occur annually. About one out of every six people ages 14 – 49 has genital type 2 herpes. That’s 16% of us. If you also account for all of the many people who have genital type 1 herpes infections, there are a lot of people living with genital herpes infections.
What’s the big deal about herpes?
It turns out that, medically speaking, genital herpes isn’t usually a big deal at all. No one wants to have it, but at the same time, it is typically more of an inconvenience and a social nuisance than a serious medical problem. The social stigma, however, is something we should not underestimate. In my experience, I find that people truly fear a herpes diagnosis. It is the Scarlet Letter H. Surprisingly, even a new diagnosis of HIV often doesn’t result in as much panic as a new diagnosis of genital herpes.
When people find out they have genital herpes, they often have a lot of questions about who gave it to them and how long they’ve had it. This is where I regularly need to talk people down. A new diagnosis of herpes does not necessary mean a new infection. Like Susan, many people have genital herpes for years – or even decades – with mild or unrecognized symptoms. In fact, many people don’t have symptoms at all. I like to explain to people that their current or most recent partner may not be the person from whom they contracted (caught) herpes.
Commonly, people get angry and assume a partner is cheating, and relationships end. Of course, you have to have a serious talk and confirm that your partner is monogamous, but if you believe your partner is loyal, you also have to consider that you or your partner might have had herpes for 5 years, 10 years, even 20 years without any awareness of the infection.
How can someone be infected for years without knowing it?
Most people with genital herpes don’t have any symptoms. Those who do have symptoms will frequently find the symptoms to be so mild that they can be attributed to something unrelated to an STD. People explain minor symptoms away, believing they may be due to rubbing during vigorous exercise, underwear or clothes that scratch against the genitals, a zipper injury in men, rough or vigorous sex, and so on. I have heard all of these explanations and more.
As many as 90% of people with genital herpes aren’t aware of their infection, which is how people can spread it unknowingly.
Is genital herpes always so mild?
Well, no, not always. Sometimes genital herpes can be painful or very uncomfortable; so, I don’t want to minimize it for those who suffer more severe symptoms. Herpes symptoms do not typically present this way, however.
When someone has a first outbreak of herpes, symptoms can be severe and may include fever, body aches, swollen glands, a discharge (women), burning with urination, a painful open sore, and so on. Primary, or first outbreaks, are the worst outbreaks and they tend to get milder over time. Fortunately, a severe first outbreak presentation is not the norm. Again, most people don’t even recognize their first outbreak as herpes and don’t see a doctor for a test.
For some, only one herpes outbreak is ever recognized. Others have outbreaks several times each year. People may have a handful of flare-ups over their lifetime. The frequency of herpes outbreaks is variable, but the first year of an infection can help us make a prediction about the future. When I talk with someone who has a lot of outbreaks in the first year, then that is someone who is more likely to continue to have regular outbreaks and may be a candidate for daily medication to reduce flare-ups. Those who have one infection and nothing else in that first year may go years or even decades before they have another outbreak.
Actually, it is entirely possible to only have one outbreak and never have another.
– – – –
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!