Why Herpes Isn't as Bad as You Think (and a Lot More Common)

The truth about the sexually transmitted infection millions of people have—but may not know it.

Few conditions have as scary a reputation as genital herpes. But for all the fear (and even lawsuits) this sexually transmitted infections (STIs) has caused, it really isn't as bad as serious or life-altering as most people think...and it's actually a lot more common than you'd imagine, especially since many people who have it don't even know they are infected.

With the help of doctors and specialists, we've broken down the 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 one of two viruses, either herpes simplex virus (HSV) type 1 or 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,” Talia Swartz, MD, assistant professor of infectious diseases at the Icahn School of Medicine at Mount Sinai in New York City, tells Health.

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

The pain of herpes can be more emotional than physical

"I don't know why genital herpes has this pariah, fearful component to it," H. Hunter Handsfield, MD, professor emeritus of medicine at the University of Washington Center for AIDS and STD, tells Health. "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,” says Dr. Handsfield. “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 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.

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 odds of spreading it to partners.

In one 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 nonexistent

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.

Herpes has 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.

Although it’s rare, herpes can be transmitted from mothers to babies as they travel through the birth canal during delivery. 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.

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. Besides Valtrex, the FDA has also approved famciclovir (Famvir) as a one-day treatment of symptomatic herpes.

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