HPV & Herpes: Why Safer Sex Isn't Always Safe Enough

At some point, you have probably heard someone say that condoms are not effective when it comes to safer sex and preventing the spread of sexually transmitted disease and infection.

You might hear someone say latex condoms have "holes" in them which are small enough to let disease, infection or sperm cells through. This is false. You may have heard someone say that condoms aren't at all effective because they break all of the time. This is also not often the case. In fact, when used correctly, and for ALL genital and/or oral contact, it's quite rare for condoms to break.

However, myths and misinformation aside, there are instances in which condom use alone - or the use of dental dams and gloves -- cannot offer the same level of protection they can in other instances, with STIs which are transmitted not via fluid exchange, but by skin-to-skin contact, namely two of the most common STIs, HPV and Herpes.

This is because condoms do not cover the entire genital area, and these infections can be transmitted via sores or warts (which may or may not always be visible or readily apparent) and by contact with parts of the genitals NOT covered by the condom (in other words, the genital anatomy besides the penile shaft and vaginal canal). Condom use for vaginal, oral or anal sex and dental dam use for anal/oral play or female oral sex certainly DOES make a difference in reducing the risk of transmitting or contracting these two infections: around 70% of a difference, beats the heck out of 0%. But it's important to realize that in the cases of infections like HPV and Herpes, safer sex tools and practices cannot provide complete protection. They never do, as condoms and other barriers aren't 100% effective at reducing the risks of pregnancy or any infections, but with Herpes and HPV, they provide somewhat less (around 20 or more percent less) protection than they can when it comes to pregnancy and other infections besides Herpes and HPV.

In other words, you just need to know, when considering and making your sexual choices, that even when using condoms, dams or gloves, you may still be at a considerable risk of transmitting or contracting HPV (human papillomabvirus, some strains of which cause genital warts) or HSV-2 (genital herpes).

HPV is one of the most common STIs among young, sexually active people under 22. At any one time, an estimated 20 million people in the United States have genital HPV infections that can be transmitted to others. Every year, about 6 million people acquire a genital HPV infection (CDC). A recent U.S. study among female college students found that an average of 14 percent became infected with genital HPV each year. About 43 percent of the women in the study were infected with HPV during the three-year study period (Ho, 1998). Typical prevalence of HPV for women under the age of 25 is between 28 and 46 percent of all women (Burk, 1996; Bauer, 1991).

Some strains of HPV produce genital warts, while others do not, and even when there are warts, they're not always where we can see them without medical instruments. The strains associated with cervical cancer are not wart strains. Most estimates suggest that one out of every three sexually active young adults may carry HPV, yet far fewer have visible, active warts they could recognize or self-diagnose (as little as only 1-2%), though they are infected and CAN and likely will still transmit HPV. Some strains of HPV may cause cervical cancer and make a person with the infection more susceptible to other infectious diseases, like HIV. It is not yet curable. Many people who wind up with HPV do shed or suppress the virus, especially younger people, but it can be hard to know when and if that has happened, especially for men or other people with penises, not vaginas, as we currently have no FDA-approved HPV tests for that group to date. And for those who do shed the virus, it may take only months for one person to do so, while it may take another many years.

For more on HPV, see the Infection Section file. For information about the HPV Vaccine, see Scarleteen's HPV Vaccine FAQ.

HSV-2 -- Genital Herpes -- is one of the most common sexually transmitted diseases in the United States, with as many as one million people in the United States becoming infected each year. While genital herpes continues to spread across all social, economic, racial and ethnic boundaries, prevalence of infection increased most dramatically in teens and young adults in the late 1980s and early 1990s (Fleming, 1997). In a national household survey, less than 10 percent of people who tested positive with herpes knew they were infected (Fleming, 1997 - from the CDC). 45 million people are infected with genital herpes, about one in every five people have it. In addition, HSV-1 (oral herpes/cold sores) is carried by about one in two people in the United States (that's at least 50%), and can be spread via oral or oral/genital contact, creating a genital herpes infection with HSV-1. Like HPV, there is currently no cure for herpes infections. For more on HSV, see the Infection Section file.

