Tuesday, September 19, 2023

I Was Diagnosed With Herpes And Never Had An Outbreak

Would I Know If I Had Herpes

Herpes Simplex Virus in Depth / Alynn Alexander, MD

Probably not. Most people with genital herpes have not received a diagnosis and do not know theyre infected. About 87% of people with HSV-2 do not know theyre infected. The main reason for this shocking statistic is that most cases herpes have few or no symptoms. In addition to a lack of symptoms, routine testing for people without herpes symptoms poses challenges of its own.

There are a couple of different ways to test for herpes simplex virus. Navigating them all is a bit complicated which is why herpes testing is often harder to access.

Direct TestingThe first type of herpes testing is a direct test for the virus in symptomatic people meaning people that have active herpes sores. This can be done with a herpes culture, which is a test done on a sample from the actual sore. Cultures are not clinically sensitive, which means that they report a large number of false negatives. A more sensitive way to test lesions is through DNA testing, which can also tell which type of herpes simplex virus is causing the infection.

Also, HSV serological tests have a high false positive rate, meaning that they often report an infection when there isnt one. Due to the stigma surrounding a herpes diagnosis, a false positive herpes test can have intense negative psychological health effects on a patient. Often, this causes more harm than good.

You’re Not Limited To A Herpes

I remember one particular night, sitting on the floor of my bedroom and reluctantly signing up for a herpes-positive dating site. It felt like my only viable option. Signing up felt embarrassing. It was another website filled with smiling partners claiming to have found love despite their positive status.

While some people appreciate these types of apps, I quickly learned that it was not the right space for me. As years passed and my understanding around stigma grew, I couldn’t help but feel that herpes and other STI-specific dating apps might be further reinforcing social stigmas.

With transparency and communication, STI-positive people can find love with STI-negative partners. I know, because I’ve experienced it.

Emily L. Depasse is a sexologist and sex educator redefining the narratives around sexually transmitted infections . Follow her on and @sexelducation.

How Is Herpes Transmitted

Herpes simplex is highly contagious. It is primarily transmitted via contact with an infected person, either with saliva or through direct contact with fluids from herpes sores.

Herpes may be transmitted either through sexual contact or non-sexual contact. HSV-1 is much more common than HSV-2.

It is not possible to get herpes from:

The CDC estimates that around 48% of the U.S. population have HSV-1, which causes oral herpes, while around 12% have HSV-2, or genital herpes.

Herpes simplex viruses may be spread by:

  • Less commonly, shared objects that touch the sores or saliva of someone with an active outbreak

In some cases, while not as common, herpes simplex can be passed from a pregnant person to their baby during birth.

Both types of herpes simplex can be asymptomatic. A person with no symptoms may still be able to spread the virus via saliva or other body fluids if it is actively shedding.

Viral infections never leave the body.

They may go dormant, during which time a person is not contagious.

Herpes simplex virus does not always reactivate, but is contagious from someone experiencing an outbreak, whether it is their first or one of many.

Most people are contagious a few days before sores appear and until the sores are fully crusted over and no longer producing liquid.

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In The Absence Of Answers

Herpes tests arent the only ones with a risk of false positive results. False positives can occur for any test that diagnoses viral infection based on antibodies, i.e., your bodys immune reaction, rather than direct detection of the virus. For similar diagnostics like HIV and hepatitis C testing, protocols automatically call for a second test that directly detects the virus whenever an antibody test comes back positive, said Paul Swenson, laboratory director in the department of public health of King County, Washington. Herpes, however, is a particularly challenging infection to directly test for, because the virus spends most of its time hiding in nerves. Swab tests can sometimes detect the virus during outbreaks, but this isnt an option for people without symptoms. Thus even the Western blot relies on antibodies, and may give indeterminate results to a small number of people.

