Herpes is common, manageable but surrounded by a lot of stigma. Sexual health experts explain what a diagnosis actually means, how it’s treated – and why regular STI testing matters.
Dr Clare Keogh has seen plenty of people burst into tears after being told they have genital herpes.
“They’re mostly afraid of the stigma associated with it – that they’ll never be able to have a relationship in the future, or certainly not a sexual relationship,” the SHINE SA Sexual Health Doctor and Medical Lead – Education and Advocacy says.
“They worry about spreading it, but often they’re even more worried about how another person will react.”
Clare doesn’t dismiss any of that. Finding sores on your genitals can be painful, upsetting and awkward to talk about – it’s the most commonly Googled STI in South Australia for a reason.
But the medical reality is often much less scary than the stigma.
“It can be really uncomfortable and make you feel generally unwell,” Clare says. “But for most healthy people, it’s unlikely to cause any long-term harm.”
First up: Herpes is incredibly common
Herpes is caused by the herpes simplex virus, or HSV, and there are two types: HSV-1 and HSV-2.
Up to three in four Australian adults carry HSV-1, while up to one in five sexually active adults have genital herpes caused by HSV-2.
Many will never know it because their symptoms are so mild – or they don’t have any at all.
And the traditional distinction between the two types isn’t as neat as you might think.
HSV-1 is commonly associated with cold sores around the mouth, while HSV-2 is more commonly found around the genitals. But either type can affect either area.
“Because of oral sex, either type can end up in either location,” Clare says.
Around half of genital herpes infections in Australia are caused by HSV-1.
So having genital herpes doesn’t automatically tell you which strain you have – or how you got it.
No, it doesn’t mean somebody cheated
You can be exposed to herpes and not develop noticeable symptoms until months or even years later.
The virus can stay dormant in nerve cells and reappear later, sometimes when you’re sick, stressed or run down.
“You could be exposed when you’re 20 and not have your first noticeable outbreak until years later, even if you’re in a long-term relationship by then,” Clare says.
She’s even diagnosed herpes for the first time in people in their 70s after they developed genital symptoms – something she says can cause a lot of distress.
That means a first outbreak during a relationship doesn’t mean anybody has cheated.
“We can’t tell from an outbreak exactly when you acquired herpes or who you got it from,” Clare says.
And no, you didn’t pick it up from a toilet seat – another myth still floating around.
Herpes spreads through direct skin-to-skin contact, including kissing and oral, vaginal or anal sex. It can also spread through genital skin rubbing that isn’t covered by a condom.
What does genital herpes actually feel like?
For some people, nothing at all.
Others might notice itching, stinging or tingling, small blisters or sores, discharge, or pain when they wee.
The first noticeable episode is often the worst and can come with swollen lymph nodes on top of the local symptoms.
“It can be really uncomfortable,” Clare says. “Some people also get flu-like symptoms, such as a fever, body aches and feeling really flat.”
Later outbreaks are usually shorter and less painful, and for many people become less frequent over time.
So how do you know if it’s herpes?
If you find a sore, blister or split in the skin around your genitals, see a GP or sexual health clinician while it’s there.
They can take a swab directly from the lesion and send it to a lab to look for HSV.
What you generally don’t need is a herpes blood test just to find out whether you’ve ever been exposed.
Clare says those tests can cause unnecessary worry.
“It doesn’t tell you when you had it, how sick you were when you got it or whether it’s causing a problem for you now.”
That’s why routine herpes blood screening isn’t recommended for people without symptoms.
You can’t cure it – but you can treat it
Once HSV is in your body, it stays there.
Prescription antiviral tablets can shorten an episode and make it less severe if you start them early.
“If you know what that first tingle feels like, starting treatment straight away can help stop an outbreak becoming more severe,” Clare says.
“The aim is to stop the virus multiplying early, so the episode is shorter and less severe.”
If outbreaks happen frequently, daily suppressive antiviral treatment is another option.
Pain relief, loose clothing, salt baths and drinking plenty of water can also help while an outbreak heals.
Can you still have sex?
Absolutely! People with the herpes virus in their system have relationships, sex and live completely normal lives.
There is a very small chance of passing HSV on when you don’t have symptoms, but the virus is much more contagious when you have an active sore or feel an outbreak starting.
So avoid sexual contact with the affected area during an outbreak. Condoms and dental dams also reduce the risk, although they can’t completely prevent herpes because they don’t cover every bit of skin.
There are important exceptions. Herpes can cause serious complications in people who are severely immunocompromised, and an active genital infection during childbirth can be dangerous for a baby. If you’re pregnant and have genital herpes, tell your doctor or midwife.
Learning to live with herpes
For some people, the harder part of a herpes diagnosis is wondering what a partner will think, worrying about rejection or feeling ashamed about having an STI.
“Shame and stigma are often the hardest part of coming to terms with a herpes diagnosis,” SHINE SA CEO Holley Skene says.
“Learning the facts, speaking with a supportive healthcare professional and choosing trusted people to confide in can help.”
The language the rest of us use matters too.
“We can all help reduce herpes stigma by avoiding jokes and moralising language, respecting people’s privacy and avoiding stigmatising language when talking about STI results, like ‘clean’ or ‘dirty’,” Holley says.
Why is regular STI testing so important?
Different STIs can affect your health in different ways, which is why routine screening looks for more than one infection.
“Syphilis and HIV are important to include in routine STI screening because they can cause serious long-term health problems if they’re missed,” Clare says. “We also routinely test for chlamydia and gonorrhoea.”
Syphilis can be cured with antibiotics, but if it goes untreated for a long time it can eventually damage the brain, eyes, heart and other organs.
It’s especially important to be tested for syphilis during pregnancy, because untreated syphilis can lead to stillbirth or serious health problems for the baby.
HIV isn’t curable, but it’s very treatable. People taking effective antiretroviral therapy usually live long, healthy lives, and when treatment reduces HIV to an undetectable level, it can’t be sexually transmitted.
Left untreated, HIV can eventually lead to AIDS and severe, life-threatening complications.
Chlamydia and gonorrhoea can also cause health problems if they aren’t diagnosed and treated, and may not cause obvious symptoms.
Getting tested is probably easier than you think
If the thought of an STI screen conjures up stirrups and an awkward examination, you can relax.
If you don’t have symptoms, you usually don’t need to get undressed at all.
“Usually it’s a urine sample or a swab you collect yourself, plus a blood test,” Clare says.
A urine sample or self-collected swab can test for infections including chlamydia and gonorrhoea, while a blood test can screen for syphilis and HIV.
If you do have a sore, discharge, pain or another symptom, your doctor may need to examine you to work out what’s going on and choose the right tests.
“The safest approach is to use condoms and get tested regularly,” Clare says. “And don’t be afraid to ask your GP or sexual health clinic about any symptoms or concerns. No question is a stupid question.”
There are medication options too that could be worth asking about: PrEP can prevent HIV, while doxy-PEP involves taking the antibiotic doxycycline after sex to reduce the risk of syphilis and chlamydia in some higher-risk people.
You can make an appointment with SHINE SA or talk anonymously to a sexual health nurse through its free Sexual Healthline on 1300 883 793, Monday to Friday, 9am-12.30pm.
