Relax. It's Just Herpes

Author name
John Vaughn, MD, Director of Duke Student Health

There is a Herpes epidemic on campus. Not of the actual infection, but of an overwhelming, almost paralyzing fear about the possibility of getting the infection. 

For the sake of your mental health, my Dear Dukies, I’m going to go out on a limb here with a relatively bold statement:

In the grand scheme of things, Herpes is not that big of a deal, so everyone just CHILL OUT! 

I’m not making light of it. I’m not saying you shouldn’t think about, or do your best to protect yourself from it, or talk to your partners about it.  You should do all of those things, but do them with a healthy dose of perspective, which I will hopefully provide to you here. 

I get it.  The thought of being “infected” by anything – especially below the belt – can make you feel gross and embarrassed and affect relationships. Even the name sounds creepy.  But while Herpes is very common and there is no cure, it’s also very manageable, not a threat to your health or the health of your sexual partners1, will not make you a social pariah, and will not doom you to a life of celibate childlessness.  Dealing with the possibility of acquiring HSV is just part of the cost of doing business when you become an adult with an active and healthy sex life.

The CDC and the American Sexual Health Association both have excellent FAQ sheets about HSV that cover all of the bases, but here are the basics.

Wanna be really creeped out?  Many, probably most, people get HSV1 from their mom or grandma!  That’s because when we talk about Herpes we are talking about two types of viruses – Herpes simplex type 1 (HSV1) and Herpes simplex type 2 (HSV2) – and for the most part, HSV1 is the “cold sore” virus that affects the mouth and lips.  So all of those smooches you got from family when you were a kid were probably exposing you to HSV1.  Have fun at that next family reunion!

HSV2 has traditionally affected the genitals.  However, both viruses are spread by direct skin-to-skin contact, and either can infect the mouth or genitals, so we are starting to see more HSV1 infections “south of the border.”  A 2011 study showed that HSV1 accounted for 78% of female and 85% of male genital herpes infections in college students. 

Why?  Because like most people, college students assume that oral sex is totally safe and are therefore much less likely to use a condom then they are with vaginal or anal sex.  Now, unless you have a really bad sense of direction, you can safely say that oral sex eliminates the risk of pregnancy, but it definitely does NOT eliminate the risk of transmitting STI’s.  In fact, it increases the risk of transmitting HSV1 because it is spread by direct contact. 

How many people have HSV?  About one in six people aged 14 to 49 years have it, and up to 90% of those people don’t even know it. 

Why is it so common?  Because about one in six people aged 14 to 49 years have it, and up to 90% of those people don’t even know it.  (Are you paying attention??)  And unfortunately, an infected individual can just as easily spread the infection when they don’t have any symptoms as when they do. 

So how do you know if you have it?  Your healthcare provider can often diagnose Herpes based on a history and physical examination if you are having symptoms, but there are some lab tests that can be done as well.  If you’re having symptoms, the fluid from a blister can be tested directly for the presence of the virus. 

What if you’ve never had any symptoms?  A blood test for antibodies to both viruses can be done.  The presence of these antibodies doesn’t necessarily mean you have or will ever have an outbreak, but if you don’t have any antibodies to the virus, you can pretty safely say that you don’t have HSV.

Can we do all of the above testing at Student Health?  Yes.

So yes, there is a fairly good chance that you will be exposed to HSV when you become sexually active.  And yes, there is no cure.  But…

There is also a fairly good chance that you were exposed to HSV at your 3rd birthday party! And it’s not a threat to your health or your future sex life.  And there are good medications that can help manage flare-ups and decrease the risk of transmitting the virus.  And you can do 2 simple and effective things (that you should already be doing anyway) to decrease your chances of getting it.  What are those, you ask?

  1. Talk to anyone you plan on getting nekked with!  Even though it’s an awkward conversation to have at the beginning of a new relationship – or the end of a long night – it’s the best way to keep you and your partner safe.
  2. Use protection every time you have sex… yes, even with oral sex!  For those keeping score at home, that means condoms or dental dams.

So to finish with some more bold straight talk (because that’s how I roll)… RELAX!  Be smart, be safe, be confident enough to be chatty with your partners, get tested if you are worried, and move on with your life.  There are much more important things to worry about at Duke – like where to park without getting towed, or figuring out why everyone you meet is an Econ major from New Jersey.

If you have any questions about HSV or any other sexually transmitted infections, make an appointment to see us at the Student Health Center.  We can answer your questions, take a look at what’s worrying you and perform any necessary lab testing.

John A. Vaughn, MD
Director, Student Health Services
Duke University

1Genital HSV can cause problems during pregnancy, so if you have HSV and are pregnant or planning to become so, be sure to discuss it with your health care provider.