Everything You Need to Know About Herpes and How to Get Tested for It
An estimated 90 percent of the population will be exposed to the virus by age 50—yet, most people know nothing about it.
If there's anything shrouded in more #fakenews than the 2016 election or Lady Gaga's relationship with Bradley Cooper after the release of A Star Is Born, it's herpes.
Sure, most people can tell you herpes is a sexually transmitted infection (STI). But beyond that, many don't know how it's spread, how you can protect yourself, or even if they have it. This is a real fail on the part of our sexual health system considering the virus is super common—as in, an estimated 50 to 80 percent of the adult population is currently living with herpes and 90 percent will be exposed to the virus by age 50, common, according to John's Hopkins Medicine.
To suss out the facts from urban legend, three doctors who specialize in sexual health are here to break down this super-duper-common STI. Below, learn exactly what herpes is, the symptoms of herpes, how it's spread, how to get tested for herpes, and why most doctors won't do a herpes test unless you explicitly request it (wild, right?).
What Is Herpes, Exactly?
Let's start with what you (likely) already know: Herpes is a sexually transmitted infection spread by skin-to-skin contact. More specifically, herpes is a viral STI, explains Kimberly Langdon, M.D., ob-gyn, medical advisor to Parenting Pod. Meaning, unlike bacterial STIs (i.e. chlamydia or gonorrhea) that can be completely cured with antibiotics, herpes stays in the nervous system once you get it (like chickenpox or HPV). So, no, herpes does not go away.
But that sounds way scarier than it is! "The virus can be or become dormant, which means that some people can have the virus but go years between outbreaks, while others never even have an initial outbreak," she explains. Plus, there are ways to manage the virus (more on that below) so having a happy, healthy, pleasure-filled sex life is totally possible. Translation: You could have herpes and never have had symptoms, and thus have no idea.
Some data suggests that there are more than 100 strains of the herpes virus. There are eight that affect humans, including strains that cause chickenpox, shingles, and mono, but you've probably only heard of two: HSV-1 and HSV-2.
What's the Difference Between HSV1 and HSV2?
Gladdddd you asked! HSV-1 and HSV-2 two are slightly different strains of the same viral family. While you may have heard folks claim that HSV-1 = oral herpes, while HSV-2 = genital herpes, that oversimplification isn't quite accurate. (Hey, no shade, fake news might be more contagious than a virus!)
The viral strain HSV-1 typically prefers the oral mucus membranes (aka your mouth), while the viral strain HSV-2 typically prefers the genital mucus membranes (aka your junk). (A mucus membrane is a moist lining with glands that make mucus, a thick, slippery fluid—and it's the type of surface where some STIs thrive.) But that doesn't mean those strains can only infect those specific spots, explains Felice Gersh, M.D., author of PCOS SOS: A Gynecologist's Lifeline to Naturally Restore Your Rhythms, Hormones, and Happiness.
Let's say, for instance, someone with HSV-1 oral herpes gives barrier-free (read: no condoms or dental dam) oral sex to their partner. That partner could contract HSV-1 on their genitals. In fact, "nowadays, HSV-1 is the leading cause of genital herpes," says Dr. Gersh. It's also possible for HSV-2 to infect the mouth and lips. (Related: Everything You Should Probably Know About Oral STDs, But Probably Don't)
Dr. Gersh's personal hypothesis is that many people don't know that cold sores (sometimes called fever blisters) are a type of herpes, so don't think twice about giving their partner (barrier-free) oral sex when they have a blister, and many people with genital herpes don't know they have it, so don't think twice about receiving oral sex. (Again, no shade—you probably had no idea.) Which brings us to the question...
How Do You Know If You Have Herpes?
We'll say it again for the people in the back: You can't tell whether or not you (or anyone else!) has an STI just by looking at them or their junk—and that includes herpes. In fact, according to Dr. Gersh, somewhere between 75 and 90 percent of people with herpes report being completely asymptomatic.
Though most cases are asymptomatic, the main symptom of herpes is herpes sores, which are typically a group of slightly itchy/tingly/or painful blisters/bumps on around the lips, vagina, cervix, penis, bum, perineum, anus, or thigh.
