Herpes and Mental Health: Part 1

I have been working with individuals diagnosed with genital herpes for over 20 years in different capacities. Most of the people I work with do not develop serious clinical depression but many of them do struggle with a period of sadness and shame. They feel scared, angry, and hurt. They can have feelings of hopelessness, lowered self-esteem, and may feel alone, either believing they can’t tell others or that others can’t understand, even if those people respond in caring ways.

Most of this sadness is associated with the stigma. Usually it is the meaning associated with herpes that is the hardest part of the diagnosis. The emotional pain and shame are primarily centered around the fear that no one will accept you if they find out, particularly romantic or sexual partners.

Feelings of Uncertainty and Loss

In the beginning, it can feel hard to imagine how you will wrap your head around the diagnosis. You might feel the loss of dreams you had about your future. You might wonder how your life will turn out. You may worry about future symptoms and what they’ll be like.

These feelings are often temporary and the first stage of adjustment. Although you might have feelings of hopelessness, reading an article like this shows that you do want to feel better and that you do in fact have some hope that you can feel better. And you can. You can have a good life with a herpes diagnosis.

Resilience

Resilience is a characteristic that gives us what we need as humans to get through difficult times. You may not feel very resilient in this moment and that is ok. It is normal to need time to adjust to something that feels life changing. It’s normal to feel grief about change and what you feel you’ve lost. And people grieve in different ways and for varying amounts of time depending on the circumstances. And this grief often is part of a process of problem solving, an attempt to understand new circumstances and figure out what you will do about them.

Hope

There are very good reasons to have hope. A genital herpes diagnosis often does not turn out to mean what a person initially thinks it will mean. And most of my patients do adjust. They do find hope again. They do feel happiness again. Their courage grows. They learn how to talk about herpes with new partners. They date, find love, have families, and even have casual sex if they choose. People with herpes can do all the things everyone else is doing. The main change is that my patients start making an effort to talk about sexual health before having sex with someone new. This may not sound very fun and may feel embarrassing at first, but people find ways to do it that feel authentic for them. And they often find partners who appreciate this and who respond in sincere and caring ways.

Of course rejection can happen. That is part of being human. But truly, after all these years of working with patients diagnosed with herpes, and witnessing the many, many partners who have accepted people with this diagnosis, I don’t believe that herpes has to get in the way of any of your life dreams or desire to connect with others in whatever way you long for. (Here’s one of my posts on rejection.)

Don’t give up hope. And don’t give up on finding a way to move forward.

In-Person Counseling in NYC

If you are in New York and would like in-person counseling or to participate in my therapy group for women diagnosed with herpes, please contact me. I’m located in the Murray Hill neighborhood of Manhattan. I would be happy to speak with you about whether counseling or the group might be helpful to you and whether working with me might be a good fit.

Other Posts on Herpes

If you’d like to read more, here are my other posts about herpes.

**This information is not intended to replace medical advice or psychotherapy and is not intended to address all the caveats of a diagnosis.

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About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Contact me if there's a topic you'd like to read about here.

**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.

The Truth about False Positive Herpes Test Results

Over the years, many people with no history of herpes symptoms have called me to begin counseling or group therapy after receiving a herpes diagnosis from a blood test screening alone. It is true that you can have herpes and not be aware of symptoms. However, if someone tells me they have never recognized any symptoms, I think it’s worth exploring a little further to make sure the diagnosis is accurate. I suggest that they obtain a copy of their results and look at whether they had an IgG or IgM based test (the CDC says IgM based tests should not be used to diagnose herpes). Once they confirm that it was an IgG based test, I ask them to look for the index value of their result. About 50% of people who test positive for HSV-2 on an IgG based test with an index value between 1.1 and 3.5 do not have herpes (the lower the value, the higher chance of a false positive, the higher the value the more likely it’s an accurate result). The CDC recommends that anyone who tests positive on an IgG based test with an index value that falls between a 1.1 and 3.0 should get confirmatory testing (experts say the Western Blot is the best confirmatory test). Research shows that there can even be false positives above this range in some people.

(**A positive swab test of a lesion in someone with symptoms can be a confirmation. Blood tests are helpful when a swab test can’t be obtained or to help sort out other matters.)

