Asymptomatic Herpes: Do I Really Have It?

It wasn’t said with malicious or demeaning intent, but it is a phrase that keeps echoing in my head. “Sometimes I don’t believe you have herpes, because I don’t have it.” I have been a carrier of the herpes simplex virus (HSV) for nearly three years, and yet, I have only had one visible outbreak. Just one; that’s it. One that I didn’t even look at because I was too afraid, too ashamed. But one was enough to make a lifelong difference for me.

Statistically, recurrences of genital herpes occur more frequently in those with HSV-2 than HSV-1, especially within the first year. I experienced an initial outbreak and, as of yet, never had another lesion surface. Sometimes it begs me to question if I am some form of genetic anomaly. Sometimes I wonder if I really do have herpes because I don’t have recurring, visible outbreaks. I feel wrong for even processing and posing those questions in my head. Questions based off difference and doused in what many would label as luck.

“Sometimes I don’t believe you have herpes, because I don’t have it.” After being with the same partner for roughly two years, one might expect that person would have contracted the virus by now. Despite a daily regimen of Valacyclovir, commonly known as Valtrex, the HSV-2 transmission rate is only lowered by 50%. Herpes can be spread through skin-to-skin contact, even when there are no visible outbreaks, which is why additional barriers are especially important if one partner is herpes-positive. Anatomically speaking, it is easier for a male to transmit genital herpes to a female than it is for a female to transmit to a male based on mucous membrane preferences. A combination of anti-viral therapy as well as some type of barrier is the most sound preventative decision in relationships where only one partner is infected. Realistically, the majority of couples ditch traditional barrier methods of protection as their relationships evolve. A Dutch study found that heterosexual couples in long-term relationships only use condoms 14% of the time, compared to those involved in casual relationships--who use condoms just 33.5% of the time. The study also found that the more similar and familiar partners were with one another, the more likely inconsistent condom use became. Even through long-term commitments, couples can unknowingly transmit the virus to one another. For example, a husband could go down on his wife when he has a cold sore and could transmit genital HSV-1 to her unintentionally. As casual and committed relationships evolve, is it possible for someone herpes-positive and herpes-negative to have an explorative and meaningful discussion of sexuality without transmission? 

The majority of herpes is spread by those who are unaware that they have the virus, most commonly through asymptomatic viral shedding, which accounts for approximately 80% of transmissions. Asymptomatic shedding is the shedding of the virus that occurs without symptoms or lesions present. A 2011 study explored the differences between asymptomatic and symptomatic carriers of HSV-2. Those classified with asymptomatic HSV-2 had a shedding rate of 10.2% compared to those with symptomatic HSV-2 infections, who shed at 20.1%. The study concluded that genital shedding is "likely universal" in seropositive persons but clinical manifestations differ widely, and that further research is needed with regard to clinically seropositive, asymptomatic HSV-2 infections. 

The so-called silent spread of herpes is a large piece of why the CDC does not recommend testing for individuals who do not present symptoms, a guideline that I disagree with. Even the CDC itself seems somewhat wary of its guidelines, stating that they “do not know" if testing everyone would stop the spread of genital herpes. Their website continues, "...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." I believe this statement calls for a shift in perspective and call to action. I do not think the focus should be so much on stopping the spread of herpes as removing the stigma associated with it. After all, over half of the world population aged 14-49 will contract HSV-1, and 11% will contract HSV-2 in their lifetimes--it is time that we stop talking around it. If the stigma of herpes were not as overshadowing and destructive, a herpes diagnosis would be much more navigable.  The thing about herpes, as common as it is, is that its complex, as that 2011 study suggested. If infected, it is likely that you’ll never know who exactly gave it to you, or when you acquired it. Serological testing can indicate which strain of the virus you have, but without a prior testing history, it is nearly impossible to determine when it was transmitted to you or how long you've had it. You may have recurring outbreaks, and you may have none. There is no "norm", no clear black and white, which makes things even more frustrating for those just diagnosed--but isn't that the nature of the human experience? 

image1 (2).jpeg

Although my blood test yields a positive HSV-2 result, nearly three years later, not much physically has changed. But here’s the thing, so much has changed because of that seropositive result. I felt somewhat lost that summer after graduating college, and strangely, my journey with herpes brought me back to, not only my academic roots, but my purpose. A purpose that I had not expected nor anticipated, or even wanted, but here I am nearly three years later in the midst of a dual degree masters program. I feel lucky at almost 25 to have a general idea of what I feel my purpose to be, but that doesn’t mean that I don’t question it. I think it would be wrong to assume my passion is static. It started as an undergraduate interest that I didn’t even know I could major in. I found solace in a field that analyzed my personal experiences with an academic lens, and it allowed for a significant amount of healing through fact-based knowledge. Even through my current research and writing, I am still healing to an extent, but my lens has an expanded audience and goal to provide resources that I did not have access to during the most difficult period of my young adult life. 

My experience of my primary outbreak is not invalidated by the shape or form my body decides to take since acquiring the virus. I lead a remarkably “normal” sex life filled with much more embarrassing moments than sharing that I am a carrier of the herpes virus. Generally speaking, no one is going to have my exact genetic makeup, and that is the beauty of being me--inside and out. No one’s body moves quite like mine, in its beauty and its faults. That is why it is so important to me to preserve its integrity, its strength, and its scars. 

RESOURCES
https://www.cdc.gov/std/herpes/screening.htm
http://dx.doi.org/10.1136/sextrans-2013-051087
https://jamanetwork.com/journals/jama/fullarticle/896698
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1871807/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006256/pdf/rsif20140160.pdf
https://www.reuters.com/article/us-couples-condom/couples-characteristics-may-predict-condom-use-idUSBREA2A18920140311