Other symptoms of herpes include:
- Swollen lymph nodes
- Headache or body aches
- Pain while peeing
- Muscle pain
- General exhaustion
When symptoms occur it's known as a "herpes outbreak." Some people will only have one outbreak in their life! And even for those who have subsequent outbreaks, Dr. Gersh says the first outbreak is usually the worst. That's because during the first outbreak (known as the 'primary infection'), the body develops antibodies that help the immune system fight off the infection, she says. That's why things that impede the immune system such as stress (physical or emotional), hormonal fluctuations (such a menstruation, pregnancy, or birth control changes), exposure to temperature change, and having other infections can trigger subsequent outbreaks or result in outbreaks lasting longer.
But, this is important: It's very possible for herpes to be contracted or transmitted in the absence of any symptoms, due to something called, 'viral shedding' (when a virus is replicating inside your body and viral cells are then released into the environment). So, the only way to know if you have herpes is to get tested. (Related: How Often Should You Actually Get Tested for STDs?)
How to Get Tested for Herpes
If you have visible herpes sores, your doctor can perform a swab test. This involves swabbing an open blister (or opening a blister to swab the fluid inside), then sending the collection to a lab for something called a polymerase chain reaction (PCR) test, which can detect HSV. (That said, your doctor may be able to diagnose you just by looking at the sore, according to the Centers for Disease Control and Prevention or CDC.)
If there are no sores present, a swab test doesn't work; "a random culture of skin or the inside of the vagina or mouth would likely be fruitless," says Dr. Langdon. Instead, the doctor could (note: could, not will) do a blood test and test your blood for HSV-1 or HSV-2 antibodies. Your body naturally produces antibodies in response to foreign invaders (like the herpes viral cells) to help fight off the infection. If antibodies are present, it indicates that you've been exposed to the virus. "A blood test can also be used if sores are present," says Dr. Langdon.
Why Doctors Don't Always Test for Herpes
Here's where it gets tricky: Even when you go to the doctor to get STI tested, many many many healthcare providers don't test for herpes. Yep, even if you say: "Test me for everything!"
Why? Because the CDC only recommends testing people who are currently experiencing genital symptoms. What gives?
For starters, the CDC recommends STD testing for gonorrhea and chlamydia with or without symptoms because if left untreated, those can have serious health outcomes. (Think: pelvic inflammatory disease, infertility, and complications during pregnancy.) Herpes, on the other hand, does not lead to any serious health problems. (Let that sink in). "As far as we know, there are absolutely no long-term health impacts of having herpes," says Dr. Gersh. And while outbreaks can be uncomfortable, she says most people only have a few outbreaks in their life. (Related: Can an STI Go Away On Its Own?)
Second, diagnosing genital herpes in someone without symptoms hasn't shown any change in their sexual behavior—such as wearing a condom or abstaining from sex—nor has it stopped the virus from spreading, according to the CDC. Basically, their point of view is that folks are crummy at using protection (which, for the record, greatly reduces the spread of STIs when used correctly), and a positive diagnosis doesn't make a difference in the virus' spread through the population.
Finally, it's possible to get a false-positive blood test result (again, that's the type of test that needs to be done in the absence of symptoms). Meaning, you could test positively for HSV antibodies when you don't actually have the virus, according to the CDC. Why? Your body creates two different antibodies in response to the herpes virus that factor into herpes antibody tests: IgG and IgM antibodies, according to the American Sexual Health Association (ASHA). Tests for each of these antibodies have a few different issues. IgM tests can produce false positives because they sometimes cross-react with other herpes viruses (ex: chickenpox or mono), cannot accurately distinguish between HSV-1 and HSV-2 antibodies, and IgM antibodies don't always appear in blood tests even during a known herpes outbreak, according to the ASHA. IgG antibody tests are more accurate and can distinguish between HSV-1 and HSV-2 antibodies; however, the time it takes for IgG antibodies to reach detectable levels can vary from person to person (from weeks to months), and it also can't determine whether the site of infection is oral or genital, according to the ASHA.
It's worth mentioning that viral swabs and PCR tests, which can be done when sores are present, are incredibly accurate, according to Dr. Gersh.
So Should You Get Tested for Herpes Even If You Don't Have Symptoms?
Doctors fall in two camps here. "While a herpes infection is generally relatively benign and no big deal, in my opinion, it's best for folks to know the state of their own body," says Dr. Gersh.
