Genital Herpes: The Fearsome Social Stigma of Living with a Sexually Transmitted Infection

What is genital herpes?

Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2).

A person actively infected with herpes tends to present with blisters/vesicles lesions over the genital, anal, or mouth region. During the first outbreak of herpes infection, one tends to have a more severe and longer duration of symptoms presentation. Systemic symptoms such as fever, swollen lymph nodes, body aches, lethargy, and general feeling of being unwell may be noticeable in patients.

In recurring outbreaks of genital herpes, the symptoms tend to be milder and with a shorter duration though a person may present with premonition symptoms such as tingling/shooting pain in the legs/buttock/pelvic region and genital pain before the presentation of herpes lesions.

How does genital herpes spread?

The herpes simplex virus is passed on through contact with another infected person through mucosal surfaces, mouth, or genital secretions. Both HSV-1 and HSV-2 can be shed from a normal looking mouth or genital mucosa/skin. A person can get HSV-2 infection during genital contact with another person who has a genital HSV-2 infection. But if you receive oral sex from a person who has an oral HSV-1 infection, you can also acquire a genital HSV-1 infection. 

Sometimes, contraction of the virus can occur when the infected partner has no active symptoms. In an asymptomatic person or someone without symptoms of HSV 2 infection, genital HSV shedding does happen but occurs less frequently compared to symptomatic individuals [1]. 

How common is genital herpes?

The Centers for Disease Control and Prevention (CDC), approximates that over 572,000 new cases of genital herpes occur annually in the USA [2]. The prevalence of patients who are diagnosed with HSV-2 infection is about 12.1% after adjustment to age (in 2015-2016) [2]. However the actual prevalence of genital herpes infection may be higher as some of the genital herpes infection may be due to HSV-1.

Stigmatisation and the emotional roller coaster following diagnosis of genital herpes/STI

Upon the diagnosis of incurable STIs such as herpes, one can be overwhelmed by a plethora of emotions ranging from embarrassment, guilt, anger, sadness, grief, or even depression. 

A combination of our cultural belief and individual educational upbringing may stir us onto the view that contracting a sexually transmitted disease generally occurs only to those who have done something ‘wrong’. This emotion is further exacerbated with the incomplete understanding of the pathophysiology of the virus and long-term medical sequelae of herpes virus infection. 

To spiral things further, the concern of living with an ‘incurable’ disease such as herpes and potentially passing it on to people around us, paints a very bleak outlook for patients upon diagnosis of the disease.

The public awareness and openness against sexual health is still at an early stage and the incomplete medical understanding of herpes virus further adds to the tumultuous negative effect of social stigma. The question that usually arises is whether we should tell a friend/family member/romantic partner of the diagnosis. Will we get rejected by people around us if we reveal our medical status? Will I ever lead a normal life, establish relationships, and have offspring? All these unanswered questions can take a toll on a person’s mental wellbeing.

At this stage, let me share a few rebuttal points:

• There is always a risk of contracting STIs whenever you embark on a sexual relationship with anyone– be it strictly monogamous or polygamous. 
• The only way to rule out the chance of acquiring STIs is through complete abstinence.
• Labelling and associating STIs with social ‘wrongness’ often reveals an untrue preposition as everyone has a different encounter, past, and history.
• Herpes infection is a viral infection that has a similar wax and wane presentation as the chickenpox virus. Over time, our body’s immune system learns and gets better control of the virus, and we recover clinically. Although the virus remains in the nervous system, it is dormant. Only during times of low immunity, the virus resurges and causes symptoms. So, why are we not as apprehensive of chickenpox as we are to herpes?
• The never ending Covid-19 pandemic, with emerging and persistent (new) Covid-19 strains in the community has not prevented us from our normal routine. We learn to live with the virus. 

The truth is, even with the presence of chronic infections, we learn to co-exist, thrive, and continue to live our lives as normal as possible. This should also apply to the case of the herpes viral infection.

Is there a way to come to terms with the diagnosis of incurable STIs such as herpes?

It is important to understand that contracting herpes virus is ‘okay’. It is a manageable medical condition, it is not a life sentence nor is it a punishment. It does not determine who you are and you should not be judged by others. Most couples with herpes are able to lead a normal life, and have healthy future generations.

Getting the correct medical information regarding herpes medical condition is paramount. It is one of the key ways to come to terms with the diagnosis and overcome the emotional turmoil associated with the condition. Understanding the fact that even though herpes is ‘incurable’, there are effective medical treatment options to manage the symptoms. One may consider scheduling a medical consultation with your trusted physician to address your concerns on herpes infection.

How can I protect my sexual partner against contracting genital herpes?

• The best long term way to prevent genital herpes or any form of STIs is via abstinence or to be in a long-term monogamous relationship with a person who has been screened for STIs and known to be negative for STIs.
• Barrier contraception such as condoms, can reduce the risk of spreading genital herpes.
• Avoid sexual intercourse if you have herpes lesions.
• Consider suppressive daily antivirals to reduce the spread of HSV-2 infection.

Am I doomed if I have genital herpes? Is it an incurable disease?

Although there is currently no cure for herpes, antiviral medication can prevent or reduce the herpes outbreak when the person is taking the medication. Studies have shown that antivirals are an effective medical option to significantly suppress the transmission of HSV [3]. You are advised to discuss with your doctor for further advice and medication guidance.

How can I tell my partner that I have genital herpes?

The topic of breaking the diagnosis of herpes to your intimate partner can be difficult. Concerns of being judged, relationships ending, and sexual activities being hindered, are all valid social issues with regards to genital herpes. Although many may fear sharing the diagnosis with their partners, most partners take the news well, and are appreciative of the honesty and trust in disclosing personal health information with them. It is also proven that with good awareness of the medical condition, the chances of transmission of herpes to partners are reduced.

One of the best ways to break bad news to your partner is by choosing suitable language when discussing the topic with them. It is always imperative to be honest, open, constructive, and hopeful. 

Bringing your partner to your doctor’s visit to obtain the right information on herpes is definitely useful for partners to debunk any myths that are associated with ‘incurable herpes STI’.  

Are there ways to deal with the social stigma associated with STI diagnosis/genital herpes?

Having better patient education on the herpes virus, general symptoms to anticipate, and understanding the progression of disease over time are important. While doing your own reading and research regarding herpes virus can be beneficial, verifying your study materials and resources with your trusted physician can avoid anxiety due to misinformation from the condition.

Be kind, empathetic and non-judgemental towards your loved ones and people around you, everyone is fighting their own battles.

The final take home message

Patients with herpes generally are able to lead a fulfilling and normal life. Most of them are able to have successful long-term relationships with their partners. They are able to have family and children uneventfully. Herpes is a virus that does not generally damage your health. The symptom outbreaks do go away with or without treatment, and overtime the flare ups get less frequent, and recurrence symptoms tend to be milder. 

If the topic of herpes remains a sore bothering point, do not hesitate to reach out to the health care professionals for further advice and guidance.

References

1. Elizabeth Tronstein, C. J.-L. (2011). Genital Shedding of Herpes Simplex Virus Among Symptomatic and Asymptomatic Persons with HSV-2 Infection. JAMA, 1441-1449.
2. Centers for Disease Control and Prevention. (2021, July 22). Genital Herpes – CDC Detailed Fact Sheet. Retrieved from Centers for Diseases Control and Prevention: https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm#
3. Bonnar, P. E. (2009). Suppressive valacyclovir therapy to reduce genital herpes transmission: Good public health policy? McGill Journal of Medicine, 39-46.