When Sarah,* a South Asian-Canadian woman in her mid-20s, was diagnosed with genital herpes shortly after her 23rd birthday, she thought it was a wrap for her sex life. She feared potential partners wouldn’t want to be with her, and had trouble feeling sexual even on her own. “I felt so dirty that I didn’t even want to sit on my bed,” she said.
The shock and desexualization people often feel after they’re diagnosed with genital herpes stems from a staggering amount of misinformation swirling around it. Many people believe genital herpes can cause infertility, even though it absolutely doesn't. Some also think herpes causes cancer, a link that numerous studies have decisively debunked. A recent survey found that over 40 percent of people in the U.S. even erroneously believe genital herpes not only spells the death of a person’s sex life, but can literally be lethal. While genital herpes is a lifelong infection that cannot be cured, it’s almost always only dangerous to people with compromised immune systems or infants who contract it at birth. (The risk of that transmission is very low.)
Like most dubious views on STIs, misperceptions about genital herpes are the byproducts of decades of moral panic about the supposedly existential dangers of having sex outside of heterosexual marriage, and of anemic-to-nonexistent sex education. The majority of Americans don’t even know how to identify genital herpes.
The truth is that life—and sex—with genital herpes is nowhere near as dire as many people seem to believe. "It took a lot of self-reflection and research," said Sarah, but she’s mostly fine with her genital herpes and has an active sex life now.
“Generally speaking, herpes is a dermatological issue,” and usually a mild one, said Terri Warren, a nurse practitioner and a leading genital herpes expert—at most a periodic outbreak of minor blisters and a tingling-itching sensation that fades within days. And that’s only for people with symptomatic herpes. The majority of infected people never have even one outbreak. Experts estimate that at least a third of people who’ve contracted genital herpes have no idea they have it.
“Having a lifelong STI isn’t fun,” said Tiffany Lashai Curtis, a sex educator who has genital herpes. “But with open communication and some changes to the ways you have sex, it doesn’t have to mean the end of your sex life.” So let’s dig into everything you might want to know about life, dating, and how to have great sex with herpes.
How do you get herpes?
Herpes is not one infection. It’s the umbrella term for a family of eight related viruses, including those that cause chickenpox, mononucleosis, and shingles. Two of these viruses, HSV-1 and HSV-2, can cause genital herpes. HSV-2 causes most cases though, while HSV-1 mainly manifests as cold sores on lips. (However, cold sores are also known as oral herpes because they are basically the same condition as genital herpes, just in a different location.)
Both viruses spend most of their time lying dormant in nerve clusters; we don’t fully understand what determines when or why the viruses go to sleep, or how long they rest. When they wake up, they start to reproduce and try to spread to new hosts. This is when symptomatic people get blisters and/or irritation. Copies of the virus spread out from these symptomatic areas, especially open sores.
However, asymptomatic people can shed viral copies as well. Some research suggests that most people get herpes from asymptomatic folks, especially those who don’t know they’re infected. The ease of unwitting transmission helps to explain why genital herpes is so common. Most studies suggest that at least one in six people between the ages of 14 and 49 have HSV-2. (At least two in three have HSV-1, although it’s only a genital infection in a small subset of these individuals.)
The viruses die so quickly when they leave the human body that it’s exceedingly rare, if not functionally impossible, to contract them through indirect contact, like sharing a drink or food with someone with cold sores. But if they come into direct contact with a mucous membrane, or an open cut on any part of the body, the viruses can set up shop there.
People usually get genital herpes when their genital regions—which feature easily accessible mucous membranes and are often covered in tiny abrasions caused by everyday friction, sexual action, or even personal grooming—come into contact with HSV-2 shedding off of someone else’s genital area. They typically get cold sores when the easily chapped or nicked skin and mucous membranes of their lips and mouths come into contact with HSV-1 shedding off of someone else’s mouth.
But Melissa King, a therapist who specializes in issues related to genital herpes, explained that HSV-1 can jump from an infected person’s mouth to an uninfected person’s genitals (and HSV-2 can jump from genitals to a mouth), usually though oral sex. Recent research suggests that the share of genital herpes caused by HSV-1 is rising, although it’s unclear why.
It’s also entirely possible to contract herpes of the anus or eye—which are also covered in mucous membranes—or of any part of the body with an open cut on it. These body parts just have to directly contact shedding tissue. Or someone just has to touch them with an unwashed hand that they used to touch a shedding body part immediately beforehand.
As the risk of transmission varies from case to case, some people can go their whole lives without ever transmitting herpes to a partner. On the other hand, being in a monogamous relationship with a person who seemingly doesn’t have genital herpes doesn’t preclude transmissions—down the line, it may become clear that one partner was asymptomatically infected, and may have avoided passing on the virus before that point by pure chance. There’s no surefire way to prevent herpes, even if someone is symptomatic and so knows when they’re at their most infectious. They can still shed some virus when they aren’t in an active, palpable outbreak.