Getting Help with Confirmatory Testing

I've found that an important part of mental health for patients with herpes is to feel a sense of understanding and agency around their diagnosis and test results and to learn information that can help them make a decision about whether they want to pursue confirmatory testing or not. I often refer patients with low positive results to consult with a medical expert if they have additional questions. The healthcare provider I trust the most with these types of questions is Terri Warren, NP, who has been an excellent resource for many of my patients. There may be other healthcare providers who can navigate appropriate confirmatory testing, but many providers have not learned how to do this. If you are questioning your diagnosis and want to learn more about confirmatory testing, you can do so here. If you need help coping with the diagnosis or with awaiting results, therapy or a support group can often help.

Low Positive Result with Symptoms

On rare occasion, I have seen people with symptoms that are assumed to be herpes, even recurring symptoms, who have not obtained a positive culture and who have a negative or low positive result on the IgG, even after an adequate amount of time has passed to have a higher value. Other conditions can cause rashes on genitals, such as eczema and even Lyme disease (yes, I have actually seen this happen). While a case like this can certainly be a true positive for herpes, if something is just not adding up in your mind, it may make sense to explore it further with your healthcare provider or perhaps seek confirmatory testing (either via a swab or Western Blot for instance).

A Little Something About HSV-1

HSV-1 can also have low index values that are false positive. If there is no history of symptoms and it is a true positive, it is impossible to know if an HSV-1 infection is oral or genital (unless the individual has never had contact that could expose the genital area). More than 50% of adults in the U.S. will test positive for HSV-1.

Take that number in…

Most HSV-1 infections are oral and plenty of people don’t recall ever having a cold sore or symptoms that would explain their HSV-1 diagnosis. That said, there are also many people who contract it genitally, often from someone who has the infection orally and performs oral sex (with or without active symptoms).

Coping with Results

Finding out your result is not a false positive or simply having to wait for confirmation of a result can be really difficult. If your result is a true positive, please know that you are not alone! I know this is not something you probably ever thought you would have to deal with. It can take time to adjust, but you absolutely can still date, have sex, have relationships, and feel good about yourself again. You may not be able to imagine it right now, but it’s true.

I offer individual therapy for men and women and group therapy for women in NYC who are diagnosed with herpes. It can be a relief to have space to talk about how you are feeling and how you will move forward with someone like me who is knowledgeable about herpes and familiar with the questions and worries people newly diagnosed with herpes often have.

I have been working with men and women with herpes for over 20 years and have watched many, many people get through this and go on to enjoy dating, sex, and relationships again. If you would like the support of therapy, I would love to help!

More Posts About Herpes

I hope the resources in this blog can further assist you. Read other posts about herpes here.

In-Person Counseling in New York

If you are in New York and would like in-person counseling or to participate in my therapy group for women diagnosed with herpes, please reach out. I’m happy to speak with you about whether counseling or the group would be a good fit.

**This information is not intended to replace medical advice or psychotherapy and is not intended to address all the caveats of a diagnosis. I am not a medical provider and simply provide this information as a resource for learning.

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If you find these posts helpful, sign-up to receive notices of new posts here. I will never sell your information. You can unsubscribe at any time. View my privacy policy here.

About Melissa King

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Contact me if there's a topic you'd like to read about here.

**Information on this site is not intended to replace medical advice and does not constitute a psychotherapeutic relationship with the reader.

Why Doctors Don't Test for Herpes

Many people diagnosed with herpes feel betrayed by the medical system when they learn they had never previously been tested for herpes and their partner likely was not either. If you didn't know before now, herpes is generally not included in a standard STD panel. That means all those screens that you so diligently obtained since becoming sexually active and the one you may have asked your partner to get as well, probably did not include herpes. 

Major medical associations regularly publish guidelines for how doctors should practice. When it comes to STD screening, the general consensus and recommendation is to not test individuals for herpes unless they have symptoms.

Most people with herpes have no idea they’re infected. While some people have classic symptoms easily identified as herpes, most people have no recognizable signs or no indications that concern them enough to head to the doctor.  

Nonetheless, asymptomatic individuals can still pass herpes on, and you could be one of them, even if you obtain regular STD testing.

Many doctors also don't inform patients that the test is not included, so when people do have symptoms and receive a diagnosis, there can be feelings of confusion and worry about whether a partner was dishonest or cheated, when their partner simply may not have known about the infection. In fact, by the time some people are diagnosed, it can be very difficult to determine how long they've had the infection. This means they may not have contracted it from their current partner.

