A recent discussion on a sexuality listserve yielded a number of useful resources and perspectives on the topic of herpes simplex virus (HSV) infections that I want to share with you. Herpes is widespread, has a lot of social stigma (which was heightened by media in the 70s and 80s), and is complicated in that some people who have either or both types may be asymptomatic or they have lesions in undetectable places, such as the cervix or inside the penis. There are also differences in how types HSV-1 and HSV-2 behave, how often the virus is shed from the skin, and so on. (Other viruses in the herpes family cause chickenpox, shingles, mononucleosis, and CMV infections.) But this complexity causes confusion in the general public as well as in health professionals. How do you know what information is reputable and useful, and what is not?
Here is an excellent source of information: The American Sexual Health Association. Good information on everything. Here’s their herpes page, with a lot of links. (Be sure to watch the video with Dr. H. Hunter Handsfield.)
For historical and social perspective on a “public sex panic,” read “How Herpes Became a Sexual Boogeyman” (L.V. Anderson, The Slate, Dec. 2, 2019).
Here’s a video of a talk on herpes given by Evelin Dacker, M.D., at the STI Symposium for Sex Positive Portland, 2017. I really like the information that she conveys and how she conveys it. Unfortunately, it sounds like the videographer–or someone nearby–is chewing potato chips or cleaning out a backpack throughout the entire presentation. It is also impossible to see the slides. Even so, it’s worth listening to this video.
These are notes from the above video regarding the differences between the two types of the virus. These notes are also combined with notes from the Understanding Genital Herpes video with Dr. H. Hunter Handsfield, found at the American Sexual Health Association herpes webpage.
HSV-1, “oral herpes:” lives in the trigeminal nerves, usually “lives above the neck” and can be dormant. 60% between ages of 14-49 have herpes 1. Can also transmit to genitals from mouth. Shedding 1-2x a month from the mouth, shedding, asymptomatic. If you have genital herpes (HSV-2), you can still get HSV-1 on the mouth, but it is rare to get HSV-2 on mouth or lips. If you have genital herpes you may only break out once every other year. If it is mild, probably HSV-1. “Not so bad.” About half of genital herpes in U.S. are HSV-1.
HSV-2, “genital herpes:” almost 90% of people who have it don’t know, can’t feel it. No lesions detectable. HSV-2 Lives in nerves of lower spine, outbreaks can happen anywhere along the nerve pathways in the “boxer short region.” These breakouts can change location. Sheds once every five days. Most transmission happens in first year of a relationship. Shedding from genitals with HSV-2 happens 20-40% of the time, averaging every couple of months, can be asymptomatic. Fewer recurrences and outbreaks of lesions. Shedding will occur for the rest of your life. Sexual transmission far more likely.
Transmission: Skin to skin, mouth to skin. Can’t cover a lesion up and hope to not transmit it. With regard to penis/vagina sex, men transmit it to women more (10% risk a year). Harder for women to transmit it to men (4% risk a year). No data with same-sex couples.
1) Primary infection: Someone who has not had herpes before. Generally sick like the flu, in pain, sores in a large area. Also swollen lympth nodes.
2) Non-primary infection: for someone who already has had HSV-1 and then gets HSV-2. Can be mild. Cervix or vaginal lesions may be undetected. Men may have lesions inside the urethra, which are not noticed or are mistaken for a urinary tract infection (UTI).
Testing: It’s important to know the virus type!
(1) Antibody test for Herpes type 1 and 2. Ask for your index score, get printout, info If index score is less than .9, it is negative. Between .9 and 1.1-results are uncertain. There is some evidence that between 1.1 and 3.5 (which is considered positive) there’s a higher likelihood that it’s a false positive (3 out of 100 tests) in this category. If over 3.5, it’s positively positive. If in 1.1-3.5 you can retest in a couple of months. Or get a different test, such as direct tests for the virus, which can be a culture from a lesion or DNA tests.
(2) “Western blot sent to the University of Washington” is the “gold standard” (but not covered by insurance).
3) Culture tests which collects specimen from a lesion and grows in laboratory. Cultures can miss an infection or give false negatives.
(4) DNA tests called Nucleic Acid Amplification Testing (NAAT), such as the PCR. Both culture and DNA tests can identify whether HSV-1 or 2. Very accurate.
Protection: Antivirals to lower risk of transmission and shedding by about 50%; use condoms; tell your partners so they can protect themselves.
This article, “How I Found Out I Didn’t Have the Herpes I’d Been Living With for Four Years” (The Hairpin, 2013), has an interesting perspective and a lot of good information. It’s written by “An HSV-Negative Lady” who’d been told she had herpes via visual inspection, and lived with that for four years before finding out otherwise.
The same author, writing as “An HSV Positive Lady,” wrote an earlier article in 2012 about “The Perks of Herpes” (The Hairpin). I rather like her perspective on dating and herpes. When she discloses to prospective partners, the way in which the prospective partner reactions make the topic of herpes “my own magic Hogwarts-esque sorting hat. If a guy freaks out, he’s not meant to be in my house.”
Other articles and website resources:
Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14–49: United States, 2015–2016, NCHS Data Brief No. 304, February 2018. U.S. Centers for Disease Control. [I cannot find a similar study for adults over the age of 49.]
“‘Herpes Made Me A Better Person’: A Spotlight on Rae Higgins” (Emily Lowinger, WaxOh!, May 20, 2019).
The Pink Tent herpes page for women.
Moss, Paul. The hidden world of the human herpes viruses. TEDxUniversity of Birmingham. https://www.youtube.com/watch?v=s-YDL_SVXNA
More links will be added as I find them.