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The Top Ten Questions About Genital Herpes: Everything You Always Wanted to Know but Were Afraid to Ask One late-night talk-show host is famous for his top-ten lists. I hope he won’t mind, but I’m going to borrow his idea. Here’s my top-ten list of questions asked most often about genital herpes. They come from patients at my clinic and from the WebMD message board. And if your question isn’t in here, I bet you’ll find it farther along in the book. 1. How did I get genital herpes? Herpes is passed from one person to another through sexual contact. You get it from someone who has herpes through intercourse, receiving oral or anal sex, or genital to genital rubbing. You don’t get it from touching doorknobs or sharing blue jeans or toilet seats—unless, of course, you’re having sex on a toilet seat, but that’s for a whole different book. A closely related, often-asked question is, “Could I have gotten herpes through a sexual encounter that didn’t involve intercourse?” Lap dancing, oral sex, genital rubbing, and mutual masturbation are all alive and well, and occur with great frequency. Sometimes these activities happen with people who aren’t regular partners or spouses, and that can create concerns about the risk of getting an STI (sexually transmitted infection). First, let me assure you with complete certainty that you can’t get genital herpes while you have your clothes on and someone is “dancing” on your lap. It doesn’t even matter if there’s moisture present. The virus doesn’t somehow “wick” through fabric and infect the genitals. When the clothes come off, however, and genitals are rubbing directly together, there is a chance of getting herpes. And the real risk of getting genital herpes during a single sexual encounter is very low, but it’s not zero. Receiving oral sex also presents some risk too, but now the risk changes to one of being infected with the cold-sore virus, herpes simplex virus type 1 (HSV 1), in the genital area. HSV 1 (very often, oral herpes) can be transmitted from the mouth of one person to the genitals of a sex partner through oral sex, even if the giver doesn’t have an active cold sore. And finally, what about when one person masturbates another? This is truly safe sex as far as herpes is concerned. Unless someone has a herpes lesion on his or her hand, which is so rare it’s not worth even considering, masturbation presents no risk for transmission. “Okay,” you say, “but what if the person touches his or her genitals and then touches mine?” Again, the risk is so low; don’t spend any time and energy even worrying about it. 2. Now that I have herpes, can I ever have sex again? Yes, you definitely can, but I’m not going to mislead you by saying that sex will be the same as it was before. There’s a risk of giving herpes to an uninfected partner, and you need to deal head-on with that issue. First, you should tell all future partners about your herpes before you have sex so that they can make educated decisions about their risk of getting infected. It may be difficult to tell your partner, but you’ll know in your heart that it’s the right thing to do. If your partner doesn’t have herpes (and he or she would need a blood test to know for sure), he or she will be vulnerable to getting herpes from you. Daily herpes medication and condoms greatly reduce the risk of transmission, but neither offers absolutely perfect prevention—not even when used together. If your partner already has the same type of herpes you do, then you can have sex just as you did before you had herpes 3. Will genital herpes shorten my life? That one’s easy— absolutely not! In years past, there was concern that herpes might be linked to cervical cancer, but we know now that human papillomavirus (HPV), not herpes, causes cervical cancer. I know—it’s easy to get all those viruses that begin with H mixed up. 4. Can herpes be cured? Right now, there’s no known cure for herpes. But in 1981 there wasn’t even a treatment for herpes, so look how far we’ve come already! Now we have three very good medicines, so you just never know what might develop. There are two kinds of herpes vaccines being studied right now. One is designed to prevent herpes infection, and the other to treat herpes, so those are promising projects. Keep in mind, however, that there are many conditions with no known cure: diabetes, hypertension, HIV, and thyroid disease, to name just a few. We, in the medical profession, simply manage those conditions, and people go on living full and happy lives. Herpes is exactly like that. You can treat it and live with it, even though you wish you didn’t have it and that it would go away. And compared to HIV, diabetes, or hypertension, the physical impact of genital herpes is far less significant. The trick is getting your head in the right place about herpes. 5. Can I give genital herpes to my children or roommates? No. Again, herpes is a sexually transmitted infection. It requires direct contact with the genital area to pass it from one person to another. (Sex toys are the small exception to this rule.) There isn’t any risk of infecting children who live in your home. Kids aren’t going to get herpes by touching your dirty laundry or sleeping in your bed. I do suggest that people use their own towels and washcloths, because these items can stay warm and moist for a while, and those are the conditions viruses love most. Having said that, there are no documented cases of anyone ever getting herpes from a towel. Roommates don’t need to worry about getting herpes from couch cushions or from sharing kitchen utensils or bathtubs. Questions about nonsexual transmission in the home are very common, but just remember these three little words: “skin to skin” (which is also “mucous membrane to mucous membrane”). That’s how herpes is passed from one person to another. 