One of the most interesting facts about Herpes, and perhaps also one of the least well publicised, is that it affects two out of every three people on the planet. At least 67% of adults worldwide suffer from Herpes according to a study released by the World Health Organisation in 2012, and many individuals don’t actually know that they suffer from it. For such a ubiquitous disease, the word ‘Herpes’ is still loaded with a magnitude of negative social connotations – despite the fact that each of us are more likely to have it than not. Perhaps it’s because ‘Herpes’ is a word we associate with sexually transmitted disease; it’s a social taboo, often conjuring up an image of licentious, sexually promiscuous individuals. This profile, however, isn’t always accurate – there are some forms of Herpes that actually aren’t sexually transmitted, and even practicing ‘safe sex’ or sticking to one sexual partner doesn’t always prevent Herpes transmission – so why does Herpes have this reputation? How has the social stigma become so bad that sufferers of it have been known to commit suicide after diagnosis? Why do these people feel ashamed despite being one of 3.7 billion people to suffer from the disease? To understand the stigma surrounding Herpes, it’s important to understand the nature of the Herpes virus – or Herpes Simplex Virus (HSV) – itself. HSV belongs to a family of DNA viruses known as ‘Herpesviridae’, a family to which diseases such as chicken pox, shingles, and Mono also belong. HSV is a ‘virus for life’, meaning that after initial infection the virus takes up residence in the soma, or cell bodies, of your sensory nerve cells, where it remains for life. Most individuals with HSV won’t suffer any symptoms at all, while others will experience small, virus-filled blisters that typically occur in clusters around the mouth, tongue or genitalia. HSV comes in two variations – HSV-1, typically affecting the mouth and tongue, and HSV-2, common to the genitalia – although there is a great deal of cross-over with HSV-1 causing up to 40% of genital herpes. HSV-1 is most frequently acquired during childhood, often from contact with a relative who has an oral lesion or ‘cold sore’. Transmission typically occurs through skin-to-skin contact, which is why condoms (which protect against fluid-borne viruses) are often ineffective unless covering the affected area. Although the risk of transmission is highest when active sores are present, HSV can still be transmitted when skin appears normal (due to viral shedding). Symptoms of HSV are most likely to be present during childhood; along with the characteristic sores around the vermillion border (tongue and mouth) children may also experience fever and enlarged lymph nodes. In adults the symptoms, if they do occur, can be accompanied by cold-like symptoms and pharyngitis. Being a latent disease, reactivation of the herpes virus is common and typically triggered by factors such as stress or illness. There are often no symptoms upon reactivation, and when there are, the blisters tend to be smaller, less painful and heal more rapidly. Physiologically speaking, a Herpes outbreak does very little damage to the body in comparison to other incurable STDs such as HIV and HPV. Despite this, Herpes has still been vilified by popular culture, referred to as “The New Scarlett Letter” in a Time magazine article featuring the disease from 1982, and has continued to be seen as a hallmark of moral decline and sexual liberation ever since. But the scientific data just doesn’t fit this profile – so where is the stigma coming from? Ella Dawson, a social media manager diagnosed with HSV-1 during her third year of college, elucidates her view on where the stigma is coming from: during her TED talk entitled ‘STIs aren’t a consequence – they’re inevitable’, Dawson proposes three sources of Herpes stigma: sex education, popular culture and doctors themselves. Doctors don’t encourage Herpes testing, Dawson explains. There are various reasons for this: Dr Sunil Goyal, MD, suggests to Broadly magazine that “[up to] 90 percent of the US adult population has been exposed to herpes or carries herpes, so getting tested is basically a moot point.” This view is common to healthcare professionals, who believe diagnosing an asymptomatic patient with HSV would cause unwarranted psychological distress. Dawson believes that because of this, however, most people aren’t aware that they might have HSV and could be transmitting it to others. Popular culture also contributes to Herpes stigma, by often portraying it as some sort of insult or joke. The majority of characters that catch STDs typically fit in with the ‘sexually promiscuous’ stereotype, and often learn a lesson about responsibility at the end of their disease. Dawson argues this portrayal harms those living with incurable disease like HIV and Herpes who don’t fit this stereotype at all. Lastly, whilst sex education is generally effective in promoting the use of condoms, regular STD testing and methods to avoid pregnancy, Ella argues that most students aren’t taught what to do in the case that they actually catch an STD – an eventuality which Dawson believes is practically inevitable. “An STI, especially Herpes, is not a reflection of your character or a bad decision; it is an inevitability of being a human being on this planet that comes into skin contact with other human beings,” she summarises to her audience. So what if do you get Herpes? This is a questionI asked Dr. Paula Baraitser, a sexual health consultant at King’s College Hospital and the director of an online sexual health platform, SH:24. Dr. Baraitser suggests that if you get Herpes, the best thing to do is not to worry. “You might never have an attack again,” she explains, “or you may have attacks when you’re run down, in the sun, or have a cold. If it’s something that really worries you then you can take suppressive therapies – where you take a tablet every day to reduce the chances of getting an outbreak – but actually, most people don’t need that.” Dr. Baraitser introduced the SH:24 website, where individuals can ask sexual health-related questions online or via text at any time of day, and have these concerns answered by clinicians. The platform is also currently developing a ‘photo diagnosis’ service, which would allow patients to get diagnosed and treated without ever having to go into clinic, by sending in a photo the affected area. Ultimately, having Herpes really isn’t all that bad. The New England Journal of Medicine documents that, “for the majority of suffers, the psychological effects are far more severe than the physical consequences of the disease,” highlighting how benign a disease it really is. Dr. Baraitser reflects, “all of these [STDs] are either easily treatable or manageable and there’s so much anxiety and unhappiness about that when there really shouldn’t be.” When asked where this unhappiness might be coming from, she simply replies that “people aren’t talking about it enough.”
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