So why is this test not included? Doesn’t the medical community care about preventing transmission?

Although it may not feel this way, the doctors and researchers who established these guidelines have been quite thoughtful about them. If you read the documents, you can see that the researchers sensitively consider their decision from many different angles. In fact, you can learn a ton about the research on genital herpes and transmission by reading the U.S. Preventive Service Task Force documents where they discuss the reasoning for their decision.

The biggest contributing factor to the guidelines is that 1) standard herpes blood tests are not totally reliable and 2) receiving a herpes diagnosis can have a significant impact on mental health while being virtually non-threatening to your physical health.

The blood tests do have a lot of value, but here are the biggest issues:

1. About 50% of the population has type 1 herpes. Type 1 can be genital or oral. If you have never had symptoms (no cold sores or genital symptoms) and obtain an IgG based type-specific blood test (the standard test for herpes simplex), and the test comes back positive for type 1, we have no way of knowing whether you are infected orally, genitally, or both. The only way we can know which location is infected is by symptoms. (Type 2 is almost always a genital infection.)

2. About 30% of negative results for HSV 1 are false negatives. This means if you test negative, you might still have HSV 1. (There is about an 8% chance of false negative with HSV 2.)

3. If you are positive for type 2 and fall within a positive range of 1.1 - 3.5, there’s a decent chance this is a false positive. About 50% of positives that fall in this range are in error, with the closer you get to 3.5 the more likely you are positive and the closer to 1.1 the less likely you are positive. There can be false positives above 3.5 as well but they’re less likely. If you do test positive within this low range, the CDC recommends confirmatory testing (update: CDC now encourages confirmation between a 1.1 and 3.0, but some experts still say below 3.5). The most accurate confirmatory blood test is the Western Blot. The Western Blot is more complicated to obtain (though not impossible) and your insurance may not cover it. In addition, many doctors do not know about the high false positive rate within this range so they incorrectly diagnose their patients without getting confirmation. I have worked with a number of patients diagnosed within this range who I encouraged to follow up with the Western Blot and they discovered they were negative. (You should not do confirmatory testing with the same blood test that gave you the positive result; and to be confident in your results, you should wait 16 weeks from the last possible exposure to be tested.)

4. Blood tests given too early after possible exposure can be false negative.

What about mental health?

We also know that due to the stigma, learning that you are positive for herpes can impact your mental health. Research shows that people diagnosed with herpes are more likely to become depressed, withdraw socially, and experience reduced self-esteem. The shame associated with contracting herpes can make a big impact on a person’s quality of life. This is despite the fact that it’s a common virus that affects people of all walks of life, all social circles, and all socioeconomic classes. It not only affects people who have casual sex partners (as is often assumed) but also people who limit their sexual behavior to monogamous relationships. It can even affect people who have only had one partner.

I can almost guarantee you know multiple people who have genital herpes even if no one has ever told you. Also, many cases of genital herpes occur as a result of oral sex from someone who has a history of cold sores (there is no need for a cold sore to be present at the time of oral sex because herpes, which causes cold sores, can shed virus when no symptoms are seen or felt). 

Medical experts pretty much agree that from a physical health perspective, outside of the rare case, herpes is by and large no big deal. Most other STDs (gonorrhea, chlamydia, syphilis, HIV, and some strains of HPV) can have a significant impact on your health if left untreated. This is not the case with herpes. If you have no symptoms but test positive for herpes, there is nothing to do differently when it comes to your personal health. So the experts who publish these guidelines feel that the risks of knowing you have herpes based on tests that might not be accurate and still leave a lot of questions will have a potentially worse impact on your mental health than it’s worth.

And perhaps they are right, however...

Research suggests that the psychological impact on people who are asymptomatic but test positive tends to get better with time. If asymptomatic people were informed of their infection, maybe they would do something to reduce the risk of transmitting the virus. In fact, one study showed that people aware of having HSV-2 were 50% less likely to transmit the infection in new relationships than people who are unaware of their infection.

As a mental health provider who sees the impact on people who contract symptomatic herpes from partners who didn't know they were infected, I think we as healthcare providers owe these individuals a bit more.