But two steps of antibody testing are still more reliable than one step todays diagnostics for Lyme disease and syphilis are a two-step antibody testing approach, said Dr. Edward Hook, a medical epidemiologist specializing in STI screening and prevention at the University of Alabama, Birmingham, who questioned why such a standardized two-step approach hasnt taken firm hold for herpes.

Who Is To Blame For My Herpes

How Herpes Is Diagnosed

We have been helping herpes-positive patients for more than 17 years.

Once a herpes diagnosis is made, itâs typically followed by embarrassment, frustration, and even anger. This article will explain why a newly diagnosed person shouldnât jump to the conclusion that infidelity by their current partner is to blame for their STD.

How herpes is transmitted from one person to another is complex.

People tend to scrutinize their life and especially their current relationship. They have a lot of questions.

  • I was always careful how could I get it?
  • Is my partner cheating on me?
  • Who gave it to me?

Itâs outside the scope of this short article to discuss these questions in great detail, but we can explain the most common scenarios that weâve seen in our practice.

Dr. Fuzayloff will briefly explain some possibilities.

Also Check: How To Know If You Have Herpes

Is Asymptomatic Herpes Really A Thing

Medically reviewed by Kristin Hall, FNP

How common is herpes? Herpes is one of the most common viral infections, with more than half of all people under 50 years of age infected with the HSV-1 type of herpes and an estimated 11% of people infected with the HSV-2 type of the virus, according to WHO data.

One of the most common herpes-related questions is whether or not its possible to be infected with the herpes virus without ever experiencing any symptoms. Unfortunately, that’s a thing, and it’s called asymptomatic herpes. In fact, it’s a major thing.

While most people associate herpes with cold sores on the lips and mouth or herpes lesions on the genitals, the reality is that most people infected with the herpes simplex virus wont get any symptoms.

This means that not only is it possible to have herpes without symptoms, but it’s actually very common. Below, well explain how often herpes results in asymptomatic infections , how asymptomatic viral shedding occurs, and the best options for testing whether or not you have herpes.

How Does Herpes Simplex Spread

Herpes spreads through close contact with a person who has the infection. The virus can be found in skin and saliva. If you have herpes simplex, you are most likely to pass the virus to another person when you have sores. But you can infect someone else even if you have no symptoms. Healthcare providers call this asymptomatic viral shedding.

People may get HSV-1 through

  • Touching a persons skin near the mouth.
  • Sharing food utensils, lip balm or razors.
  • If you receive oral sex from someone who has a cold sore, it may spread a herpes infection to your genitals.

People may get HSV-2 through

  • Oral sex with someone whos infected.
  • Touching open sores, including while breastfeeding.
  • Childbirth by a mother or gestational parent who has an active infection.

You cant get genital herpes from objects like toilet seats. But you could pass genital herpes through shared sex toys.

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What Else Should I Know

Genital herpes is a lifelong condition, but there are ways to manage it. If you have genital herpes:

  • Take medicines to stop outbreaks or make them less frequent and less severe.
  • Help reduce the risk of spreading genital herpes to others by taking medicines, always using a condom during sex, and avoiding sex during outbreaks.

So Cold Sores Are Only Caused By Hsv

Herpes (oral & genital) – causes, symptoms, diagnosis, treatment, pathology

Both HSV-1 and HSV-2 can cause cold sores on the mouth and face.

Although its more common for HSV-1 to cause cold sores, it isnt impossible for HSV-2 to cause them, too.

Cold sores arent the same thing as canker sores or mouth ulcers. They each have different causes and two entirely different presentations.

Cold sores:

  • are caused by the herpes simplex virus
  • usually develop near the outside of the mouth, such as below your nostrils or on your lips
  • cause redness and fluid-filled blisters
  • usually appear in groups
  • eventually break and ooze, forming a crust-like scab
  • may take 2 to 4 weeks to completely heal

Canker sores:

  • may be caused by food or chemical sensitivities, dietary deficiencies, minor injury, or stress
  • may develop anywhere inside your mouth, such as at the base of your gum line, inside your lip, or under your tongue
  • are shaped like a circle or oval
  • are typically yellow or white with a red border
  • may appear solo or in groups
  • usually take 1 to 2 weeks to completely heal

HSV-1 is spread through direct contact with the virus, which can be present in or around cold sores, in oral secretions , and in genital secretions .

