Overcoming the Stigma of Herpes, by Eric Sabo of the New York Times

Genital herpes may be the largest epidemic no one wants to talk about. An estimated one out of five Americans over the age of 12 quietly harbor a meek but distressing virus that can cause painful and ugly outbreaks on areas that seldom see the light of day.

The silence has as much to do with the disease as concerns over what it can do to a budding romance. Symptoms, at least for most, are either nonexistent or so mild that it’s often nearly impossible to notice an infection. The main harm in suffering herpes, as many will attest to, comes from the dread of telling your partner the truth.

“Herpes has a stigma attached to it that even H.I.V. doesn’t have anymore,” said Dr. Anna Wald, a virologist at the University of Washington. “It’s very rare to get people to talk about it as openly.”

But a new test — which doctors use to detect herpes in the blood rather than wait for symptoms to appear — is pushing the taboo virus into the spotlight as it becomes easier to know your status and, ideally, take steps to protect others.

There is still no cure for avoiding the delicate topic with your partner. The disease is potentially contagious before or after noticeable outbreaks, and condoms are less protective than against AIDS, since genital herpes also spreads through skin contact.

So it’s often left to public health officials to spread the word: Be honest about having herpes, they say, to keep it from spreading in the bedroom.

A study by Dr. Wald found that such openness clearly helps, at least for a time. Out of 200 people with herpes, those who revealed their diagnosis were able to keep partners free of the disease for about nine months on average, compared to the two months it took when left secret.

Couples who share this information often agree to use condoms, hold off on sex during flare-ups, and avoid skin-to-skin contact around the genital region, which all reduce the risk of transmitting herpes. Some may take prescription drugs that, in addition to relieving symptoms, block some of the viral shedding that causes infections.

“Maybe it’s not even a conscious decision, but people do things differently when they know,” Dr. Wald said.

The push for greater openness has become more urgent as researchers suspect that herpes is adding to the spread of H.I.V. and AIDS. The virus responsible for most outbreaks of genital herpes, herpes simplex type 2, blunts the immune response and leads to higher levels of H.I.V. in the blood, raising the chance of transmitting both infections.

“Herpes is like AIDS in that everyone thinks of it as someone else’s disease,” said Dr. Peter Leone, an associate professor at the University of North Carolina Medical School and director of the state’s sexually transmitted disease program. “But guess what, if you’re sexually active, you’re at risk for herpes.”

Still, getting people to talk openly about the virus remains an uphill battle. Only about half of those knowingly infected with genital herpes divulge their status to regular sex partners. And when it comes to casual hookups, disclosure nosedives to nearly 20 percent.

Medical groups also remain leery of widespread screening for herpes, fearing that a small margin of error on the tests could result in a flood of misdiagnosed patients. The latest blood tests are wrong 2 to 4 percent of the time.

Even with the correct diagnosis, those who find out they have genital herpes through a random screening test often take the news the hardest, according to studies led by Dr. Kenneth Fife of Indiana University.

“It’s pretty tough to deal with when you’re not prepared,” Dr. Fife said.

And after all that trouble, there’s no guarantee that the virus can be stopped. Herpes sheds on areas of skin that condoms fail to protect, regardless of whether symptoms are visible or not, and at any time. The virus appears most contagious during the first few hours of flare-ups, researchers now believe. But there is no way to predict when these outbreaks will occur, and drugs are less effective at blocking viral shedding during such short, potent attacks.

Dr. Wald says she gets calls at least once a month from people asking if scientists created a better herpes test to “use on a Saturday night to see if it’s safe for them to go out.” Unfortunately the answer is no, but the disease does not inevitably jump from one person to the next, nor is there any long-term bodily harm from herpes infections. Genital flare-ups come and go, then largely subside after the first year.

That’s one reason why experts advise it’s better to be upfront about herpes status at first, rather than watching a relationship fall apart after an outbreak occurs.

“People are lucky in a way when they don’t know their symptoms,” Dr. Wald said. “But they may infect a partner, who may be extremely symptomatic.”

-Eric Sabo
Publish date: 5/26/2010
New York Times

Who Are You?

Mostly I'm a random person with a desire to teach people. A desire to tell them the things they didn't learn in school and the things we, as a group, don't talk about. Ignorance is bliss until you find yourself in a bad situation.

I have a few credentials to go with this. At University, I was the Sex Lady (they actually called me this around campus, to my secret pleasure), teaching a section of the required health class every semester. I have been to classes on how to teach sex-ed and have been certified as a result. I keep up with the current politics on sexual health/freedom. I went to Africa to join the fight against AIDS, and I continue to find ways to reach out to groups to educate them on HIV/AIDS prevention.

My preferred audience are adolescents. We make mistakes when we're young & lost, and sex-related mistakes can often have life-long consequences. Being less negative, young people are the perfect age to learn good, safe habits.

If I don't know an answer, it's hard for me to not chase down the facts. I may even occasionally include my sources for those dying for further reading!

So... Bring it on!