The few patients with knowledge of their infection shouldn't have to bear the full burden of herpes stigma while most people with herpes are able to go on with their lives, transmitting unknowingly.

My call is for more informative conversation about herpes between practitioners and patients who are seeking sexual health services.

At the very least, I believe providers should inform patients if herpes is not included in their test. Providers should take this opportunity to educate patients on how common herpes is, dispel some myths, inform them that most providers don’t test and therefore the patient and their partners are unlikely to know if they have herpes unless they exhibit symptoms.

STDs are a public health concern, so STD testing should come with education, which hopefully will help reduce stigma. If we all heard about herpes every time we were tested for STDs (regardless of whether we are tested for herpes), learning that we could have the virus and not know it, that genital herpes can be contracted via oral sex by someone with oral herpes even when no symptoms are present, that all types of people have herpes and contracting it doesn't mean you're "dirty"--then this might do a lot for reducing the mental health impact for people who do receive a diagnosis.

I can't say that everyone should be tested. But I can say that patients should be informed about what is not included in their test, especially since they are likely to assume herpes will be a part of it. Doctors (or their nurses) should take the opportunity to inform patients and reduce stigma, hopefully mitigating some of the mental health impact should a patient be diagnosed in the future or learn that someone they care about has herpes.

A few notes and resources:

**If you have tested low positive for herpes (between 1.1 and 3.5) via a herpes IgG blood test and want information about obtaining confirmatory testing via the Western Blot, you can find that information at The University of Washington's website or contact Terri Warren, NP who is an expert in herpes and can help guide you through the process of obtaining the Western Blot and interpreting your results. If you've had a positive swab for herpes from a genital lesion, this can act as confirmation.

**People with herpes simplex who have a partner with the same type of herpes simplex are very unlikely to "re-infect" or transmit herpes to their partner since their partner already has antibodies for the same virus. For instance if both partners have HSV-1 (even if one has it orally and the other genitally). Check out The Updated Herpes Handbook or The Good New About The Bad News for a thorough discussion on transmission.

**Pregnant women who are negative for herpes simplex should avoid activities that could put them at risk for contracting genital herpes during the 3rd trimester, as becoming infected at this time carries the highest risk for neonatal herpes.

**Women who have a genital herpes diagnosis prior to becoming pregnant are at a very low risk for transmitting to their infants during birth, however it's still important to inform your doctor as you will likely be prescribed antivirals at the end of your pregnancy to reduce the chances of an outbreak at delivery. Most women in this situation are able to give birth vaginally and do not need a cesarean section.

**You can read my other posts on genital herpes here.

Counseling in NYC to Help Cope with a Diagnosis

You do not have to go through the experience of being diagnosed with herpes or awaiting a diagnosis alone. I have been working with women and men with herpes for over 20 years. While I know that awaiting a possible diagnosis or receiving a diagnosis can be a very difficult emotional experience, I have so much hope for you. I have watched many people work through these difficult feelings and come out stronger on the other side, finding confidence to enjoy dating, sex, and relationships again. If you are in NYC and interested in whether therapy might be helpful, please contact me for a complimentary phone consultation. I also am able to offer virtual counseling to individuals in California, Florida, and Upstate New York.

Disclaimer

My hope is to keep you informed, but this is a blog post and not meant to be exhaustive. I am not a medical doctor and it’s possible information written here does not apply to your unique circumstances. Also, I do my best to stay up-to-date on the best information regarding herpes, however, a blog post can become out-of-date without my realizing it, so I always encourage patients to do their own research. Information on this website is not intended to substitute professional medical or psychotherapeutic advice.

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About Melissa King, LMHC

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about on this blog.

Get Updates about New Blog Posts

If you find these posts helpful, sign-up to receive notices of new posts here. I will never sell your information. You can unsubscribe at any time. View my privacy policy here.

Life After Herpes

I recently connected with Lori Fauquier, a nurse practitioner who used to practice at Callen-Lorde, here in New York City. She now has a tele-medicine practice focusing on women's health issues. I've found Lori to be a knowledgeable and passionate provider who is also comfortable talking about sex and sexual health. She is very generous with providing education through her blog and a regular Facebook Live show, both of which I've been so excited to participate in this month.