Some of the ways it can be transmitted include:

  • kissing someone on the mouth
  • sharing eating utensils or cups
  • sharing lip balm
  • performing oral sex

The herpes virus usually affects the area where it first made contact with the body.

Some of the ways HSV-2 can be transmitted include:

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Myth #: You Get Tested For It Every Time You Ask For An Sti Check

In the midst of reporting this piece, I happened to see my OB/GYN. Regarding herpes, he told me, and I quote, “We can land a man on the moon but we can’t figure out herpes diagnosis.”

So, here’s the thing: The Center for Disease Control and Prevention doesn’t recommend routine herpes testing, which means that unless you specifically ask for it, you’re not getting tested for it. This might seem like a massive oversight, but there are a number of good reasons for this.

“When you do blood testing for herpes, it’s very difficult to interpret,” says NYC-based gynecologist Alyssa Dweck, MD. “It might tell you you’ve been exposed at one point at your life, but it won’t tell you when that happened or who you got it fromso the usual STD screen doesn’t test for herpes in the blood unless people ask for it.” Even then, a positive result will mean you’ll be told you’ve been exposed to herpes, which isn’t quite the same thing as being told you have it. Plus, per the CDC, diagnosing someone without symptoms via a blood test has not shown to change their sexual behavior or stop the spread of the virus.

Case #5 She Got Genital Herpes Through Oral Sex

A 23-year-old woman, Jill, came to the office with a genital rash. A swab test confirmed genital herpes. She immediately suspected her current partner, Joe, of giving it to her.

The next day they showed up together. Joe denied having been diagnosed with genital herpes.

After being asked a series of questions, Joe remembered having sores around his mouth as a kid. But heâs not getting them anymore. All his previous STD tests were negative for âeverything.â

Joe was very hurt and swore that he wouldnât hurt Jill because he loves her.

Joeâs blood test came back positive for HSV-2. This is the virus that Jill has genitally.

Jill got HSV-2 from Joe via oral sex.

Dr. Fâs Explanation

  • Jill got the infection from Joe. Joe most likely has the HSV-2 virus in his mouth and passed it to her by giving oral sex. Itâs not common to have HSV-2 in the mouth, but weâve been seeing it more often.
  • Joe passed the infection to Jill via silent shedding .
  • Most likely, Joe got HSV-2 in a nonsexual way from his parents or friends.
  • Since Joe has had this issue since childhood, he thought of it as only minor fever blisters that he wasnât having anymore. He didnât realize it was an STD and didnât hurt Jill intentionally.

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Myth #: You Can’t Get Herpes If You’re Not Sexually Active

Herpes can be passed from skin-to-skin contact that isn’t sexual in nature, Hawkins tells me. “If you look at the leotards that wrestlers wear, if you have upper thigh genital herpes in an area thats low enough that it shows under the leotard, someone can get it, too,” Hawkins tells me.

With that said, Hawkins tells me you don’t need to worry about getting it from trying on a swimsuit or sharing a towel, because the virus doesn’t live outside of the body for long. “Now if youre trying on bathing suits without any underwear underneath, there are plenty of wonderful infections that you can get even if herpes is not one of them,” she says. “People are still strongly advised to make sure theyre using proper hygienic options.”

How Can I Best Learn To Cope With Herpes Simplex

Herpes outbreak? MC? HPV? Or folliculitis

Some people feel distressed or embarrassed about their herpes simplex infection. Its important to understand that the herpes virus is common. For most people, herpes doesnt significantly interfere with daily life.

To cope with negative feelings, you may consider:

  • Connecting with others through support groups or online forums.
  • Sharing your feelings with a trusted friend or loved one.
  • Speaking with a therapist.

