Herpes Simplex Virus 101
This is a guest blog. Original article can be found here.
The most common versions of herpes simplex virus, or HSV, are HSV-1 and HSV-2. Generally speaking, HSV-1 causes cold sores (oral herpes) on the mouth, and HSV-2 causes genital herpes (which is essentially just having cold sores in your genital area, rather than your face). With this in mind, it’s possible to get HSV-1 genitally and/or HSV-2 orally, but not as likely as the other way around. While HSV-1 and HSV-2 aren’t super picky, they do tend to prefer their former positions.
An extremely ignorant yet common belief is that only prostitutes, porn stars and/or promiscuous people acquire HSV. However, the reality of the situation is that this myth could not be farther from the truth.
HSV doesn’t check resumes—it’s a virus. As far as it’s concerned, any human with a pulse is sufficient. Literally, the only way to be 100% sure you don’t get it is complete abstinence from sexual activity. Because most people are not okay with completely abstaining from sex, most people are at risk for contracting HSV—this is fact. While condoms lessen the risk of transmission, they do not offer full protection from the virus as it can spread from mere skin-to-skin contact. Millions of people have contracted and continue to contract HSV while having protected sex.
HSV can also be acquired through oral sex. If someone has a cold sore on their lips while performing oral sex on their partner, they can actually infect their partner genitally (yes, it’s that easy). Usually, this is how genital HSV-1 occurs. In addition, it can also be possible to infect someone through oral sex without a cold sore visible via asymptomatic shedding of the virus. While a reasonable amount of people (though not anywhere close to all) use protection during sexual intercourse, few to none use protection during oral sex. Sexually active people, whether they know it or not, put themselves at risk daily for contracting HSV. The risk is always there.
In the United States of America alone, 16% of society carries HSV-2. For the record, that’s over 25 million people and counting. As far as HSV-1 goes, we’re looking at a whopping 80%—well over half of the population! Considering these numbers, it’s actually uncommon to not have HSV, rather than the other way around. If you’ve kissed 2 or more people, you’ve already kissed someone with HSV, whether you knew it or not. If you’ve had sex with 4 or more people, you’ve already had sex with someone with HSV, whether you knew it or not.
The United Kingdom has similar percentages, except their HSV-1 rate is higher by 10% or so. In Italy, it’s estimated that around 90% of the population carries HSV-1. In total, about 2/3 or 67% (upwards of 80%) of the entire world carries it. HSV is everywhere.
If it’s so common, you may be wondering why it can seem so rare at times. This is because many people who are HSV+ are asymptomatic—they do not have herpes symptoms, and therefore have absolutely no idea that they carry the virus. Other times, they have symptoms so mild that they’re unnoticeable or mistaken for something else, including but not limited to allergic reaction, skin irritation, jock itch, etc. Of course, it also doesn’t help that HSV testing is not included in the standard STI (sexually transmitted infection) checkup. People that are responsible enough to get tested may have HSV and still not know about it because of this. So, a week or two later when they come out negative, they think they’re good and continue to spread the virus unknowingly via asymptomatic shedding.
Let’s not get started on individuals who don’t get tested and continue to have sex with multiple partners. The head-in-the-sand approach seems to be a popular choice among people these days. After all, ignorance is bliss, right? (Wrong.) Try telling yourself that after you have full-blown AIDS, when you could have caught HIV in time and actually saved your life. Or, tell yourself that ignorance is bliss when investing your savings and retirement fund in the stock market without doing any research first. Yeah… that should turn out well…
So, please, get tested, and also request the HSV-specific blood test called the “IgG” while you’re at it. This ensures that you get all the information regarding your sexual health, for the sake of both yourself and your partner(s).
In essence, most people carry the virus, but only a few people realize it. So, the next time you hear someone say they are HSV+, just know that they aren’t different because they have HSV—they’re different because they’re aware that they have HSV. Nothing more, nothing less.
As we talked about earlier, the only fail-proof way to prevent HSV is to abstain from sexual activity. And actually, that’s not even entirely true, as millions of people contract oral HSV-1 through friendly kisses from friends and family members (often as young kids). So, honestly, the only way to completely prevent yourself from getting HSV is to abstain from human contact altogether. Unless you plan on moving to the jungle sometime soon (in which case, you’ll have much bigger problems to worry about), avoiding human contact isn’t very realistic. (Oh, and animals get HSV, too, by the way. Just FYI.)