6. What’s the best treatment strategy for my herpes? That decision depends entirely on your social and sexual situation, and your feelings about herpes outbreaks. If you want to reduce the risk of passing herpes to someone else, taking preventive medicine every day will help. And if you’re bothered by outbreaks, daily therapy will help with that too. If your partner also has herpes, and you aren’t having frequent outbreaks, then maybe taking medicine only during outbreaks is enough for you. And, if you don’t want to take medicine at all, you don’t have to. Herpes isn’t like a bacterial infection, which requires taking antibiotics to keep it from getting worse. With herpes, you take medicine to relieve symptoms or reduce the risk of passing the virus to someone else, not to permanently get rid of your herpes infection. It’s good to remember that this choice isn’t permanent: treatment decisions can be flexible and change if your situation changes. 7. How do I know if I really have herpes? There are excellent tests available now for herpes, and they’re much better than what we had only a few years ago. In the past, you had to have a herpes symptom present to make a diagnosis, but now there are blood antibody tests that detect herpes infection even if you’ve never had a symptom. And the swab tests that we have now are up to four times more sensitive than the older culture-style swab tests. Finding out that you have herpes through one of these tests is a double-edged sword. The bad news is that you find out you have herpes, but the good news is that you now know you have herpes and can manage it—whereas, if you didn’t know you had it, you could do nothing about it. 8. Who gave me herpes, and how long have I had it? Sometimes these two questions can be answered, but more often they can’t. If you’ve only had one sex partner in your life and you now have herpes, you know where you got it—either from intercourse with that person or by receiving oral sex from him or her. If you’ve had more than one partner, it’s going to be tougher to sort out. Let’s say you get a new sore in the genital area, and you’ve never had one before. You get a swab test from the sore, and it comes back positive for HSV 2 (herpes simplex virus type 2). During the same visit, you get a blood antibody test done for HSV 2, and it comes back negative. So you have HSV 2 in the sore, but you don’t have any HSV 2 antibodies in your blood. You don’t have the antibody, because the infection is brand new and not enough time has gone by for your body to make it. That means it’s a new infection that you recently acquired. A positive IgG antibody test (a specific kind of blood test that we will talk about in great detail in chapter 4) combined with a positive swab test means that the infection has been present for at least a week or perhaps twenty years; with this combination, you can’t know how long you’ve been infected. Timing is important though. Fifty percent of people will make the antibody within three weeks of infection (Ashley-Morrow, Krantz, and Wald 2003), so if you’re going to try to nail down new infection versus old, the tests have to happen fairly quickly after the first symptoms show up. But getting both tests at the same time is really the only way to know if the infection is new or old, and, perhaps, who gave it to you. 9. Can I still have children? Definitely! Since almost one out of five American adults already has HSV 2 infection (Xu et al. 2006), it’s apparent that many women are safely having babies despite having herpes. And the female partners of men with herpes are getting pregnant and having healthy babies too. The key to infected parents having a healthy baby is twofold: First, women and their partners need to know the herpes status of everyone involved. If a father has herpes but doesn’t know it, he can unknowingly infect his female partner, and if that happens late in pregnancy, that’s a very bad thing. A pregnant woman who gets herpes may not know about it and won’t be taking the necessary precautions to protect her baby at delivery. Second, women need an obstetric provider who knows how to manage genital herpes or the risk of transmitting herpes to the baby during delivery. If a woman already has genital herpes and knows it, the risk of her giving it to her baby is very small indeed! 10. Will my life ever be the same again? Though this may not be the first question people ask, it’s the one that’s at the heart of concerns about herpes. Babies, sex, blame, transmission, and symptoms—all of those concerns require that you think about herpes and deal with it. It really can’t be ignored, so in that sense, yes, your life will be changed. But if you were to develop diabetes, you’d need to change your diet, take medicine, and track your blood sugars. You wouldn’t, however, be a different person at the core of yourself. Yet somehow, maybe because you’re dealing with a sexually transmitted disease, concern about this is greater when dealing with herpes. You might wonder, “Will people accept me the way I am? Will I be as happy as I was before this diagnosis? Will people think less of me? Will I live in fear of people discovering I have herpes?” It’s good to know that three detailed studies have determined that most everyone who’s newly diagnosed with herpes gets back to his or her former psychological functioning level within six months (Miyai et al. 2004). Yes, you have a virus in the genital area, but you’re not really any different inside—unless, of course, you somehow let this virus define who you are. *** Excerpt from The Good News About the Bad News: Herpes: Everything You Need to Know (New Harbinger Publications)
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