First Lesson of Herpes Transmission: There Is Pretty Much No Way to Know Who Gave You Herpes

Aug 11, 2017   ·  SELF  ·  Link to Article

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By now, you’ve heard RadarOnline and TMZ claiming that Usher knowingly transmitted herpes to an unnamed woman without disclosing it before they had sex. Cue the whole internet losing their minds. Thankfully, Snopes isn’t convinced, and neither were Amber Rose or The Game.

I'm very familiar with these kinds of accusations and stigmatized reactions as the Founder of TheSTDProject.com, the Communications Action Committee Tri-chair Leader for the National Coalition for Sexual Health, and spokesperson for PositiveSingles.com. So I knew better than to jump on the witch hunt without considering the facts of herpes transmission. Trouble is, we don’t know the facts or circumstances about Usher’s case, and herpes is complicated if you don’t have all that information.

Don’t get me wrong, honesty and transparency in relationships are incredibly important. If you’re willing to be intimate with someone's genitals, it shouldn't be a huge leap to assume that you'd also have an intimate discussion about your STD status—including herpes. From a practical perspective, we realize that doesn’t always happen. So we brought in the experts to help us better understand how herpes is actually transmitted and diagnosed.

First of all, it's possible to have herpes and never even know it.

Herpes doesn't often look or feel like the gruesome slides you were shown in 7th grade sex ed. Those were meant to do one thing: scare you (it worked, didn't it?). But they also contributed to the growing stigma and shame around herpes infections—not to mention confusion about how the infection actually presents. For starters, there are two different kinds: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). HSV-2 is responsible for most genital herpes cases, while HSV-1 is predominately responsible for oral herpes infections (cold sores), but it can also cause genital infections. According to data from 2010, 53.9 percent of people had HSV-1 and 15.7 percent had HSV-2. But the actual number of genital herpes infections is likely much higher than that for a few reasons: this is pretty old data, the numbers only take into consideration diagnosed cases, and HSV-1 can also cause genital infections.

You can have herpes and never have an outbreak or any other noticeable signs or symptoms. In fact, the CDC reports that an estimated 87.4 percent of 14-49 year olds with HSV-2 infections in the U.S. don't know they have it.

“The symptoms of a herpes infection vary widely from person to person, and most of the time there are no clinical manifestations," Kathleen Page, M.D., an associate professor in the department of medicine for the division of infectious diseases at Johns Hopkins University School of Medicine, tells SELF. The thing is, it's possible to transmit the virus whether you have symptoms or not. "In fact, most transmissions occur from people who don't have any symptoms and do not even know they are infected,” says Dr. Page.

The takeaway: If most people don’t know they have herpes because they never experienced symptoms, then why is the overwhelming reaction to assign blame in these situations? The data shows there's a very high chance that person didn’t know they were infected—let alone contagious. We don’t lie awake at night trying to figure out who gave us a cold or the flu, and herpes should be no different.

The only way to know for sure if you have herpes is by getting tested, but you're probably not getting tested for herpes even when you say "test me for everything."

The US Preventive Services Task Force (USPSTF) only recommends testing for herpes if you are experiencing signs or symptoms, either by obtaining a viral culture from the site (a swab test) or by administering a PCR test (a blood test) which detects the DNA of the virus and can distinguish between HSV-1 and HSV-2 infections. That might seem irresponsible, (can't you just tell us if we have herpes?), but there are few reasons for this, including the high false positive rate for the widely used blood test. Not to mention, even if you test positive for HSV-1, the test won't be able to tell if it's an oral or genital infection.

“All laboratory tests, including the tests for herpes, have a margin of error (in other words they are not 100 percent accurate in identifying who is positive and who is not),” says Dr. Page. “The worry is that if we test everyone, there will be a lot of 'false positive' or 'false negative' results.”

