As many as one in eight adults in Australia (and one in six in the United States) have it. Most of those are women. 80% of people with it don’t realise, while 70% report getting it from a partner who did not have an outbreak at the time of sexual contact. Yet when you mention it, people shy away. It’s the virus that generates sniggers and disgust, which no one wants to talk about. It’s HSV2, or genital herpes.
The stigma surrounding HSV2 can make getting accurate information difficult. Broaching the subject with new partners can be scary and uncomfortable. Nicole shared her story with me about first encountering herpes with her partner, Jason.
‘I’d been casually dating for a little over a year. I wasn’t always as careful as I should have been. I always made sure I got tested for STIs and so far I had been lucky. That was when I met Jason.’
Jason has lived with genital herpes for almost nine years. He was in a monogamous relationship when he acquired the virus from his then girlfriend. She had a drunken encounter in a bar one night and didn’t use protection.
‘Jason had already slept with her when she had her first outbreak. A week later he experienced the same symptoms,’ Nicole said. ‘I never thought I would find myself in this position. An accidental contraction would have been bad enough, but could I knowingly sleep with someone who was already infected?’
Nicole said it was the sexually transmitted disease she dreaded: ugly, painful, and incurable. Once infected, you have it for life.
‘Here it was in front of me, and I realised I knew almost nothing about it. Was it like cold sores, but down there? How exactly did you catch it? What could you do once you had it?’
She told Jason she needed to know more before deciding to become sexually active with him. ‘He was fantastic, really patient. He answered all my questions, no matter how stupid,’ she said.
But Nicole found reaching out for help difficult. ‘I asked some of my friends what they knew about the virus. One said, “Is that the one that gives you cancer?” Half of them confused it with genital warts. Researching online was just as bad. I didn’t know what I could believe.’
‘Everything I read said that people who have outbreaks can feel them coming,’ she said. ‘I figured if you can only catch the virus when your partner has the herpes sores, it should be easy to avoid. This isn’t the case at all.’
Genital Herpes can be passed on at any time through something called viral shedding, which is where the virus is shed from the skin’s surface, even when there is no sign of an outbreak. Condoms help, but the virus lives on areas that condoms don’t cover. As HSV2 carriers can be shedding the virus even when they don’t have symptoms, there is always some risk of infection.
Jason’s doctor had prescribed an antiviral medication called Valtrex (Valacyclovir HCL): a treatment, not a cure. ‘If Jason takes the Valtrex every day he gets fewer outbreaks, and when they do happen, they don’t last as long,’ Nicole said.
The other benefit of taking antivirals in this way (called suppressive therapy) is that it helps reduce the risk of passing the virus on to a partner by decreasing the amount of viral shedding that occurs, but it doesn’t stop it altogether.
Not everyone with herpes needs to take medication daily, but without it Jason has eight to ten outbreaks a year; with it, he might have one or two. At the other extreme, people like Jason’s former girlfriend can have a single outbreak and never experience symptoms again, or their symptoms can be so mild, they don’t even know they have the virus.
‘For all I knew I had already been exposed to herpes by a previous partner,’ Nicole said.
In Australia, unless a person presents with specific symptoms, the standard screening for sexually transmitted infections leaves out HSV and HPV, the Human Papilloma Virus, or genital warts — two of the most prevalent STIs.
Both viruses are so common and so easy to contract it is assumed people will come into contact with them at some point, so unless someone shows specific symptoms that need treatment, they won’t get diagnosed.
Cancer-causing strains of HPV are typically picked up during pap smears, but herpes is only found if a person presents with painful blisters or itching and redness that keeps coming back.
In the United States partners of people with HSV2 are encouraged to get tested in case they have already come into contact with herpes but are asymptomatic. No such practice has been approved in Australia, with some experts arguing screening is ineffective as tests can return false negative results.
‘I had no idea where to turn to find out what Jason and I could do,’ Nicole said. ‘What about oral sex? Could we even be naked together? I couldn’t be the only person in this position, but herpes isn’t something people talk about.’
Nicole discovered a sexual health clinic in her neighbourhood. ‘I was able to speak with a nurse who specialises in sexually transmitted infections,’ Nicole said. The nurse explained the disease is most likely to be transmitted during the first year of a relationship, at the time of an outbreak, or when the non-infected partner has legions on the skin that might let the virus into the blood stream. At other times, the risk of transmission from someone using suppressive antiviral medication, and while using condoms, is very small. ‘There is a risk of transmission through oral sex,’ she said, ‘but a tiny one.’
While the HSV1 strain of the virus, which causes cold sores, prefers the environment of the mouth (though it can live on the genitals, too), HSV2 prefers the genital region.
‘She also said that as long as I didn’t have any breaks on my skin, we should be able to get intimate without having to wear the equivalent of a biohazard suit,’ Nicole said.
‘I kept hoping she would say, “If you just do this and this and this, you will be safe”,’ Nicole said. ‘Instead the nurse confirmed my worst fear: there is no guaranteed way to protect against the virus. She told me that sex is always a risk, and that all you can do is to take reasonable precautions in the same way you look both ways before crossing the street.’
Rather than dwelling on what might happen, the nurse encouraged Nicole to think about the worst case scenario and whether she could live with that.
‘I had seen pictures of the painful blisters that the virus can cause. Jason had lived with them for years. His was a severe case. I would have to be pretty unlucky to have an outbreak as often as a period,’ Nicole said.
‘None of Jason’s other lovers have ever had an outbreak, but if I was unlucky enough to catch it, I knew I would become an infection risk to all my future lovers,’ Nicole said. ‘I might be able to live with herpes myself, but I wasn’t sure I wanted to live with that. Just think, every time I met someone new, I would have to have that conversation.’
‘I thought about how Jason had told me. As awkward as it was, it made me want to be with him more, not less, because I knew how difficult it must have been. He cared enough to tell me, and that meant a lot,’ Nicole said.
‘I’ll never forget what Jason said after the night he first told me. “Thank you for not kicking me on to the street.” And I could have, because herpes really has that much stigma,’ she said.
But once Nicole learned more, once she really thought about it, she realised it isn’t some horrible dirty disease contracted by sleazy Lotharios. ‘It’s a manageable inconvenience at worst, invisible at best,’ she said, ‘and it can happen to anyone.’