This does NOT mean the smart thing to do is to say, "Then why bother with safer sex?" and not practice at all, because there are both other diseases and infections out there they DO offer protection from, and use still DOES greatly decrease your risk of contracting HPV and Herpes as well.

We don't say these things to scare you, but rather so that you can just make informed choices based on what level of risk feels manageable to you.

Should you choose to engage in manual ("hand jobs" or "fingering"), oral ("giving head" or "eating out"), vaginal or anal sex right now, even when you do so safely (with safer sex practices and regular testing for you and your partner, and by limiting the number of partners), you are taking a decent risk of contracting an STI, including HPV or Herpes. While both of these infections can be treated -- and thus, you can reduce or decrease your symptoms -- they still cannot be cured. So, while plenty of people can feel just fine with either infection in many cases with certain treatments and medications, the infection itself may not go away and may remain transmissible to all the sexual partners of an infected person (and in the case of oral Herpes, can also be, and is, transmitted by nonsexual contact as well) for the whole of their life. If you know you or a partner have either of these infections, even with safer sex, you have a risk of contracting or transmitting them. As well, some people won't do just fine. It's dangerous for people with some health conditions to have Herpes, and some strains of HPV can and do cause cervical and other cancers.

HPV and Herpes infections become further complicated by the fact that not everyone has access to the tests and screenings specifically for these infections (a pap smear is not the same as an HPV test) to discover either unless there are active sores or warts which are visible or a health complication found in more typical sexual healthcare, like cervical dysplasia, has occurred.

What's the answer? There isn't an easy one. In most cases, if you simply chose to abstain from all sexual activities, forever, you could likely avoid HPV and HSV-2. But very few people are want to do that, and our quality of life is part of our sexual choices. Cutting off sexual or affectionate contact with all people, or with sexual partners within reasonable limits (those of their and our own physical, emotional safety and health, in general) for all of our lives would, for many of us, greatly impact and reduce that quality of life, potentially more than an infection would. But to make informed choices, we should consider that even with safer sex practices in play -- even with only one sexual partner -- we may still be taking a substantial risk at contracting or transmitting skin-to-skin STDs and STIs.

If you're going to be sexually active knowing and accepting that, then there are some steps you can take to help heighten your safety levels.

  • Even if you've already become sexually active, you can talk to your doctor about and consider getting the HPV vaccine, which can offer protection from HPV.
  • Practice safer sex, especially for oral, vaginal and manual sex, including using condoms and latex barriers and getting regularly tested for what STIs you can. same goes for your partners.
  • Read up on skin-to-skin STIs to find out what noticeable symptoms might be when they are present, and have yourself and your partner(s) be on the lookout for those symptoms, primarily: warts, which often are small, whitish or pinkish, and raised with a cauliflower-like texture, and Herpes zoster sores which look a bit like red, raw blisters (see examples of both above), or may crust over slightly on the top. In addition, at the sign of any unusual itching burning or tingling of the genitals, check in with your doctor. As well, don't accept that a lack of symptoms or partners for intercourse means you or your partner are not carrying any STDs or STIs: for most people, most of the time, most STIs do not present any noticeable symptoms. Instead, have annual or biannual sexual health visits at your local clinic, or with your OB/GYN and get full STD and STI screens at least yearly.
  • Reduce the number of sexual partners you have. This is not a ploy to say everyone needs to be or should be monogamous or with the same partner forever and ever. However, if you are with sexual partners who you cannot trust, do not know well over time, and with whom you cannot both check in on your sexual health together and with your doctors openly and regularly, you are probably increasing your risks. Math alone is enough to tell us that keeping track of all of those things between two or three people just over one year can be a serious challenge -- trying to do it for real with more can be difficult if not impossible for most people.
  • Don't let ignorance or denial drive your car. Thinking you and yours can't have HPV, Herpes or any other infection doesn't offer any protection, and it can't make existing infections, or the likelihood of transmitting them, go away. Sizing up your risk factors for these things is a Big Life Decision. You wouldn't blow off similar life choices that could impact the rest of your life, like finishing high school, or becoming pregnant, so be just as wise here. take the time to give these things thought, and really weigh your options, needs and wants. It's your choice, but only if you actively make it.

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