It's still possible to request a herpes blood test from your health care provider or a sexual health clinic if you think you've been exposed or had symptoms in the past. “There is another test which detects antibodies to the virus and can be used to see if a person is infected even when they are not having any symptoms," says Dr. Page. "We sometimes use this test in people who have a history of genital ulcers without confirmation of herpes infection, or in new partners of a person with a known herpes infection (to see if the partner is at risk of infection, or has already been infected in the past).

But that's why herpes testing is so confusing. People may assume they're getting tested when they're not, or they may be discouraged from testing when they request it. In any case, there's no evidence to assume that someone is irresponsible or unhealthy for not knowing they have herpes.

If you do test positive for herpes, telling previous and future partners is the responsible thing to do.

“Although we can take steps to significantly reduce the risk of transmission, it’s not zero," Peter Leone, M.D., professor of medicine for the School of Medicine and adjunct associate professor of epidemiology for the Gillings School of Global Public Health at the University of North Carolina, tells SELF. "If you have it, you can shed, and if you’re shedding, you’re infectious. Condoms, abstaining [from sexual activities] during outbreaks, and taking daily [antiviral] therapy all reduce the risk of herpes transmission, but it’s still not zero."

The common misconception is that people who contract herpes are irresponsible or that they didn’t practice safer sex, and that’s usually not the case. Condoms can help minimize the risk of spreading herpes, but it won't eliminate the risk completely. "The issue with condoms is that they don’t cover everything—shedding for herpes occurs anywhere there is skin, and where there is moist skin, you get greater amounts of shedding. Those episodes [of shedding] are intermittent, frequent, and usually without symptoms,” says Dr. Leone. “Condoms do work in reducing transmission, but unless you cover your genital area in latex, the risk of transmission is still going to exist.”

And then there are cold sores (caused by HSV-1)—the common condition that somehow carries less stigma than HSV-2, even though it can also lead to genital herpes infections. “What people need to understand is there’s a risk of a person with cold sores passing it from mouth to genitals,” Leone warns. “When a person has a history of cold sores, the rate of shedding from the mouth in the absence of lesions (an outbreak) is pretty high, and you can find virus in their saliva, even though there aren’t cold sores present. Right now, about half of all new genital herpes infections in women are due to HSV-1 [from oral to genital transmission]. Because a lot of people don’t think about cold sores and they view oral sex as being safe, we’re seeing increasing transmission of other STDs through oral genital contact as well.”

In fact, genital HSV-1 infections are on the rise, which is likely the result of not using condoms or dental dams during oral sex.

All of this is to say that if you do test positive for herpes, there is almost no chance of pinpointing who gave it to you.

“For these infections, it gets complicated,” Leone affirms. “For HSV-1, you can be negative on the test and still have HSV-1, because it misses about 30 percent of infections. For HSV-2, the antibody test sometimes has false positives. Another issue: A positive HSV-1 test doesn’t tell me whether they have it orally, genitally, or both. If you have a positive blood test [for either HSV-1 or HSV-2], I also can’t tell you if you got infected four months ago or 10 years ago.” The whole thing is confusing to say the least.

In Leone’s experience, “Not much good comes of trying to figure out who gave you the infection, and it frequently results in a lot of anger, a lot of hurt.” He says, “Either you trust your partner or you don’t, and [if you don’t] you’ve got bigger issues than whether or not that person gave you herpes. We live in a complex society in which we’re hung up about sex, and we want to have sex that’s risk free, and unfortunately, it’s not.”

When you take into consideration all of things we do know about herpes: that most people don’t know they have it, that routine screening isn't recommended, that it can be transmitted even when you’re practicing safer sex, and that it can be passed during oral sex if your partner has ever had a cold sore—it's shocking that there's still a stigma surrounding this virus. But the more we buy into the stigma by blaming and shaming people with herpes, the farther we get from the facts. Like that you can still have a satisfying, sexually healthy life with herpes; that it might just mean a few uncomfortable days every once in a while; and that medication can help minimize your symptoms. And most of all, that it's no one's fault.

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