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Related: Syphilis And Gonorrhea Rates Have Risen Sharply In Us Cdc Says

When tests fall between 1.1 and 3.5, more testing is necessary, said Johnston. This recommendation is also noted in the 2015 CDC Sexually Transmitted Diseases Treatment Guidelines. But some patients will never be referred for a second test.

I think most clinicians are unaware and perhaps labs dont have this available and/or it is not straightforward to order, Johnston said of second-step tests.

But while her facilitys Western blot is considered highly accurate, it is expensive and cumbersome to perform. Each test costs over $200 and the University of Washington is the only lab that provides it.

Other confirmatory tests also exist, for instance Biokits HSV-2 Rapid Test and Quests own HSV-2 IgG Inhibition assay. The latter, which adds only $4 to the price of the HerpeSelect test, performed well in a study conducted over a decade ago. Rick Pesano, the medical director for infectious disease at Quest, believes that with more awareness, the test could stand in for the Western blot. But the test was not mentioned in the USPSTF guidelines because it still has not been evaluated in asymptomatic individuals, according to Cindy Feltner, associate director of the RTI-UNC Evidence-based Practice Center, who helped prepare the science review for USPSTF.

We need better diagnostic testing. That is where we are stuck at this point, said Johnston. We dont have a good test thats inexpensive, high throughput, and reliable.

Living With Herpes Often Means Accepting A Lot Of Uncertainty

When I got my diagnosis, my health-care providers reminded me that herpes is much more common than you’d think , gave me sets of facts and figures, and told me that eventually I’d be just fine. For some, this might resonate, but for me, it produced additional feelings of isolation. It didn’t answer my questions about what my love life or health would be like in the future.

The more I scanned the herpes informational pamphlets I was given, the further removed I felt. The photographs of happy partners with hopeful futures seemed fake. I wondered how much they were paid to pose for the images. After all, the only media representations of people with herpes that I recalled involved rejection and humiliation.

So I did what anyone with questions and elevated levels of anxiety does: I turned to the internet. I remember nights when I stayed up until two and three oclock in the morning scouring forums, blogs, and the crevices of Google search results for answers to questions like, what is my rate of transmission to sexual partners? and how many outbreaks will I have going forward?

But a lot of these questions don’t have definitive answers. That’s one of the most difficult aspects of being diagnosed with herpes, or any STI. While there are estimates of transmission rates and studies on the impact of suppressive antiviral therapy, everyones body responds differently to the virus and treatment methods.

Below are a few of my favorite resources :

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Useful Methods Include Testing An Actual Lesion

Keep in mind that there’s no such thing as “safe” sex, only safer sex, which means using protection and being open and honest with your partner. “It can definitely happen,” Friedman says of the chances of transmitting the virus to a partner without a visible outbreak. “Its called asymptotic shedding there are studies showing that the rates of transmission of HSV-2 are the same for symptomatic and asymptomatic.” He adds that this is why using protection during sexual contact is so important, regardless of what blood tests say. Unfortunately, you can never ensure your risk of transmission will be zero, whether or not you know you have herpes, but using a condom or dental dam will get you closer to it.

Herpes Average Incubation Period

Apollo Hospitals | All You Need To Know About Herpes | Dr. Ravikiran Barigala

Both HSV-1 and HSV-2 cause painful sores and blisters that present in five stages:

  • Stage 1:About 1-2 days before the cold sore or blister appears, tingling, itching, burning, or numbing sensation starts where the outbreak will occur.
  • Stage 2:One or more painful sores appear, typically around the mouth or the genitals.
  • Stage 3:Several days later, the sores burst, which allows the fluid inside to escape. This fluid can easily transmit the virus to othersthis is a highly contagious time.
  • Stage 4: A crust forms, covering the sores as they dry out.
  • Stage 5:A scab forms over the crust, and eventually flakes off once the sore is fully healed.

From start to finish, a herpes simplex sore outbreak typically lasts 1-2 weeks.

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