Anti-viral drug therapies can significantly reduce the frequency or severity of outbreaks, as well as the amount of virus people shed—and the risk of transmission, especially when they’re paired with condoms and information about safer sex. Condoms don’t block all skin-to-skin contact, so they’re also not a failsafe method, but they, too, can be effective in reducing transmission risk along with avoiding contact during outbreaks, informed decision-making, and drug therapies. Although there are never any guarantees when it comes to prevention, King explained that when people use consistent and overlapping protection strategies they’re far less likely to transmit herpes to negative partners.
What are the symptoms of herpes?
People usually associate genital herpes with recurring blisters that bubble up in an infected area, breaking, oozing, and lingering as painful sores for a week or two. “I assumed you’d know for sure if you had it, because you’d always be having those outbreaks,” said Jenelle Marie Pierce, executive director of The STI Project, an education and advocacy group, who was diagnosed with genital herpes as a teenager. “Your genitals would be full of blisters and look painful and gross.”
Again, most people never get those symptoms. Those who do usually have a bad initial outbreak, which may last a few weeks and be accompanied by headaches, fatigue, and fever. After that, though, most suffer progressively fewer and less severe recurrences as their bodies presumably get better at responding to the virus. Some people may have multiple outbreaks every year, while others may only rarely or never have another.
“In the first year [I had herpes], I got a lot of outbreaks,” said Sarah. “I thought that was going to be the rest of my life. But I barely get them now. Over the last two years, I’ve only had one.”
Outbreak symptoms themselves can differ, too. Many symptomatic people rarely or never get blisters, but instead feel slight pain, itching, or tingling when their genital herpes flares up. Sometimes, symptoms are so mild people don’t register them. When Lily,* a Chinese-Canadian woman who contracted genital herpes in her early 30s, described her initial irritation symptoms to a doctor, they wrote them off as the aftereffects of rough sex.
How do I deal with the stigma around herpes?
Even people with symptomatic herpes often argue that the negative connotations are the worst part of having it. “Physically, yeah, it does suck,” Sarah said. “But the emotional toll that this takes on people is all because of the stigma.”
After being diagnosed with genital herpes, some people report feeling anxious, depressed, and alienated. Pierce described years spent “feeling like a walking virus, always worrying about transmission.”
Medical care providers can exacerbate this insecurity by failing to give people meaningful information about how to navigate sex with herpes. “When I got my diagnosis, the nurse just gave me a pamphlet and told me to go on with my day.” Sarah said. Too often, providers also use openly stigmatizing language, misrepresenting the severity of the condition. “When I told my family doctor about my diagnosis, she was horrified,” Sarah added. “She said, ‘I wish you’d gotten chlamydia instead, because then, I could have just given you a pill, and it would have gone away. Now, you can’t have kids.’” (Again, this is just untrue.)
“When I tried to research this on my own, most of the information I found was pretty vague, and a lot of sources seemed to contradict each other at least a bit,” Sarah added.
Stigma and misinformation can lead people with genital herpes to withdraw from dating and sex. After her diagnosis, Lily said, “I felt I wouldn’t be able to have casual sexual experiences ever again. Sometimes I even felt unable to flirt.” To build a full and satisfying sex life after a herpes diagnosis, the first step is often to break out of this mode of thinking.
“That healing journey really starts with being reminded of who you were the split second before you were diagnosed,” explained Courtney Brame of Something Positive for Positive People, a group working to break stigmas around STIs. (Brame got their own genital herpes diagnoses a few years back.) That includes finding ways of reconnecting with themselves sexually. Brame said many people find masturbation useful, as it allows them to be sexual without worrying about transmission.
It also helps to see examples of people living full sexual lives while openly identifying with their diagnoses. Chris,* a Canadian man in his early 40s who was diagnosed in his early 20s, found support through The Phoenix Association, a genital herpes peer support group—where he met Lily; the two of them are currently a couple.
King said that working through stigma may take time and effort, but argued that it’s worth plugging away at. “For most of my patients, processing herpes becomes an avenue for addressing self-esteem issues that were present and affecting their sex lives even before their diagnoses,” she explained. “They eventually come to [gain] a stronger sense of self-worth. This helps them feel more empowered in pursuing sexual relationships overall.” Many people with genital herpes diagnoses told VICE that working through anxieties about the condition helped them figure out who they really feel comfortable being intimate with and how to speak candidly about sex, in general.
When and how should I tell someone I want to sleep with that I have herpes?
Jumping back into dating and hooking up post-diagnosis can be daunting even if you’ve accepted your genital herpes, because at some point you’ll need to disclose your status to a potential partner. You might worry that you’ll face judgment, rejection, or a barrage of invasive or ill-informed questions.
There is no one perfect time to disclose a genital herpes diagnosis. Some people told VICE that they put their status in their dating profiles, or tell people on a first date, in order to rip the Band-Aid off as soon as possible, in the interest of full disclosure—and to weed out jerks ASAP. But most acknowledged that front-loading a health-focused conversation like this can feel like too much, too soon.
