The Stigma Surrounding Sexually Transmitted Infections
One afternoon I was sitting at Hermann’s with a friend who had been eating a curry and had become full before finishing the entire thing. I asked her ‘are you gonna finish that?’ to which she replied ‘nah, you can have it’, but then corrected herself a moment later by saying that she had a coldsore and so I probably shouldn’t.
I knew what this meant. A coldsore is a symptom only exhibited by a so-called ‘outbreak’ of the viral infection known as the herpes simplex virus - usually type 1 (HSV-1) although every now and then HSV-2 can be found in the mouth - and during an outbreak the virus ‘sheds’, i.e. it can be transmitted from one person to another through their saliva, some of which was by now probably mixed into the curry. She was telling me that eating this curry meant potentially catching HSV-1 in the mouth - and becoming part of the 60-80% of adults between the ages of 12 and 49 with herpes - either as an asymptomatic carrier or as someone who, every now and then, would get a coldsore and flu-like symptoms such as swollen lymph nodes and maybe a few headaches for a week or two at a time.
This sounds like a massive informational dump researched specifically for the sake of this article, but it was actually all information that I had in mind when she made this comment, because I had spent probably the previous week and a half leading up until that moment doing intense research on herpes and going through the kind of personal crisis I had not expected myself to be going through at the age of eighteen, having been sexually active for approximately a year, with a total of only four sexual partners under my belt.
This was because I had just experienced what could have been my first outbreak of HSV near my genitals. Without going into any vivid descriptions, my symptoms were very mild, particularly at first - so mild that I completely dismissed them initially as an injury caused by vigorous sex. And when this ‘injury’ didn’t heal, I convinced myself that it was due to the fact that I had continued to, fairly regularly, have sex without giving the injury an opportunity to heal.
This sort of ‘ignorance is bliss’ type of denial eventually degraded into frantic-google-searching-to-find-anything-else-that-it-could-be-rather-than-herpes denial which was also accompanied by my-symptoms-don’t-perfectly-match-the-descriptions-of-herpes-therefore-it-must-be-something-else denial. I was reading every available page online, looking through fairly extreme google image search results, and acquiring a lot of knowledge that I really wish I had been taught earlier in sexual education.
After sex one morning I looked down at the spot and saw that it looked worse than previously, and I began to really panic, asking my partner when they had last been tested, how many sexual partners they had had since then, and if any of those partners had ever had a coldsore. It turned out that one had, and that they had avoided oral sex and kissing whenever she had a coldsore, but my partner was unaware until I informed them in that moment that these coldsores could only have been caused by HSV, and that they were a potential carrier who might’ve unwittingly transmitted the virus to me despite never having had any symptoms.
That afternoon I called a nurse at the Sydney Sexual Health Centre in Sydney Hospital, and two days later finally recognised that my symptoms had lasted long enough for the denial to come to a close, and went to get tested.
Unfortunately, by the time I got to the clinic my symptoms were really just scabs of dead skin and couldn’t be ‘swabbed’ - meaning that I couldn’t be tested. The only surefire way to test for HSV is to take a swab of a coldsore or genital outbreak, and mine (if that’s what it was) was almost finished, and there was nothing to test. There’s a reason why an estimated 80% of people with HSV don’t know they have it: despite the descriptions of herpes usually being graphic depictions of painful sores covering the genitals, most people have very mild symptoms or no symptoms at all. You can test for HSV exposure in the blood, but it can be prone to false negatives and false positives, and because HSV is located in the nerves and takes a while to reach the blood, you can only really receive useful results up to 6 months after exposure anyway. Plus, a blood test will tell you whether you have type 1 or 2, but it won’t tell you where your HSV is located - whether it’s oral or genital herpes - and that won’t help you reduce transmission if you’re interested in doing so (which you would be if you’re getting a test, right?).
This means I still don’t know whether or not I have herpes, or had just been experiencing some sort of small injury - just like my partner who has no symptoms doesn’t and didn’t know, or like anyone else who has ever had sex really doesn’t know. On the one hand, the potential outbreak ended up looking fairly unusual for an injury; but on the other hand, I’d never experienced any of the flu-like symptoms that accompany HSV outbreaks, or experienced an unusual discharge (another regular symptom). I essentially only had the one symptom, which was a bit itchy but not painful - including during sex, 99% of the time - and which didn’t look like any of the scary google image results I had pored over repeatedly. This either means that the vulva is a very sensitive place, or that herpes symptoms can be really very mild - both of which are, in fact, true.
Walking out of the clinic, I felt a kind of relief in not knowing, which would’ve been close to equalling the relief I might’ve felt if I had been given a negative result. This was because in the two days leading up to the test I had done an awful amount of research, watched a ted talk or two, read a few articles, spoken to some beautiful nurses who specialised in STDs, cried to my partner on the phone a bit, and come to the realisation that having an STD, even an incurable one, wasn’t actually the end of the world; and that even if I didn’t have herpes yet, it was likely that I would end up having it later in life anyway. But the anxiety that I had initially felt - the anxiety that tempted me to say hurtful things to my partner, and had made me cry more than once - was a far cry from that position, and was informed so much more by social stigma surrounding STDs and herpes especially, than it was informed by actual facts.
