What to know about the sexually transmitted infection, in light of the scandalous headlines about Usher.

February 29, 2016

Singer and songwriter Usher allegedly paid $1.1 million in 2012 to settle a lawsuit alleging that he “consciously and purposefully” withheld a diagnosis of genital herpes from a woman he was having unprotected sex with, People reported yesterday. The woman reportedly developed symptoms of the disease and said she feels her "health and body have been ruined.”

Amidst the gossip and gory details, there are important lessons to learn from this story, say doctors who regularly treat and council patients about sexually transmitted infections (STIs)—as well as some misconceptions about living with a disease like herpes. Here are seven things experts want everyone to know.

Herpes is very common—and often hidden

Genital herpes is caused by two viruses, herpes simplex virus (HSV) type 1 and type 2. HSV-1 also causes cold sores or fever blisters around the mouth, “but the disease trends have changed over time and now they can both cause genital sores,” says Talia Swartz, MD, assistant professor of infectious diseases at the Icahn School of Medicine at Mount Sinai in New York City.

When it comes to STIs, herpes is one of the most notorious. But in most cases, genital herpes is a “manageable infection without long-term physical health consequences,” says Christine Johnston, MD, associate professor of allergy and infectious diseases at the University of Washington. It’s also surprisingly common: About one in six American adults has HSV-2—and even more have HSV-1—though most people don't realize it.

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The pain of herpes can be more emotional than physical

"I don't know why genital herpes has this pariah, fearful component to it," says H. Hunter Handsfield, MD, professor emeritus of medicine at the University of Washington Center for AIDS and STD. "People are more afraid of herpes than they are of chlamydia, and in the long run chlamydia is more likely to cause serious damage to their reproductive and general health than herpes ever is."

But getting a herpes diagnosis does come with emotional baggage. “If you are infected you have a duty to warn partners and that is a big deal for lots of people,” Dr. Handsfield adds. “You’re impairing the natural development of a relationship, which is a big psychological burden for people to carry.”

It’s usually spread by people who don’t have symptoms

Most people with genital herpes don’t know they’re infected, says Dr. Johnston, and the disease is usually spread “during periods of asymptomatic shedding, when people do not have symptoms.” Women are at higher risk of contracting herpes than men, and risk increases for people with higher numbers of lifetime sexual partners.

“It is true that the partner can lie and say they are clean, but the story we hear more often is that the partner did not know they had the infection,” says Dr. Johnston. Warning signs can include genital blisters and open sores, she adds, “but the findings can often be subtle.” There is also a blood test that can diagnose herpes—but because false-positives are possible, it’s generally only recommended for people who have symptoms or who know they’ve been exposed to the virus.

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Condoms and antiviral meds can reduce transmission risk

Using a condom can decrease the risk of spreading or acquiring genital herpes—but it’s not 100% effective, says Dr. Swartz, because the virus can be on parts of the genital area that are still exposed. For people who know they have an infection, taking daily antiviral medication can also cut the risk of spreading it to partners.

In a 2005 study from the University of North Carolina, researchers followed couples (in which one partner had genital herpes) for eight months. All couples were offered condoms, but half of the infected partners took the antiviral drug Valacyclovir (Valtrex), while the other half took a placebo. Overall, use of antiviral medicines reduced the risk of transmission between partners by 48%—from 3.6% in the placebo group to 1.9% in the medication group.

Symptoms can be serious, mild, or non-existent

Some people won’t have their first herpes outbreak for months or years after transmission. (Because of that, says Dr. Johnston, it can be very difficult to identify the source.) For others, symptoms can appear as early as six days after infection, and can include pain and blisters in the genital area, pain with urination, and fever, chills, headache, and lymph-node swelling.

According to court papers in the newly revealed case against Usher, his partner claimed she noticed a “greenish discharge” coming from the singer’s penis. However, says Dr. Handsfield (who has not treated Usher or the woman in the lawsuit), urethral discharge is not a typical symptom of herpes infection.

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There are a few serious risks

In developing countries, genital herpes can double a person’s risk of contracting HIV if he or she is exposed to it, says Dr. Handsfield, although that’s not the case in the United States, especially not for heterosexual men and women. “Herpes helps drive the AIDS epidemic internationally,” he says.

And although it’s rare, herpes can be transmitted from mothers to babies as they travel through the birth canal. Even less frequently, infants can pick up a herpes infection from skin-to-skin or mouth-to-skin contact with another person. These are serious concerns, because newborns can develop dangerous or even fatal complications when infected with the herpes virus. An infant’s death in Iowa was recently attributed to meningitis caused by HSV-1, believed to have been transmitted from by a kiss.

Treatment can help patients and their partners

There’s no cure for herpes, but antiviral drugs can reduce the intensity and duration of symptoms, and—if taken daily—can also reduce the frequency of outbreaks. In 2006, the FDA also approved famciclovir (Famvir) as the first one-day treatment of symptomatic herpes.

Vaccines for herpes are also being investigated, and preliminary study results have suggested that vaccination may be an effective way to prevent infection in young girls, says Dr. Schwartz. It may be years, however, before any are commercially available.