Scared and hopeless with herpes

Dear Hopeless in NY, 

Your dedication to compiling information about your diagnosis is admirable. While there’s no cure for herpes, there are treatments to handle symptoms and prevention methods to protect your partners. The reality is that herpes is a common sexually transmitted infection (STI), meaning that you aren’t alone nor without support. Many people with herpes have been able to lead full lives that include the potential for long, committed relationships.  

Herpes simplex is a common virus that’s spread by direct skin-to-skin contact. If you’re interested in the characteristics of the different strains, including the one you’ve been diagnosed with, you can check out the Q&A What is herpes?. The flu-like symptoms experienced in the first outbreak are seldom present during subsequent outbreaks, but herpes affects each person differently. Some people have frequent recurrences, while others rarely do. For many, this number decreases with time. With each recurrence, your body is more prepared to fight off the infection, so there are usually fewer sores, they heal faster, and the outbreak is less painful. The following factors may bring on an episode: surgery, illness, stress, fatigue, skin irritation (such as sunburn), diet, menstruation, or excessive friction during sex. 

It’s understandable to be worried about transmission to partners. Sexual contact poses a significant risk for transmitting herpes from the time the first symptoms of itching, tingling, or other skin sensations are noticeable, until the area is completely healed. Even in the absence of any detectable symptoms, the virus can become active and transmitted during a period of viral shedding, or asymptomatic shedding. During this time, the virus travels along the nerves and becomes present at the surface of the skin and mucous membrane sites. The good news is that sexual contact during periods when no symptoms are present is less likely to cause infection; some caution is warranted since people tend to have sex more often when they have no sores, which can increase the risk of transmission. Using a condom or dam during these periods can mitigate this risk.  

You’ve mentioned a concern about sex being unsafe even with a condom. While it’s recommended to refrain from sex during outbreaks, the risk of transmission outside of these periods and with a condom or latex barrier is low. For further reduction of transmission, managing symptoms and reducing the number of outbreaks can also protect partners. A health care provider can talk to you about the different FDA-approved treatment options available — acyclovir, famciclovir, and valacyclovir — which can reduce the number of outbreaks, shorten those that do occur, and then reduce asymptomatic shedding of the virus that could contribute to transmission. Additionally, maintaining general good health by keeping your stress levels in check, eating well, and sleeping enough may also reduce outbreaks.  

This diagnosis may be daunting, and it may seem intimidating to consider discussing it with partners. However, you’re in control of where and how you want to have this conversation. Choosing a private time and place and broaching the subject in a calm, relaxed manner are great places to start. Also, you don’t need to bring it up as soon as you meet someone, but it’s recommended to discuss your diagnosis before any sexual contact. It may be helpful to approach the conversation not as a confession, but as the beginning of a discussion of the concerns and considerations of everyone involved when it comes to sex. Providing space and time to process the information may also help your partners come to terms with your diagnosis. You can always come back to the topic when you’re ready to continue.  

For more information, the American Sexual Health Association (ASHA) is one resource that can provide the most recent research regarding herpes and its potential treatments and cures. The ASHA also has information for support groups that you can reach out to for some extra guidance. 

Take care,