HSV
About 1 in 6 people have genital herpes (HSV), and most of them have no idea. Half of us carry the virus that causes oral herpes.
The good news is that herpes simplex virus will likely never make you sick. For the vast majority, the worst that might happen is a cold sore, either on your mouth or down below.
So why do friends keep showing up in my DMs saying “Kim, I think I have herpes. This is the worst thing that I can imagine”?
A national survey commissioned in 1983 by Glamour found that 25 percent of women thought that “higher incidence of diseases transmitted through sexual intercourse … is God’s punishment for sexual promiscuity.” I think it’s fascinating that we treat oral HSV as a “normal” cold sore and genital HSV as a cause of shame. This is a virus that has evolved alongside us to spread by pro-social human behaviour like kissing, sharing food, and having sex. If you have HSV it’s because you’re good at being human. Congratulations!
People often ask if they can get a blood test to see if they have asymptomatic HSV. Unfortunately, this test is not helpful in most cases. A herpes blood test can determine if you have herpes. It cannot tell you who gave you the infection, when you got the infection, or whether it might affect the mouth or genitals (up to 40% of genital herpes is caused by HSV-1 and the rest is HSV-2).
Canadian guidelines and the CDC do not recommend screening for genital herpes. The CDC writes that in addition to the risk of false positives, “the risk of shaming and stigmatizing people outweighs the potential benefits of testing everyone.”
In an intimate, sexual relationship with a person who has herpes, the risk of contracting the infection will never be zero. Some couples have sexual relationships for years without transmitting herpes just by avoiding sexual contact during outbreaks, using condoms regularly and using suppressive antiviral therapy to reduce outbreaks. With these precautions, the risk of female sexual partners developing herpes from an infected partner is about 5% annually (men have a lower risk of contracting herpes from a female sexual partner).
Couples deal successfully with herpes all the time. Since herpes does not pose a serious health risk, some couples may decide not to use condoms in a long-term relationship. It really is a minor inconvenience in the big scheme of things.
Is there anything we really need to know from a safety standpoint about herpes? Yes, if you are pregnant. HSV can cause seizures and even death in the newborn. The risk of this is 1.7/100,000. The risk of your child being struck by lightning is 6.5/100,000.
Obviously, this is a very rare risk, and there are plans to manage that risk. People with recurrent genital HSV lesions should consider taking anti-viral medication for the last few weeks of pregnancy, and if lesions develop around the time of delivery C-section is recommended.
What do you do if you notice 1 or more painful ulcers on your genitals? Pop into your local Sexual Health clinic for a swab ASAP for an accurate diagnosis, and they’ll start you on a week of medication to decrease the length and severity of your symptoms. You can decide to stay on the medication in the long term to prevent recurrences, or just wait and see what happens and treat as needed. Use a simple online tool like tellyourpartner.org to anonymously notify your current or past partners by text.
It may feel daunting to initiate a conversation about this out in the dating world, however, 80% of us have had an STI at some point, and 20% of us have one right now. If you can be brave and vulnerable enough to ask your partner about their STI history and disclose your own, you’re doing it right.
People are afraid that they’ll disclose their history and their partner will say “no thanks bye”. Fair. That might happen! But if it happens it’s a blessing because that person is evidently not the right person for you and believe me, you can get on to the next. That person might just go date someone with an undiagnosed STI and get it anyways!
I see patients who’ve been diagnosed with common STIs and stop dating. They feel betrayed by their sexual partners and terrified that they could infect someone else. For them, this is a life-altering diagnosis that changes everything they know about the world. Being human is a messy business. We get sick, and grow lumps and bumps, and love each other anyways.
One great solution to the problem of contagious sexual infections are Dating apps like Positive Singles and MPWH.com (Meet People with Herpes). These apps have millions of members who are willing to be open and honest about their sexual health status. If you can’t imagine having a conversation about STIs with a potential partner, you can just skip it by making your status clear in your dating profile.