Other doctors counter that there's no benefit to herpes testing without the presence of symptoms. "From a medical standpoint, [testing for herpes without symptoms] is unnecessary," says Sheila Loanzon, M.D., author of Yes, I Have Herpes and a board-certified ob-gyn with more than 15 years of patient and personal experience diagnosing herpes. "And due to the stigma of the virus, the diagnosis can be detrimental to a person's wellbeing and create unnecessary shame, mental-anguish, and stress." Considering stress has been linked to a host of health issues such as increased risk of stroke, chronic diseases, heart attack, and more, a diagnosis may actually do more harm than good.
Whether or not you ask your doctor to test you for herpes is up to you. Symptoms or not, you absolutely have the right to know your HSV status. So, if you're curious, take a stand and explicitly ask your doctor to test you for herpes. Note: At-home STD testing is now super easy, and many companies include an at-home herpes test—usually a PCR blood test—as part of their offerings. That said, home herpes testing offerings vary by company; for example, some only test for one strain of the virus, some offering post-diagnosis counseling, etc.
However, before you decide to get tested, spend some time unlearning some of the HSV-stigma currently ingrained in the culture. "The amount of stigma around herpes is absolutely ridiculous; there's nothing shameful about having a virus," says Dr. Gersh. "Shaming someone for having herpes is as ridiculous as shaming someone for having the coronavirus." Especially when such a huge chunk of the population has it or likely will contract it in their lifetime.
Following shame-free STI-information Instagram accounts such as @sexelducation, @hsvinthecity, @Honmychest, watching Ella Dawson's TedTalk "STIs Aren't a Consequence, They're Inevitable," and listening to the podcast Something Positive for Positive People are good places to start.
You may also want to think about what you'll do with that information. "If you test positive, have never had an outbreak, and don't have a partner with the antibodies, it can be really hard to know what to do with the information," says Dr. Loanzon. For example, are you going to take antiviral medication (more on that, below) for the rest of your life even if you've never had an outbreak? Will you and your partner start using condoms and dental dams if you've never used them before? Will you tell all your previous partners about the diagnosis? These are all questions you'll have to address with a positive diagnosis. Ask yourself: What would you want a partner do to if they were in your situation? Arming yourself with the facts—and addressing the stigma head-on, so you both see the full picture and not just the diagnosis—can go far. (See More: Your Guide to Dealing with a Positive STI Diagnosis)
How Do You Treat Herpes?
Herpes can't be cured and does not "go away." But the virus can be managed.
If you test positive, you might take an antiviral drug such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). "These can be taken to prevent outbreaks or can be started with the onset of symptoms to lessen the severity and duration," explains Dr. Langdon. (Tingling and soreness in the area where herpes is present and low-grade fever are common right before a blister appears, she says.)
When taken correctly, drugs can greatly reduce the risk of transmission to a partner, according to research. However, they do not make the infection totally non-contagious. Remember: Herpes may be more contagious when symptoms are present, but it is contagious even when no symptoms are present, according to Planned Parenthood.
Of course, there are many valid reasons someone might not want to take an anti-viral. "Some people find taking medicine every day triggering, or feel that it reminds them of their diagnosis in an upsetting way," says Dr. Loanzon. "Others have outbreaks so infrequently that it doesn't make sense for them to take something 365 days a year for a virus that only pops up every few years." And remember, that some people only have one outbreak ever. Plus, some people might not be sexually active, so the risk of transmission is a non-issue.
Regardless of whether or not you decide to take medicine, "whether you've had an oral herpes outbreak or a genital herpes outbreak or not, it's best to disclose your HSV-status to your partner because you can be asymptomatic and still pass along the infection," says Dr. Gersh. That way your partner can make an informed decision about what kind of safer sex practices you're going to use. (BTW: Here's How to Have the Safest Sex Possible Every Time You Get Busy)
The Bottom Line
If you're experiencing herpes symptoms, getting tested for herpes can help you get the treatment (or peace of mind) you need to minimize discomfort and rule out other issues. (After all, there are a lot of reasons you might be experiencing random bumps on or around your vagina.) Without symptoms, it's your decision whether or not you want to get tested for herpes—knowing that a positive diagnosis comes with its own set of consequences.
Ultimately, what's most important is that you understand that unless you *explicitly* request a herpes test, your doctor likely is not including it in your regular STI panel.