My Guest Post - Life After Herpes

I wrote a guest blog at Lori's site, Women's Health on the Go, for patients recently diagnosed with herpes: Life After Herpes

The Emotional Impact of Herpes - Facebook Live Interview

Lori will also be interviewing me this Friday at noon for her weekly Facebook Live educational show. We'll be talking about the emotional impact of herpes. It will be recorded and posted after the show in case you miss us!

Melissa

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About Melissa King, LMHC

I am a licensed mental health counselor in New York City with a psychotherapy office in the neighborhood of Murray Hill in Manhattan. Find out more about me here. I'd love to hear from you. Email me if there's a topic you'd like to read about here.

Get Updates about New Blog Posts

If you find these posts helpful, sign-up to receive notices of new posts here. I will never sell your information. You can unsubscribe at any time. View my privacy policy here.

DISCLAIMER

Please remember that we are continuously learning new things about herpes. I will try to keep this website updated but remember that research may come out today that changes what we currently know about herpes. Information on this website is not intended to substitute professional medical or psychotherapeutic advice.

Let's Talk About Herpes Part 4: My Favorite Herpes Resources

These are my favorite herpes resources. They include my most recommended sites for facts and information, good books, positive encouraging websites, and some great articles. I hope you find these supportive on your journey.

FACTS/INFORMATION

The Updated Herpes Handbook by herpes expert and nurse practitioner, Terri Warren. View for free: westoverheights.com

Ms. Warren also has a forum on her website that can be viewed for free and medical questions about herpes can be posted for a small fee.

I have looked to Ms. Warren for many years for her opinions and medical expertise with herpes. She is one of the most respected and well-known in this area of medicine.

American Sexual Health Association: Herpes Resource Center
ashasexualhealth.org

BOOKS

The Good News About the Bad News by Terri Warren, RN, NP
Dr. Ruth’s Guide to Talking About Herpes by Dr. Ruth K. Westheimer

POSITIVE, ENCOURAGING WEBSITES

The STD Project
Ella Dawson
Something Positive for Positive People - Podcast

WORTHWHILE ARTICLES ON THE WEB

Herpes Was the Best Thing to Happen to My Stand-Up Career by Ariel Elias

What It's Like to Have Genital Herpes When You're Pregnant by Britni De La Cretaz

What to Expect When You're Expecting--With Herpes by Britni De La Cretaz

Why I Celebrate The Day I Was Diagnosed With Herpes by Ella Dawson

You Probably Have Herpes and That's Okay (video clip from Adam Ruins Everything)

TEDx Talk by Ella Dawson: STIs Aren't A Consequence, They're Inevitable.

RESEARCH

Recently the US Preventive Services Task Force recommended against routine blood testing for genital herpes in adolescents and adults who don't have symptoms. Whether or not you agree with the position (you are not alone if you disagree--and I plan to write an opinion on the position soon), if you like reading research, this document provides an excellent summary of important areas of research on herpes and will help you understand why they've taken the position they have. Serologic Screening for Genital Herpes: An Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Further commentary on the above recommendation: A Recommendation Against Serological Screening for Genital Herpes Infection--What Now?

MORES POSTS IN THIS SERIES

Read Other Posts in the Let's Talk About Herpes Series

ABOUT MELISSA

I am a licensed mental health counselor in New York City with a psychotherapy office in Murray Hill, Manhattan. Find out more about me here.

DISCLAIMER

Please remember that we are continuously learning new things about herpes. I will try to keep this list updated but remember that research may come out today that changes what we currently know about herpes. Information on this website is not intended to substitute professional medical or psychotherapeutic advice.

Let's Talk About Herpes Part 3: Common Questions Women Diagnosed With Genital Herpes Ask

Below are some answers to common questions or misconceptions my clients diagnosed with herpes often ask or talk with me about in therapy sessions. I hope these are helpful to you as you process your feelings and thoughts about your diagnosis. 

Isn’t Genital Herpes Type 2 Herpes?

Many people assume that because they have genital herpes that they have type 2 herpes. However, there are two types of genital herpes: Herpes Simplex Type 1 and Herpes Simplex Type 2. Type 1 genital infections are increasing. The only way you can be sure which type you have is through testing (which I’ll talk about later in this post). You cannot tell the difference by looking at the symptoms. Some people think the severity of the first outbreak is predictive of whether it’s type 1 or type 2. Nope. An outbreak of type 1 and type 2 can look the same in appearance. Type 2 does tend to cause more frequent genital outbreaks than type 1 in people who get symptoms.

