Me & HSV
Hi! I'm a 22 year old woman, and we've probably never met. If you read this article top to bottom, you'll learn more than you probably wanted to know about my vagina. If that makes you uncomfortable, hey, totally fair, but you might want to stop here.
Still with me? Sweet.
I have genital herpes.
Those people you see in the Valtrex commercials, running down a beach with five beautiful women chasing after them? Totally me.
Okay. Let me back up a little. Herpes is short for the herpes simplex virus, which is (wait for it) a virus that hides out in the nerve cells around the infection site (usually, though not necessarily, around the mouth or genitals) and can manifest in localized, infectious outbreaks of small itchy or painful blisters.
That's what herpes is, and that is all it is.
There are actually two different types of herpes simplex virus, called HSV-1 and HSV-2 (this science stuff is pretty easy, right?). HSV-1 is mostly oral and HSV-2 is mostly genital, but you can get either type orally or genitally. The vagina is generally more susceptible to genital infection than the penis, because it has a greater surface area of vulnerable skin (sorry, ladies), but penile and anal infections are also entirely possible. Transmission is more likely if the contact happens between moist or slightly broken areas of skin, and is way, way more likely if there's contact with an active sore. A blister comes in contact with your mouth or genitals, or comes in contact with something that comes in contact with your mouth or genitals, and voila.
Though it's classified as a sexually transmitted infection, you can contract the herpes simplex virus from sharing a drink with someone with a cold sore or fever blister in their mouth (though if you manage to get genital herpes from sharing a drink, I commend your clearly superhuman agility). You're not going to get herpes from a handshake, a doorknob or a bathroom faucet--though those are good ways to get any number of gross things, so wash your hands--but you can probably start to see why this is such a common virus.
"But how common is it really?" I hear you cry. Nobody knows for sure, for reasons I'll discuss in a moment, but the short answer is extremely. The commercials will tell you that one out of every four people you know has genital herpes, but of course, that depends on who you know. Like any disease of inadequate education, genital herpes skews vastly higher in under-served populations. Overall, though, it looks like about 80% of Americans will have detectable HSV-1, HSV-2 or both in their blood at some point in their lives. A lot of people have the virus in their bodies all their lives and never have symptoms orally or genitally, but once you have it, you will always have it.
If you know you (or a partner) get cold sores, fever blisters, whatever you want to call them that makes you less uncomfortable than herpes, say so. And tell your partner why it's important. Yes, it's unsexy. Do it anyway. Even if you don't have a visible sore at the time, your mouth can still shed enough of the virus to infect your partner without either of you knowing, and trust me when I say that conversation is way less fun when one of you has oozing blisters all over your junk.
I'm not going to go into the details of symptoms and the diagnostic process or the differences between types here, since this site links to much more articulate and informed resources than I could offer you, but a word on testing: it's tricky. Because so many people have HSV in their blood, standard blood tests aren't particularly helpful, and even a positive result won't differentiate between oral and genital, or symptomatic and asymptomatic. What a blood test can tell you is whether you or your partner(s) even have the virus in your bodies.
If you know that you and your monogamous partner have tested negative for any sexually transmitted infections, and don't engage in any other high-risk behaviors, great. Otherwise, like I said: the virus can be transmitted even if there are no visible sores. Use protection every time, even if you're having oral sex, and know how to use it correctly. This isn't rocket science, right? Cover up. You can use condoms or dental dams (and if you don't have a dam, a cut-up condom or latex glove over the vaginal area will work too). Also, be aware that because the virus is spread by skin-to-skin contact rather than semen, blood or vaginal fluids, condoms and dams are not 100% effective even when used correctly.
If you think you may be having an outbreak and go in for an exam, your healthcare provider may decide to do a swab test, which will collect a small sample from a sore (which is definitely not the most fun you can have with your pants off, but isn't as horrifying as it sounds, either). Other conditions can manifest in similar ways, so you really do need to suck it up and see a doctor to know for sure. Public health clinics can be excellent for this, and often have free, anonymous STI testing or a sliding scale payment plan for low-income clients.