The upside is that HSV is a mostly harmless virus, and the social stigma attached to it is falsely manufactured out of pure public ignorance. If some crazy guy on the street came up to you and started yelling that the world was going to end, would you believe him? People have been saying that since the beginning of time, yet here we are. The same is essentially true for HSV—don’t believe the hype. Most people have no idea what they’re talking about when it comes to the subject, anyway. There really isn’t much to fear. In fact, what you should be scared of most is false information provided by people who haven’t done their research. End of story.
To minimize transmission during physical intimacy, including but not limited to sexual activity, there are a few things to keep in mind. Although nothing is 100% except fully abstaining from human contact (yes, human contact—not just sexual contact), as explained earlier, it is still in your power (or the power of your partner, depending on who’s positive and who’s negative) to significantly lessen the chances of contracting HSV.
A few things are obvious. If someone has a visible cold sore on their mouth—generally on the lips—you should avoid kissing and oral sex until it clears up. While it is still possible to spread the virus via asymptomatic shedding, it’s much less likely. On top of that, with well over half the population being infected orally, that’s about as safe as you’re going to get. Actually, there is a way to be safer, and that will be shown momentarily (and don’t worry, it’s not abstinence).
The first rule of sexual intercourse is pretty similar: no sex during an active outbreak. When you’re not having an outbreak, however, there are precautions you can take to exponentially decrease chances of transmission—so much that it’s literally safer to have sex with an HSV+ individual that is aware of their status, rather than a complete stranger. Oh, and to clarify “complete stranger,” just to avoid any confusion or possible twisting of words, this is referring to someone whose sexual health you do not completely know.
A “complete stranger” is not necessarily a random person you picked up a bar or party and barely learned their name before hopping in the sack, although that would certain qualify as well. In this situation, it’s simply someone whose official health records you have not seen with your own two eyes, along with some kind of assurance that those health records were confirmed after their most recent sexual partner. Not great chances, we know. Yet, this is honestly the reality of sex, and anything else you may have previously believed is essentially nothing more than a fairy tale or Hollywood propaganda. So, considering what’s just been said, almost everyone—even people you have known for years—can and most likely do qualify as “complete strangers” sexually.
If this concerns you, and it should (not even just for HSV anymore, but for potentially life-threatening infections such as HIV/AIDS), there is hope. HSV+ individuals that are aware of their status generally tend to take better of their sexual health than most people. This is because they have already had a “scare” (HSV), then consequently realize how lucky they are to only have something as minor as HSV—a mostly harmless, oftentimes asymptomatic virus—and in turn become extremely responsible sexually. At the same time, a large portion of society continues to have sex while remaining completely unaware of their sexual health, because they still live in fantasy-land created by the movies they’ve seen and music they listen to. “Bad things won’t happen to me,” or, “this doesn’t apply to me” are a couple of thoughts prevalent in the average person’s mind. Wrong and wrong.
The (seriously) good news about being involved romantically or sexually with someone that’s aware of their HSV+ status, is that you can both take the precautions necessary to practically destroy any chances of transmission. In an ironic way, this is actually what makes sex with an HSV+ partner safer than sex with someone else whose recent and proper medical documents you have not examined. When active outbreaks aren’t occurring, use of anti-viral medication such as Valtrex or Aciclovir, combined with “protection” (condoms) almost completely kill your chances of transmission—especially when used together.
To give you a realistic idea that demonstrates exactly how much safer sex with an HSV+ partner is, take a look at the numbers provided by scientific studies.
By avoiding sex during an active outbreak, chances of virus transmission are 4% a year (Terri Warren, RN, NP – WebMD, 2005). Yes, per year, not sexual session. Dividing this figure by 365 days (or nights), this makes the possibility of spreading the virus on any given day/night .0001%, or 1/10,000 (.04 / 365 = 0.000109589041).
If also using condoms or anti-viral drugs, it cuts those already-staggering odds in half to 2% a year. The possibility of spreading HSV on any given night would then become 1/20,000. To put this in perspective, you have a better chance of literally dying in a car accident tomorrow on your way to school or work (1/18,585), although, surely this “risk” won’t stop you from driving. 1 in 18,000… driving seems pretty safe, doesn’t it? The fact that you will still drive your car (or ride in cars) after reading this article is proof that you agree.
[Herpes Opportunity note: I don’t agree with this guest article’s math logic. For example, if the chances of transmission are 4% a year, dividing that by 365 doesn’t accurately reflect your chances of transmission. If it’s 4% year-round, then it’s also 4% at any given moment.]
It’s cool, though, because you’d be right. Driving is pretty safe. Just remember: having a knowledgeable HSV+ partner is safer. If you’re not scared to drive, you are agreeing to this by default.