Most people who have herpes don't recognize symptoms, although once taught, many of these individuals can learn to identify them. People who do experience symptoms tend to get fewer and milder outbreaks over time. Terri Warren, ANP, who is an expert in the field and has lots of experience diagnosing and treating patients with genital herpes, reports that the first year is when the virus is most active and is not a good indicator of outbreaks long-term.

If you are someone who gets symptoms, you are definitely not alone. I see many clients, mostly young women, in my practice who also have symptoms.

Can I Transmit If I Don’t Have Symptoms?

This is probably one of the most frustrating things about herpes. Yes, you can still transmit when you don’t notice any symptoms. With herpes, there is viral shedding, meaning the virus is coming to the surface of the skin without producing recognizable symptoms. Most transmissions occur when people don’t recognize symptoms. Herpes is transmitted through sexual contact with the affected area (intercourse, oral sex, rubbing together of genitals without clothes on). Oral herpes can be transmitted to someone else's lips during passionate kissing when there is asymptomatic shedding or kissing during an outbreak.

Is It Possible My Partner Didn’t Know They Had Herpes?

Yes. If your partner tells you they didn’t know they had herpes, it’s quite likely that they really didn’t know. This is so important because when one partner has a first outbreak, it’s easy to assume the other lied or cheated. Unfortunately, herpes is just not a reliable detector for lying or cheating in a relationship. You will have to use some other method to determine whether your partner is trustworthy. It’s also important to know that you can be in a relationship for years before herpes pops up. In addition, if your partner has type 1 oral herpes (which is very common) and you don’t have type 1, even if your partner hasn’t had a cold sore since childhood, they can still transmit herpes to you through asymptomatic viral shedding. Many people don’t realize that they can transmit oral herpes to their partners genitals when they don’t have a cold sore and this can be very surprising for couples when it happens.

Is Knowing What Type I Have Important?

Knowing what type you have is important because if you have a partner who has the same type, it will be very unlikely that you would transmit to each other in a different location. For instance, if your partner has type 1 on the mouth and you have type 1 genital herpes, you both have antibodies to the type 1 virus. This means you wouldn’t have to think about giving each other herpes in a different location. And since so many people don’t know they have herpes, having your partner get tested can be valuable. Herpes isn’t included in most standard STD testing, so even if your partner has been tested for STDs, there’s a good chance they weren’t tested for herpes. If your partner gets tested, you may find that they have the same virus and type that you do and they just never knew it. If so, this will likely change the conversation you and your partner have about reducing risk of transmission. There are some caveats about blood tests in individuals with no symptoms that you need to know, however, which I will talk more about later in this post.

Can You Pass Genital Type 2 to Your Partner’s Mouth Through Oral Sex?

This question is asked a lot. Yes, it is possible, but type 2 oral infections are uncommon. For some reason, the mouth is not a site of preference for type 2. When type 2 does occur on the mouth, it looks just like a cold sore and it rarely recurs and very rarely sheds virus.

Can I Still Have Babies?

Many women worry that having herpes means they won’t be able to have a safe pregnancy and birth. I hope it comforts you to know that neonatal herpes is very rare. Most women with herpes are able to have a vaginal birth and deliver with no complications with herpes. Contracting herpes in the 3rd trimester creates the most significant risk. The antibodies you develop by having herpes prior to pregnancy contribute significantly to protecting your baby. Partner with your doctor when the time comes to reduce any risks. You can also read this piece about one woman’s experience of herpes during pregnancy and delivery.

Can I Reduce the Risk of Transmitting to My Partner?

Yes. It’s great that you are informing yourself about your diagnosis because you can do a few things to reduce risk to your partner: 1) The most important thing you can do is to get to know your body and learn about your symptoms as well as the sensations you experience just before you see symptoms. Abstain from sex from the time you notice those sensations to the time any lesions have healed. 2) Use condoms. Condoms aren’t 100% protective, but they do reduce risk significantly. 3) Take daily antiviral medication, known as suppressive therapy. One important study showed that daily Valtrex reduced the risk of transmission for people with recurrent type 2 by almost 50%.

