What Exactly is Genital Herpes? Looking Beyond Shame and Stigma
By Jonathyn Elliott
Based on the way some describe it you’d think that herpes was the plague itself. As a college student, I’ve heard my fair share of malicious rumor mongering involving herpes. The outsized role this disease has in the public imagination is juxtaposed by the fact that most healthcare professionals just aren’t that concerned about the disease in most situations. The CDC doesn’t collect data about the incidence and prevalence of herpes; in fact, they recommend against routine screening for herpes unless symptoms are present.
Health officials are more concerned that the damaging psychosocial effects positive diagnoses rendered from such a stigmatized condition outweigh the effects of the disease itself.
So, what’s with all the fuss about herpes then? To get to the bottom of this, we’ll be examining what exactly herpes is, dive into a brief history of how it became the boogieman it is today, and how to combat the stigma about this misunderstood condition.
The Most Overhyped Blister
Herpes is a dermatological condition characterized by the appearance of painful blisters along the infected area caused by the herpes simplex virus family. Oral herpes, commonly referred to as cold sores or fever blisters, is caused by HSV-1 and is often contracted in childhood. According to the World Health Organization, 67% of the global population have an HSV-1 infection. While HSV-1 is typically associated with oral herpes, it can occasionally cause herpes sores on the genitals. More commonly, genital herpes is caused by HSV-2. The only noticeable difference between cold sores and genital herpes is location, with genital herpes occurring around the genitals or rectum rather than on the lips or mouth. HSV is transmitted via direct contact with herpes blisters or through HSV-containing oral or genital fluids. The virus is rendered inert quickly after leaving the body, meaning it can’t be spread via swimming pools or via surfaces like toilet seats or doorknobs Amongst individuals ages 14-49, an estimated 89% of folks who have HSV infections don’t know that they have it.
“Well, no problem,” you may be thinking, “safer sex methods like condom use can eliminate my risk for acquiring HSV, especially if they have open sores.” Well, you’d be partially right. Condom use has been found to reduce risk for acquiring HSV. That said, condoms and dental dams don’t cover the entire genital area, and HSV virus particles can shed off the skin of an asymptomatic individual. That’s right, you can get it after having sex one time with an asymptomatic individual, who most likely has no idea themselves that they have it, after doing everything “right.”
This would be much more worrying if the virus was as severe as the stigma surrounding it. The worst symptoms individuals experience, if they experience any at all, typically occur 2-12 days after infection. The first episode features flu-like symptoms in addition to blisters that can 1-4 weeks to resolve. Subsequent episodes are usually less severe, resolve faster, and happen less frequently. Additionally, antiviral medications are available to mitigate symptoms.
That said, there are two major risks associated with genital herpes. First, a genital herpes episode during the third trimester of pregnancy does carry the risk of infecting an infant with congenital herpes, a life-threatening condition. In this case, depending on timing of the outbreak, a person can take antiviral medications, or the baby can be delivered via C-Section. Second, genital herpes, even asymptomatic HSV infections, increase risk of HIV infection by two to three times. Safer sex methods like condom use, testing and talking, and pre-exposure prophylaxis (PrEP) can help manage this risk.
Herpes Stigma, Moral Panic, and a Slow Day in the Newsroom
So, if genital herpes is usually a common, manageable, non-debilitating condition with only intermittent episodes (if any occur at all), where does our overwhelmingly negative perception of the condition and the people who have it come from? The most obvious answer to this would be the predominant attitude of sex negativity in our society that shapes our attitudes around all STIs.
The moral panics of the 1980s that arose in response to the sexual revolution of the 60s and 70s spawned articles such as Time Magazine’s “The New Scarlet Letter” or “Herpes: The New Sexual Leprosy” filled with lurid claims of herpes devasting vast swaths of American society. Others claim that genital herpes stigma was the result of pharmaceutical industry fearmongering in order to sell herpes antivirals. No matter the source, the stigma lives on today, creating barriers for people living with the condition from forming rewarding relationships and/or having fulfilling sex lives.
Communication is always key to navigating sex and relationships, and it’s no different if one partner has an HSV infection. Potential sexual or romantic partners should be informed early about the condition, given the facts about what it is and is not, and what steps are being taken to mitigate transmission. Open and frank communication allows for informed consent, but also for the opportunity to normalize and destigmatize a condition for which misinformation abounds.
Try to have this conversation somewhere you and your partner won’t be disturbed or interrupted. Your partner might need some time to process, and that’s okay. They may have some questions; remember that communication is a two-way street. Give them the opportunity to disclose information about their sexual health as well. It may even be helpful to practice beforehand with a trusted friend so that you feel confident when you do tell your partner. Finally, it’s important to remember that if your partner doesn’t treat you with respect or shames you for your condition, it’s a reflection on them, not you.
While genital herpes presents challenges for starting and maintaining relationships, the movement toward de-stigmatization has led to individuals and couples speaking out about their experiences, providing a framework for others to follow. If you are currently living with genital herpes and you wish to explore your options or have any questions, feel free to schedule an appointment with one of our providers.