There’s nothing wrong with waiting until the moment feels right. The only hard and fast rule is that you should disclose your status before you’re about to be intimate with someone, so that your potential partner has a chance to weigh their feelings, ask questions, and make an informed decision. Chris said that he almost certainly got herpes after sleeping with someone who knew they were infected, but chose not to tell him until after the fact. “I felt assaulted,” he said. Even though he’s aware of how manageable the condition is, he stressed that it’s always painful and wrong to “be changed by somebody, and to have had no say in the matter.”
Consider carving out a dedicated time to talk, like a date night when you can have a private, relaxed moment with your potential partner. Open the conversation simply and directly—you can lead with, “I want to share something with you,” or, “I need to let you know something.”
Don’t make telling someone you have genital herpes feel like an apology or something you’re ashamed of, Pierce said. “It’s just communicating information that’s helpful and relevant to a potential partner,” she explained. State simply and directly that you have genital herpes, explain what the condition is like for you, and ask if your potential partner has any questions or concerns. If they do—and they’re respectful about it—then answer those questions with simple medical information. (If they’re not respectful about this, maybe don’t bother with them.)
If you bring facts and confidence to the table, it will increase the likelihood of someone responding with curiosity rather than judgment. It’s particularly useful to step into a conversation with fast facts about how herpes spreads, how common the condition actually is, and how rare real and substantive health risks related to it are. It doesn’t hurt to come ready with the receipts necessary to debunk the most persistent and pernicious herpes misinformation.
The more you practice disclosing your status, the easier it gets. “The first time I had a successful disclosure, it was like a high,” said Adrial Dale, an advocate for herpes awareness and education who has genital herpes. “I realized, Oh, this isn’t a dealbreaker. It’s an opportunity to be vulnerable… That’s what intimacy is all about. I got almost excited to disclose my status to people after that.”
Warren, the nurse practitioner, explained that disclosures actually seem to reduce the risk of transmissions, likely because they encourage information-sharing, and discussions about protection options. When you talk to someone openly about your condition, it’s also entirely possible they’ll feel more comfortable opening up about things that affect their sex life as well, which almost always makes sex better for everyone involved.
What do I need to know about having sex, especially if I’m having an outbreak?
Most health experts recommend avoiding sex from the moment that you feel an outbreak coming on until about a week after your symptoms fade, if you’re at all worried about transmitting to a partner or about contracting another STI. Typically, when you’re symptomatic, you’re shedding more virus than usual—and your open sores or subtle inflammation mean that it’s easier for another infection to make its way into your system.
“If I’m having an outbreak, I don’t feel sexy just because of the true physical discomfort,” said Pierce. Like many other people with symptomatic genital herpes, she chooses to avoid all sexual contact during flare-ups.
But as Warren, the nurse practitioner and herpes expert, stressed: “People have a right to do whatever they want to do,” based on their informed consent and comfort. There’s no rule saying people with genital herpes can’t have any form of sexual contact during an outbreak.
“My symptoms may be uncomfortable, but they don’t always take away my horniness,” said Lily. During flare-ups, she avoids penetration, instead opting for mutual masturbation and external toy use. Other people said that they still give oral or manual stimulation to partners, even if they don’t feel up to stimulation for themselves. Others just cuddle and spend time together to maintain a sense of intimacy.
You can even take an outbreak as an invitation to explore new forms of sexual contact involving unaffected parts of your body. Dale said that he recently tried rimming his partner for the first time during a recent outbreak, and they found they were both into it.
Outside of outbreaks, everything sexual that you enjoyed before your diagnosis is still on the table—including unprotected sex. People with genital herpes may feel like they have to do everything in their power to limit transmission risks, and thus the prospect of putting someone else through the stigma and uncertainty they’ve endured. But this can reinforce the sense that they’re somehow dirty and desexualized. “There is always risk when people interact intimately,” Pierce pointed out. “Everyone has a different perception of what an acceptable level of risk is… Some partners are cool with the risk of not using barriers, and some aren’t. Every relationship is a bit different.”
Pierce said that as long as she’s given a partner complete information about genital herpes and the risks of transmission, she respects their choices. “I trust their decision-making, and don’t put that fully on myself,” she said.
Even people who’ve come to terms with their genital herpes can still get into their own heads about it, which can take them out of sex. Maintaining a hot and fulfilling sex life often requires ongoing internal effort: “Reframing and challenging negative thoughts about the diagnosis, and finding people who affirm them and their right to pleasure,” as Curtis, the sex educator, put it.
Dale said he still periodically struggles with distracting thoughts about the risk of transmitting the virus, even though his partner isn’t at all worried herself. “But I notice the moments when I really am in my head, and switch back into that intimacy,” he added. “I can say, ‘I really care about this person, so I’m going to be considerate and careful while we’re having sex—but not paranoid,’” Dale explained.
* Last name has been omitted by request for reasons of privacy.