What We’re Getting Wrong About Herpes

There’s an episode of “The Office” that begins when Michael Scott, the branch manager, arrives at work wearing a fake mustache, an attempt to disguise what he believes to be a pimple. His coworkers inform him that it’s not a pimple, but a cold sore. The word “herpes” floats around the workplace and Michael begins to panic.

This begins the episode’s comedic arc: Michael tracks down all of his past lovers to let them know that they might be “crawling with herpes.” The joke is that Michael is overreacting— cold sores (also known as oral herpes) are widely seen as irritating and painful, but too benign and common to make that type of fuss about.

There are other iterations of this joke. If you’ve ever been in middle school, you may have seen one sixth grader ask another if they’ve every had chickenpox– and if the answer is yes, announce that their classmate has herpes. Shingles are herpes. It’s a dumb joke.

While most people know that there are other infections, like cold sores and chickenpox, that are technically caused by a herpes virus, the similarity is treated almost as if it were a funny linguistic coincidence. The word “herpes” is generally reserved for the feared and stigmatized cousin, genital herpes.

How similar are oral herpes and genital herpes?

The infections are caused by two viruses, herpes simpex virus I and herpes simplex virus II (or HSV-1 and HSV-2). Under a microscope the strains look nearly identical, and the physical symptoms are indistinguishable. Both HSV-1 and HSV-2 cause sores by irritating mucous membranes, and both viruses spread by contact with affected skin, and either saliva or genital secretions (depending on the site of the infection). Sporadic outbreaks last for a period of weeks, but as the body’s immune system becomes more familiar with the virus, the outbreaks decrease in frequency and severity. Neither virus is curable, but both can be managed through diet, lifestyle, and medication. Just as someone who has had chickenpox will always have the virus in their body, someone who has contracted HSV-1 or HSV-2 will always have it within them as well, but it will not always be active.

The big difference

The most notable difference is that while HSV-1 generally establishes a site of preference near the mouth and remains dormant in the nerves at the base of neck, HSV-2 typically establishes a site of preference near the genitals and remains dormant in nerves lower down in the spine. However, both viruses can occur at either site; an estimated 30% of new genital herpes cases are caused by the HSV-1 virus. In this light, it feels less funny that Michael Scott warned his ex-girlfriends that they may have been exposed to an sexually transmitted infection (STI)— people genuinely catch genital herpes from partners with oral herpes all the time.

Does everyone have herpes?

Most adults in the US carry either the HSV-1 or HSV-2 virus, although since the majority of people either don’t express symptoms, or express symptoms very mildly, between 60-90% don’t realize that they’re carriers. A standard STI test does not check for herpes, since the virus is incurable, wildly common, and poses very little medical risk. While it is technically possible that a woman with genital herpes could transmit it to an infant during childbirth, the incidence of infection is estimated at one per 3,000 – 20,000 live births. Herpes can also spread to a person’s eye, but again, this is very unlikely. The CDC reports that one in eight or one in six adults in the USA have genital herpes, although given how many cases are free of symptoms and how infrequently herpes is tested for, the true number is unknown.

A quick google search will give you a wide range of numbers and estimates for these statistics. It’s a hard virus to measure, and varies from year to year and country to country. However, in essence, the story remains the same: herpes is everywhere, and most people don’t know they have it.

The stigma

Despite all of the jokes and stigma genital herpes evoke in our culture, it is not an inherently more serious infection than a cold sore. Although rare instances may lead to complications, both are considered benign viral infections. It may receive extra attention because it occurs in a more private part of the body, and because it reveals that the person affected by it has been sexually active. Precautions, such as using condoms, taking anti-viral medicine, and abstaining from sex during an outbreak, certainly reduce the risk of contracting or spreading the virus, but do not remove it entirely. Genital herpes does not reveal the nature of an individual’s sexual activity, the number of sexual partners they have had, or which safety measures were taken. 

Although herpes has been occurring in humans for millenia (HSV-1 has actually been in humans since before we were humans), it wasn’t really seen as a big deal throughout history. The dark stigma surrounding it now actually roots back to the 1970s, when a drug company, Burroughs Wellcomme, created a pretty effective treatment for herpes. The big snag with the treatment was that not enough people cared enough about the sores to buy an expensive anti-viral– essentially there was no market for the medicine. The company ran a herpes awareness campaign, attaching words like “incurable” and “sufferer” to a run-of-the-mill virus that posed very little threat. From a marketing standpoint, this was a really successful move. From a psychological standpoint, it hurt a lot of people. Want to fall down this rabbit hole? Check out the history here.

The real toll

For many people, the heaviest effect of genital herpes is psychological. It’s common to experience anxiety, hostility, shame, depression, low self-esteem and social isolation, especially in the weeks and months after the initial diagnosis. Social and self-stigmatization can lead to feelings of being “damaged goods,” fear that the diagnosis could prevent sexual or romantic relationships, and difficulties dealing with rejection or misunderstandings about the nature of herpes. A tragic irony of this situation is that many of the people perpetuating the stereotypes about herpes unknowingly carry the virus themselves.

These emotional effects can, however, be lessened by therapeutic counseling, support groups, and time. The vast majority of people diagnosed with herpes go on to live healthy lives and enter successful romantic and sexual relationships, largely undefined by a virus that causes sores that could be mistaken for a pimple.

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