The Five Most Common Herpes Questions

... at least the five most common questions asked of your Guide to STDs.

When I give talks about sexually transmitted diseases, people generally have more questions about herpes than they do about any other STD. In part that reflects the stigma associated with the virus, which makes it very difficult for people to talk about. However, it also reflects the vast quantity of misinformation that's out there. For a pair of diseases that affect such a large proportion of the population, there's a lot about both genital and oral herpes that most people just don't know.

Can people get genital herpes from oral sex?

Condom on a banana. Photo: r4v3n / stockxpert

When I talk to people about the risks of oral sex, one of the things that they're most surprised to hear is that cold sores can be transmitted to the genitals during oral sex. In fact, genital HSV-1 is a growing problem in the United States. Some scientists estimate that more than half of all genital herpes cases will soon be caused by what was once known as the oral herpes or cold sore virus.

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I've heard that genital HSV-1 isn't a big deal, is that true?

Herpes Virus, artwork. David Mack/Science Photo Library/Getty Images

There is a myth that if you are infected with genital HSV-1, as opposed to HSV-2, that you will only ever have one outbreak and then never have problems again. While it's true that genital HSV-1 is somewhat less likely to be symptomatic than genital HSV-2, people with either viral infection can have multiple outbreaks of similar severity. There is no way to tell whether someone has HSV-1 or HSV-2 genitally just by looking at symptoms. Furthermore, in general, most people with genital herpes experience fewer and less severe outbreaks over time - independent of which virus they're infected with.

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Doctors don't care enough to work on a herpes cure, right?

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You'd be surprised at how often people tell me that the only reason there isn't a cure for herpes or a vaccine is that doctors and scientists don't care. It's not true. People are working on both cures and vaccines, but herpes is a hard target. With HPVvaccine development was relatively certain to work, since most people fight off HPV infections on their own.

However, antibodies or no antibodies, herpes infections are thought to be for life. That means there's no easy path for getting a vaccine. Still, anyone who came up with a successful vaccine or cure would likely receive both fame and fortune. There's a huge market out there for either one and no financial benefit to be gained by holding them back.

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If I Have Cold Sores (HSV1) Am I Protected Against Genital Herpes (HSV2)?

herpes cold sore on face
Herpes Cold Sore on Face. Todd Keith/E+/Getty Images

A lot of people believe that if they have cold sores, they can't also be infected with genital herpes. Unfortunately, it's not true. People can be infected with herpes in multiple locations.

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Why don't doctors test for genital herpes?

Doctor with male patient. Image Source/Photodisc/Getty Images

There are a number of reasons why doctors don't test for genital herpes. However, they mostly come back to the following concern:

Doctors worry that the stigma associated with a herpes diagnosis is so devastating that it puts people at risk of serious emotional harm, when there's not necessarily a huge benefit to their knowing they're infected if they don't have symptoms.

I don't necessarily agree with that concern, but I do understand it. People are worried about false positives causing needless stress and depression. They're also concerned about true positives causing shame and stigma for people who might otherwise never have known they were infected.

Personally, I think that more screening, and awareness of how common herpes is, could help to reduce the stigma. I also think there's a value in people knowing whether or not they're infected when they negotiate their sexual relationships. There may not be a cure for herpes, and condoms may not be fully effective in stopping transmission, but there are ways to reduce partner risk - including both suppressive therapy and condom use. Unfortunately, for such conversations to be possible, people need to be able to talk about herpes with less shame and less judgement. That requires a shift in social norms that may still be decades away.

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Bernstein DI, Bellamy AR, Hook EW 3rd, Levin MJ, Wald A, Ewell MG, Wolff PA, Deal CD, Heineman TC, Dubin G, Belshe RB. Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women. Clin Infect Dis. 2013 Feb;56(3):344-51.
Peña KC, Adelson ME, Mordechai E, Blaho JA. Genital herpes simplex virus type 1 in women: detection in cervicovaginal specimens from gynecological practices in the United States. J Clin Microbiol. 2010 Jan;48(1):150-3.

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