So, that was my big 'prevention' talk. From here on out I'll mostly be talking to people who are reading this because they have herpes, or might have herpes, or have a partner or a friend with herpes, or otherwise have an immediate interest in what this is like. Obviously, I can speak only for myself and my experience, and since I was single and insured, there are a lot of potential issues I didn't have to deal with. Take all of this with a you-sized grain of salt.
The physical consequences of HSV are often manageable, mild, or totally asymptomatic. They sometimes aren't. Suppressive therapies, like Valtrex or Aciclovir, are available and of huge help to some people with recurrent outbreaks, though I have no personal experience with them. The social, psychosexual and emotional consequences are often fairly serious--depression, anxiety, fear of rejection, and the fear of being outed are all overwhelmingly common, and that's just what you can do to yourself. I mostly tried to be macho and tough it out, and it just made everything harder than it needed to be. If you think you might need help, please try and find it, either in person, by phone or on the internet, and especially from people who understand what you're going through.
Socially, you'll be around people who treat herpes like it's the worst thing that could ever happen to someone, and are terrified by the idea of STIs; be patient with them. You'll also be around people for whom herpes is deeply hilarious, synonymous with promiscuous behavior, and/or something that only happens to people who "deserve" it. I have to ask that you be patient with them too, though if you wanted to thwap them over the head with a newspaper while you were at it, that'd be okay with me too.
I've had herpes since I was eighteen. How I got it is actually a pretty funny story, as these things go, but the G-rated version is that I was depressed and drunk off my ass, and I apparently slept through that day in health class when they went over how you could get herpes from unprotected oral sex. D'oh. I was lucky enough to still be under my parents' insurance at the time, and was able to quietly get myself to an OB-GYN, at which point the story becomes a morbid comedy of errors that I will spare you for the sake of brevity. The important part is that once I knew, I was able to inform my partner and figure out how to minimize both of our risk factors in the future.
Which brings me to one of the first questions I had, when I found out: if I have herpes, will I ever get laid again?
Short answer: absolutely. Less short answer: absolutely, but not necessarily with everyone you might have otherwise.
I decided pretty much right away that I was going to tell any future partners that I have herpes. It was a few months before I actually went out and found any future partners. For one thing, I knew my judgment at the time wasn't that great, and combining bad judgment and sex had clearly been not been working out for me so far. For another thing, any partner I did have would need to accept the risk of getting herpes, and frankly, that seemed like a lousy trade-off for having sex with me. I haven't reconciled that one hundred percent yet, but I've also come to realize that herpes isn't a catastrophe, and my only responsibilities are to be honest with my partners and respect their decision.
Once I felt confident that I wasn't going to be dating my vibrator for the rest of my life, I learned very quickly that my attitude has more of an impact on my partner's reaction than anything else. I've had wonderful partners who were sympathetic, accepting and educated. I've had almost-partners who took off running in the middle of dinner like I was a walking ebola lab, though that's definitely the minority. Somebody who's fine with it on Saturday night may be at your door having a panic attack Monday morning. That's okay. Try to remember that they're not where you are, and vice versa. It's an extremely personal decision, even for people who love each other, and you need to respect that as much as they need to respect your honesty and privacy (and obviously, if they don't respect that, you might want to rethink sleeping with them anyway). For the most part, if I treat it like a big dark secret, that's what it is. If I treat it like an annoying skin condition with a certain assumption of risk, then that's what it is.
And finally, if you have an STI, or if you ever get an STI, and nobody's actually said this to you yet: you are not disgusting. You're not guilty. You are not worthless, dirty, damaged goods, undesirable, or doomed to a life of celibacy, loneliness and rejection; you're certainly not alone, even though you may feel that way sometimes, especially at first. This is something that's going to be a part of you, and it's something you'll need to deal with, but it doesn't say anything about you. You may need to remind yourself of this every day for five years before it sinks in, but it's true. No, really.
Educate yourself, manage your risk factors, expect to deal with the occasional rejection, and jump in.