What is herpes? Should I get tested for it?
What is herpes?
“Herpes” usually refers to one of two viral infections: oral herpes, which generally causes oozing and blistering sores (often called cold sores) in and around the mouth; or genital herpes, which generally presents as oozing and blistering sores in and around the genitals.
There are two strains of herpes, herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2), and both can cause either oral or genital herpes. That said, a lot of information about HSV will associate HSV-1 with oral herpes, of which it is most often the cause, and HSV-2 with genital herpes. Both viruses are transmitted through skin-to-skin contact - like kissing, oral sex, vaginal and anal sex.
HSV-1 and HSV-2 are in the same family as herpes zoster (VZV), which is known as chickenpox the first time you get it, or shingles when it happens later in life. Like many viral infections, there’s no cure - your immune system can keep the virus at bay, but it stays dormant or asleep in your body. If you had chickenpox as a kid, you might remember adults around you wanting you to get chickenpox. That’s because shingles can be very painful, so developing a resistance to chickenpox as a child makes you more likely to resist shingles as an adult.
How many people have herpes?
It’s estimated that worldwide, two thirds of people under the age of 50 test positive for HSV-1; it is usually passed on in childhood via hugs and kisses from relatives. In the US, an estimated 70-80% of people are carriers of HSV-1, and an estimated 16% are carriers of HSV-2. Statistically, it’s very likely that you, dear reader, are a carrier of one or both viruses.
So why aren’t herpes sores a more common occurrence?
That’s because most carriers have no symptoms, or very mild symptoms that can go unnoticed or be mistaken for other ailments. Unfortunately, you can still pass the virus on to others even if you’ve never had symptoms. And that means the vast majority of people who have either HSV-1 or HSV-2 don’t know they have it - in the case of HSV-2, almost 90% are unaware. The only way to know is a blood test or a test of an open sore, and the US Preventive Services Task Force doesn’t recommend being screened for the virus unless you’re showing symptoms.
Okay, so you’ve learned that we all probably have herpes, and we can get it from someone who doesn’t know they have it, or spread it to people without knowing we have it. But not all carriers are created equal: you are far more likely to transmit the virus if you have frequent outbreaks, and most likely to spread it if you currently have an outbreak.
The numbers here are for HSV-2, since it is most frequently associated with genital herpes, which is less common than oral herpes. People who have frequent outbreaks (more than eight per year) are contagious about 31% of the time, and people who have one to seven outbreaks a year are contagious about 19% of the time. For both groups, the risk of spreading the virus goes up if they’re having an active outbreak. But even people who have no symptoms are still contagious about 10% of the time.
What can you do to protect yourself and others? First of all, if you know you have either HSV-1 or HSV-2, it’s your responsibility to disclose that status to partners past and future. Even if you don’t know your status, using safer sex practices like condoms and dental dams can reduce your risk of getting (or passing on!) HSV. Avoid skin-to-skin contact with the affected areas if you’re having an outbreak. Medication can help you control the frequency and severity of outbreaks.
Should I get the blood test even if I’ve never had an outbreak?
To recap: routine screenings are not recommended. In other words, if you’ve never had an outbreak, it’s not recommended to get the blood test. Most people are carriers of HSV, and received it through non-sexual means. Most people who have it don’t know they’re infected, and don’t show any symptoms. Plus, if the blood test comes back positive with only HSV-1 or HSV-2 there is no way for you to know if you have oral herpes or genital herpes. If you’re concerned about having the virus, and want to get tested, talk to a doctor about whether it makes sense to do a blood test.
The Centers for Disease Control and Prevention (CDC) [doesn’t recommend routine screenings]((https://www.cdc.gov/std/herpes/screening.htm) for HSV-2:
There is no evidence that diagnosing genital herpes with a blood test in someone without symptoms would change their sexual behavior and stop the virus from spreading. In addition, without knowing the benefits of testing, the risk of shaming and stigmatizing people outweighs the potential benefits. For these reasons, testing everyone for herpes is not recommended at this time.
So if you don’t have any symptoms, just be aware: limit your sharing of straws, utensils, toothbrushes, etc. And use safer sex methods—even with oral sex, as HSV-1 can be spread from the mouth to the genitals. Doctors can often diagnose herpes just by looking at it, so if you have pus-filled, clustered sores on your mouth or genitals, make an appointment. Of course, if you find out a current or former partner tested positive, the CDC says you might want to get tested in that case.
The best way to test for HSV is by doing a swab of an open sore (as opposed to the blood tests) so if you have symptoms schedule an appointment to be seen in person as soon as possible.
Remember, you have to ask specifically to be tested for HSV-1 and/or HSV-2—for the reasons mentioned above, it’s not part of the routine testing for STIs that sexually active people should undergo on a regular basis. And as always, regardless of symptoms, if anxiety about HSV (or any other illness) is significantly impacting your life, it’s probably worth talking to a doctor just to ease your mind.