Some partners choose to only avoid sex during outbreaks while other partners choose to combine all three precautions. Many long-term partners eventually choose to forego condoms. Most of my clients who use suppressive therapy have reported success in avoiding transmission. Either way, I think relationships work best when partners are aware of and comfortable with the risk.

What Should I Know about Testing?

If you have an outbreak, hopefully your doctor will swab and type it to determine if it's 1 or 2 using a PCR test, which has less chance of a false negative than a viral culture. If your doctor does an IgG based blood test at the same time as your first outbreak, it can help you sort out whether this is a new infection or an old infection (if the swab comes back positive and the blood test comes back negative for the same type, you are likely still building up antibodies which would mean this is a recent infection). But if you don’t have symptoms, you can seek out a blood test. Blood tests are tricky though and it’s very important to be informed about what the results mean. I always recommend that patients get a copy of their results.

The most common and accessible test is the HerpesSelect IgG based test. You don’t want an IgM based test. Some doctors still use them but the CDC recommends against their use in diagnosing herpes. When the HerpesSelect came on the market it was so helpful to many people who had herpes as they could find out if they had type 1 or type 2. The unfortunate thing is that there are problems with false positives for type 2 and false negatives for type 1. Most of the false positives for type 2 have a positive result value between 1.1-3.5 and a large number of those that fall into that range do turn out to be negative. Many doctors don’t have this updated information and diagnose their patients with herpes even when results are in this low positive range. (Keep in mind, if it has been less than 3 or 4 months since exposure, antibodies may still need time to rise.) If you or your partner have a positive result in that low range and don’t have symptoms or have atypical symptoms, it’s important to get confirmatory testing. The best confirmatory test is the Western Blot. There has been a lot written about testing and if you are confused about your results or want to pursue confirmatory testing, I recommend reading the “Diagnosing Herpes” section in the Free Herpes Handbook written by nurse practitioner and herpes expert, Terri Warren.

In someone without symptoms, a positive type 2 blood test is assumed to be genital herpes. In someone who has never had symptoms, a positive type 1 blood test cannot determine the location of infection. If you do have symptoms, don’t simply settle for a visual diagnosis. Visual diagnoses can be unreliable and clinicians have diagnosed things as herpes that are not herpes. 

Can Counseling Help Me Cope with a Diagnosis?

You do not have to go through the experience of being diagnosed or awaiting a diagnosis alone. I have been working with women with herpes for over 20 years. While I know that awaiting a possible diagnosis or having received a diagnosis can be a very difficult emotional experience, I have so much hope for you. I have watched many women work through these difficult feelings and come out stronger on the other side, finding confidence to enjoy dating, sex, and relationships again. While there are no guarantees with therapy, and the success of therapy depends on the work you do in and between sessions, it can be very helpful to talk with someone knowledgeable about herpes and familiar with supporting women in finding a way forward. If you are in NYC and interested in whether therapy might be helpful, please contact me for a complimentary phone consultation.

Other Posts In This Series

Let's Talk About Herpes Part 1: Rejection (It Might Not Really Be About Herpes)

Let's Talk About Herpes Part 2: When to Tell a Partner

Let's Talk About Herpes Part 4: My Favorite Herpes Resources

For More Help and Information

Supporting women with herpes here in New York City is a passion of mine. I do make a point to stay up-to-date, however, I am not a medical expert. If you want to learn more in depth about the topics above, I highly recommend the Free Herpes Handbook, written by nurse practitioner, Terri Warren.

DISCLAIMER

Please remember that we are continuously learning new things about herpes. I will try to keep this post updated but research may come out today that changes what we currently know about herpes. **This information is not intended to replace medical advice or psychotherapy and is not intended to address all the caveats of a diagnosis. I am not a medical provider and simply provide this information as a resource for learning.

Let's Talk About Herpes Part 2: When To Tell A Partner

The most pressing question many of my clients with genital herpes have, even more than worry about how to tell someone they're dating that they have herpes, is when to tell someone they’re dating that they have herpes.

Most of the clients who work with me describe themselves as preferring sex within the context of a relationship. I do have some clients who enjoy casual sex and who have success disclosing to those partners, but today I’m going to focus on those of you who are seeking something more serious.