With the use of both simultaneously (condoms and anti-viral drugs), it cuts the number in half once again: a mere 1% chance of transmitting the virus per annual basis. On any given night, we’re now entertaining a “risk” of 1/40,000. You now have better odds of becoming a pro athlete (1/22,000). Do you plan on signing that million-dollar contract anytime soon?
Didn’t think so.
Simply put: 99% odds are excellent. If you had a 99% chance of winning the lottery, would you buy a ticket? You’d be crazy not to. There’s no arguing with that.
Therefore, considering that the only (truly) guaranteed thing in life is death, 99% odds are as solid as it gets. 96% is pretty assuring as well. Plus, people that are aware of their HSV+ status generally tend to notice even the mildest of symptoms, including prodrome symptoms. Because of this, they are much more likely to recognize when an outbreak is about to occur, and can then inform their partner in time to knock transmission rates down to 1-4% per year by abstaining from sex temporarily.
For females, the chances of contracting HSV are slightly higher, but not by much. Ideally, we’re looking at about 98% prevention instead of 99% (“risk” is doubled because of increased point of contact). Hardly a significant difference overall, though.
On the contrary, “strangers” or people unaware of their status, can have the lightest outbreak the world has ever seen yet end up spreading the virus because they have no idea what’s going on, or that they’re even positive in the first place. This, along with asymptomatic shedding (generally from those not taking anti-viral medication), is how most people actually get HSV to begin with.
If you get anything out of this, it should be this: most people contract HSV from people who do not know they are infected, rather than from people who are aware of their status and hence bring it up for discussion. With this in mind, do not be scared off by “the herpes talk” (whether you are giving it or listening). The information is clear: the former person is risky, and the latter person is safe as long as the proper precautions are taken. The numbers speak for themselves.
Finally, one last friendly reminder: just because you do not discuss each other’s sexual health prior to engaging in sexual activity does not make you okay. And, it certainly doesn’t mean that you and your partner are clear of HSV… or anything else for that matter. Always be smart, responsible, and respectful of your partner (HSV+ or HSV-)—and your love life will be amazing. Awareness and education in addition to honest and consistent communication make HSV a virtual non-issue in any relationship.
Taking relationships to the next level, it’s time to discuss the possibilities of starting a family. This brings up the inevitable worries of HSV and pregnancy.
Before we go any further on this topic, just know that (as usual) everything is good. Do you think the world would be nearly as populated as it is today if only HSV- people had kids? If that was the case, this planet wouldn’t currently hold 7 billion people… that’s for sure. So, obviously it happens, and it happens often—like every day.
Having said that, it’s great that you’re concerned about the health of your future child (or children). That shows you’ll be a good parent. However, it’s not logical or healthy for you to worry needlessly, so we’re going to clear everything up.
First and foremost, if you plan to get pregnant, or suspect that you’re pregnant, inform your doctor about your HSV+ status. This way, they can give you their professional opinion and thoughts regarding necessary precautions. You do not want to keep your physician in the dark about this.
During pregnancy, it’s usually recommended that you take anti-viral medication on a regular basis—if you haven’t been doing so already. At the absolute very least, it’s important to begin taking it a couple months before delivery. This will help to ensure you remain outbreak-free during the time of childbirth.
While neonatal herpes can be fatal since an infant’s immune system is so undeveloped, it is extremely rare. Medical doctor Zane Brown, an expert on neonatal herpes and a member of the Department of Obstetrics and Gynecology at the University of Washington, has been quoted saying: “Neonatal herpes is a remarkably rare event.” To give you an idea of how uncommon this type of transmission is, we’re looking at odds of less than 0.1%.
Like information about HSV in general, most of the fear associated with childbirth transmission is falsely manufactured out of ignorance. Remember: believe the research, not the hype. The former is grounded on fact, the latter on fiction.
Additional good news for being HSV+ and pregnant is that if you contracted HSV prior to pregnancy (rather than during), your odds of transmission colossally decrease to about .04% (Randolph, JAMA, 1993). This is assuming that you are still outbreak-free at the time of childbirth, of course.
For situations where the woman is having an outbreak during time of delivery, the doctor can perform a Caesarean section, or C-section, to prevent the child from contracting the virus. HSV or not, women have C-sections all the time, so there really isn’t anything too crazy about this.
All in all, it’s not necessary to stress about passing the virus to your baby. Aside from empowering the virus, stress just makes life in general worse. Inform your physician of the situation and take the proper precautions to ensure safety—and everything will be fine. You deserve to have a family if you want one, and HSV is not going to get in your way.
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