Facts like the ones I’ve already mentioned: that HSV is both common and usually mild, coming in two types, 1 and 2, with type 1 usually manifesting as something as mundane as a cold sore; and can’t really be tested for without actual symptoms.
And there are other comforting facts too. Like the fact that the reason why herpes is incurable isn’t because it’s an STD only possessed by evil sluts who deserve it; but because it is like many other viruses (e.g. Epstein-Barr virus, chicken pox) that ‘stay with you for life’, but in the long-term remain effectively dormant.
Or the fact that most people are exposed to HSV during childhood from adults passing HSV-1 on to children non-sexually and inadvertently, usually through kissing or even sharing drinks, meaning that antibodies are developed early on and the chances of having recurring symptoms or contracting a different type of HSV (1 or 2) in adulthood are severely curtailed.
Or the fact that once you have HSV in one location - genitals or mouth - it’s very difficult to get it in the other location, or that it’s pretty difficult to transfer HSV from the genitals to the mouth, particularly if it’s HSV-2 (although it’s best to avoid sex during outbreaks if you want to prevent transmission because this is when viral shedding typically occurs).
Or the fact that outbreaks reduce in frequency and severity over the course of one’s life, and the first outbreak is always the worst - even if it’s mild.
Or the fact that HSV poses no real medical risk: unlike curable STDs like syphilis which can lead to serious organ damage when left untreated, or chlamydia which can leave you infertile if left untreated, herpes is seen by doctors as a simple skin infection in the same family as chicken pox and shingles, which is passed on by skin-to-skin contact…because that’s what it is. This is why herpes isn’t routinely tested for in the way that gonorrhoea, chlamydia, HIV, hepatitis, and syphilis are; in fact, it’s never tested for unless it’s requested by the patient in the form of a blood test or swab. This is why getting herpes particularly shouldn’t be seen as some sort of shameful personal failure despite the fact that STD stigma teaches us to see it this way - the nature of herpes transmission is that condoms can’t fully protect you against it because condoms can’t fully cover your genitals - and they certainly can’t fully cover your mouth. I came to the realisation that I shouldn’t continue to condemn myself as an ‘idiot’ for not insisting that my partner get tested earlier, or for having condomless sex, because we really could not have 100% prevented transmission through those means anyway. In essence, as the nurse told me when I went to get tested, if you really want to avoid ever getting any type of herpes when the statistics are that the majority of people will end up with either of the two types and not even know they have it, you should probably be completely abstinent.
That’s not to say that safe sex isn’t still important: we should all try and get tested every 3 months or after every new sexual partner; wear condoms; use other forms of contraception; use safe words and so on. We should also employ the ethics of informed consent and let people know if we have an STD that we’re aware of to allow them to make an informed, autonomous decision about their own sexual health. But if we do happen to acquire or transmit an STD it shouldn’t be seen as the end of the world, and we shouldn’t make our friends or partners feel bad or ashamed if it happens to them. Somehow, at the age of eighteen, I had already internalised a bunch of stigma that had made me anxious, angry at myself and my partner (and their previous partner), and convinced that not only did I have no one to talk to about it besides my partner, that once we eventually stopped seeing each other, I would be confined to celibacy for the rest of my life, unless I exclusively had sex with other people with herpes; or, at the very least, that any chance of having an ethical and casual sexual encounter ever again was completely unthinkable. This anxiety is the reason why herpes dating sites exist; and it’s also the reason why it was weirdly comforting for my friend to so casually mention her coldsore to me (which I hadn’t even noticed) in a way that normalised the reality of herpes to me.
STD stigma, particularly the stigma surrounding HSV, is something I hadn’t fully appreciated until I had felt the fear of being slut-shamed and then rejected by every potential sexual partner for the rest of my life. It’s a stigma that is in many ways borne of ignorance, and a stigma that needs to be undone. It’s also a stigma that affects those with genital herpes, whether it be type 1 or 2, more so than those with oral herpes, which is purely arbitrary, and is the reason why I am unfortunately publishing this article anonymously. HSV is considered the second-most stigmatised STD following HIV - even the term ‘outbreak’ has fairly pejorative connotations. Stigmatisation also has many dimensions, because whilst internalised stigma can cause a person with an STD such as herpes to feel anxious or depressed, this is then compounded with feelings of loneliness and isolation as the stigma also prevents them from turning to friends or family for guidance and support. This is a loneliness that I felt very strongly, and that was lessened at least in part when I was able to say to my friend, ‘I might have herpes anyway, actually’, and casually mention it to her in the same way she had done to me.
This is why it is crucial for each of us as individuals and members of different communities to ensure that we do not perpetuate stigma to do with STDs, either through making casual jokes, gossiping about other people’s sexual health, or being cruel to friends or partners who open up to us about their experiences with STDs. STD stigma is part of a broader problem to do with how we approach sex as a society - an approach that marginalises people if they have ‘too much’ sex or ‘not enough’, if that sex is paid for, or if it’s gay. It’s part of a strange confusion between seeing prolific sexual freedom as an ideal, but also something somehow deserving of punishment. Rather than punishing each other, and even punishing ourselves, by perceiving sex and sexual health through an antiquated conservative moral lens, we should be committed to a more realistic view that treats sexual health as a health issue, and treats those around us with compassion.