Liz: We get a lot of questions about herpes and especially with polyamory, how do you know if you’re at risk, who has it, how common is it, how do you prevent it, all of those questions and more. This is Cathy Vartuli from The Intimacy Dojo.
Cathy: And this Dr. Liz from Sex-Positive Psych. And it’s a great question. And there’s a lot of confusion in this information out there and if you bring in multiple partners, how do you juggle all this? And herpes has got such – like I think all STIs have a lot of shame associated with them but herpes because there’s no way to cure it, there’s a lot of like, “oh no!”
Liz: It has some of the highest degrees of shame and stigma associated with it. So let’s get super science-y. So herpes is kind of an umbrella term for a whole family of viruses which includes stuff like chicken pox and shingles.
Cathy: Which I’ve had.
Liz: Right. I’ve had chicken pox. So when we talk about herpes, usually, we’re referring to HSV-1 or HSV-2, the herpes simplex viruses 1 and 2. The majority of people who have HSV-1 have oral symptoms or an oral infection. They may or may never have an outbreak of cold sores but generally, the infection is oral. The majority of people who have genital herpes have an HSV-2 infection.
Cathy: Right. And not everyone who gets cold sores actually has herpes. There are other ways you can get cold sores besides the herpes virus. But a large proportion of our society has herpes1, the oral kind. There are estimates between 50 to 80% and some people think as high as 90%.
Liz: Have HSV-1.
Cathy: Yeah. And once you’ve been exposed to it, that virus is present in your body.
Liz: And it’s difficult to actually diagnose unless you have an active outbreak because when they test you for it, they test you in a blood test. The majority of people who get STI screens, unless they specifically request a test for HSV, are not actually being tested for either of the herpes viruses.
So if you’ve gone to your doctor and said, “I want a full panel for STIs.” And you haven’t asked them specifically what’s in it, it’s unlikely that they tested you for HSV for several reasons.
One, the test is relatively expensive. So particularly if your insurance is covering it, they’re not going to want to pay for it unless there’s a reason that you think you’ve been exposed.
Two, the test only shows whether you’ve ever been exposed to the virus.
Cathy: Not if you are actually having outbreaks or …
Liz: Not if you’re having a natural infection even.
And three, there are – the results are not always reliable. So because of the stigma is so high for herpes …
Cathy: Shame in that.
Liz: … often that the effects that they have herpes is far more negative than the effects of them having been exposed to it once, never having any outbreaks and possibly never being at risk of transmitting it to anyone else.
Cathy: Yeah. The average person who has – gets herpes will have three to five outbreaks with less in the intensity with people with certain immune conditions or suppressed immunity, there can be some very painful or repeated outbreaks. So we’re not at all diminishing the pain those people go through but we also want to normalize.
Because I’ve had a client that called me up in a panic one time that she had found out she had gotten herpes and she was going to break up with her boyfriend and never have sex again. And it was heartbreaking to listen to her go through all of this and I just – we started talking about how many people have it, what she could do. There are drugs that can suppress the outbreaks. There are other things they can do. It’s a fact of being human that if we contact each other, a lot of people get herpes 1, the oral one, around their mouth from kissing at Christmas.
Cathy: And may not be having an outbreak. You can still spread it even if you’re not having an outbreak at the moment. So we believe that knowing the risks and we call it safer sex because it’s not – there’s no safe sex.
Liz: Well, there’s – so safer sex is one model. Another model is risk-aware sex which poses that looking at sex through a place of safety is not necessarily the best idea because when we talk about safer sex, generally, we’re referring only to like STI prevention when there are risks associated with sex that have to do with things that aren’t STIs.
Cathy: Pregnancy, being close to someone who might be an asshole.
Liz: Emotions, right? There are all kind of other physical risks. And so, when you’re making a decision about sex, you have to decide what level of risk you are willing to accept and that includes the risk that someone may not know what they have, that they may have contracted something they don’t know about that they may be dishonest with you and you have to make decisions about what you’re doing based on that level of risk, and accept accountability for the decisions that you made.
Cathy: About 40% of genital herpes is actually HSV-1 so that’s not just limited – it likes to be around moist areas so it generally lives around the mouth and the genitals.
Liz: And the genitals, yeah. There are some people who get HSV outbreaks in other places. I know someone who got an HSV outbreak on her hand.
Liz: It can happen anywhere.
Cathy: Less likely.
Liz: It’s less likely. It’s a skin to skin contact thing. So even if you use barriers for sex, you’re not necessarily preventing yourself from being exposed to HSV.
Cathy: It depends on where the virus is and there’s no really one good way to determine that unless you have an outbreak. So unless we wear full body condoms which I find not comfortable …
Liz: Not comfortable.
Cathy: … there’s no way to like eliminate that. So when we’re talking with people who are poly, you and I both work with a lot of people that are poly, there is the concern, what if my partner’s partner has something? Should I ask them not to do certain activities because I don’t want to risk getting herpes?
Cathy: The problem is, there’s no way – it’s not just like this week.
Cathy: It’s not this month or a year. It’s like it’s an on-going risk because even if you don’t have an outbreak, it is possible to transmit it.
Liz: There’s no way to predict when viral shedding is going to occur with HSV. So if you are someone who genuinely cannot risk getting HSV then you shouldn’t play with the majority of people. And I would say that a lot of people have an over exaggerated fear of HSV because there is so much stigma around it and that the realities of living with HSV is really, really different than what most people imagine it would be.
I’ve also have clients who were worried that they would never be able to have sex again because now they have herpes. And that’s not at all the case. I mean I have oral cold sores. I have HSV-1 in my mouth and every time I go to play parties, I tell people about it. And everyone is still willing to have great fun with me.
Cathy: Yeah. I have some partners that have HSV-1. I’ve been playing with some of them for years. I have never tested positive for HSV-1. And I’ve had people at parties decline to play with me or with them because they are exposed to that and I just disclose and they get to choose. And that’s I think just being aware and being willing to communicate about it and it’s really powerful.
Liz: And I think also being aware of the ways that your fears maybe hijacking your ability to make a clear decision, right? When our limbic system is super activated, it overrides the parts of our brain that do logical, clear thinking. If you are making a decision about who not to have sex with or who not to see or asking partners to make changes to their behavior because of your fears, I would ask you what really you’re at risk for, right? If you’re not someone with a comprising immune system, the reality of being exposed to HSV-1 for you is highly unlikely to affect your life in any significant way.
And I think it’s worth unpacking that stigma that we’re holding and it’s almost an ablest connotation of people who have herpes versus people who don’t, people who are clean versus people who are dirty and the way that we associate those ideas.
Cathy: Right. And there are risks that you can have painful outbreaks. There’s also a risk of you getting in a car and drive to the store. So being alive involves risks. We all get to choose what – I don’t prefer to jump from airplanes.
Liz: I love skydiving. I was a licensed skydiver for years.
Cathy: So you get to decide what risks are acceptable and are you willing to engage in.
Cathy: Just we’d like you – we encourage you to be informed and make conscious decisions rather than ones based on shame that are our society has piled on a lot of anything that’s associated with sex.
Liz: And if you want to hear more about unpacking the stigma around HSV, Ella Dawson writes a ton about her experiences dating and having sex with HSV. She has a great TEX Talk on it. We’ll put links down below to her blog and her TED Talk.
Cathy: Yup. And the herpes experience is also great. We’ll put that link below.
Cathy: So, we hope this helped. If you have questions about it, please let us know. We’d love to help.
Liz: Let us know. Yeah. Let’s do it.