First, it’s important to me to help you build a strong sense of self-acceptance and self-esteem so that you can feel happier with yourself and more secure in relationships—and not just secure, but be able to create truly healthy, intimate relationships in which you can be yourself, feel loved, and feel close to your partner. I’m not just interested in helping you to avoid rejection. I want you to have a good life and sometimes rejection, even though it hurts, saves us from misery with the wrong person. Many of my clients say that herpes really helped them to start choosing better quality partners and to weed out partners who weren’t a great fit. I want to help you get to a place where you highly value your own opinions and feelings and make choices throughout a relationship because they’re right for you (not because you're trying to please someone else or guess what they want), including choosing the timing of when to tell someone you're dating.

Thinking Through Timing

Most people agree that disclosure should happen before sexual behavior that puts your partner at risk. Your partner should have an opportunity to make an informed choice, but more importantly, your partner will want to be able to trust you and may question your trustworthiness if you wait until after sex. (That said, I’ve certainly had clients who have chickened out of the talk or sex happened after a night of drinking and they didn’t disclose. If you are there, you are not alone. It also doesn’t mean that there’s no hope for saving your relationship. Believe it or not, I’ve seen disclosures after sex work out. But hopefully this series of articles will help you to avoid being in that position.)

Can You Disclose Too Soon?

While some people delay sharing their status, others are so anxious about disclosing that they want to find out right away whether their new romantic interest is comfortable with herpes. I think disclosing very early is okay if it feels comfortable and natural to you. Sometimes conversation works that way. My concern is that many people do this to avoid anxiety. Rather than trying to be vulnerable and move closer to their new partner, they want to get the rejection over with before they are too invested. In this case, rushing to tell your partner might have more to do with fear of intimacy and vulnerability.

If this is you, take a deep breath. I want to help you get more in tune with yourself so that you’re making choices that feel right rather than just reacting to fear or other challenging emotions.

Tune Into Your Needs

Deciding the right time is unique to each person and each relationship. I wish I could say there is a formula but there's not. That’s why being in tune with yourself, what you need, and how you feel about the person sitting across from you is so important.

Many of my clients do worry about waiting too long and that their new love interest will resent them as a result. They worry that they are being deceptive or that they might be wasting someone’s time by not disclosing early enough.

Let me just say, if someone is spending time with you and enjoying you and making effort to get to know you, you are not wasting their time unless you are misleading them (i.e. you just want someone to pay for your dinner tonight).

You have the right to get to know someone well enough before choosing to disclose personal information. What if you find out you don't even like this person after a few dates? Part of dating is exploring whether a person is worth sharing deeper parts of yourself. 

What About All The Other Things You Have To Give?

Herpes doesn’t negate all the other wonderful things about you that you bring to a potential relationship. What if you have just the right combination of characteristics that your partner needs or is looking for? We might think that the person we’re dating could just go out and date anyone (i.e. someone without herpes), but if it was that easy to find the right match, they would’ve found it already. If your partner is looking for a relationship, then they also want to find someone they have chemistry with, who they enjoy spending time with, and who they feel safe with. What if that person is you? You are unique and have a lot to give.

Besides, none of us get to date and see everything laid out before us right away. There are things you and your partner will discover about each other long after you have been together that you might not like. Maybe you’ll find out about significant money problems, an over-involved parent, an annoying or gross habit, anger issues, or a mismatch in values or dreams. We all take this risk when we are dating. There will be multiple points in every relationship in which information is learned and partners evaluate and decide whether to stay or leave. Getting to know and care about someone helps us make decisions about the information we learn. If we knew everything about our partners from the beginning, most of us would probably be afraid to get involved with anyone, and we’d miss out on all the great things that come with loving someone.

So, please don’t think you are wasting someone’s time. And if someone does get mad at you for waiting to share something personal (when you haven’t put them at risk), please be grateful for the opportunity to learn something about how they handle your feelings and think about whether this person could actually be a good partner to you.

How Will You Know When You're Ready to Tell?

Building self-esteem and choosing a great partner means that part of your work is to prioritize what you think of the person you are dating over what you imagine that person is thinking of you. When you like someone, if you find yourself spending a lot of time worrying about what that person thinks of you and trying to adjust your every move to please them, it’s time to refocus. This is your life. This is your effort and time. Is this person impressing you, not just with their charming smile and magical personality, but in the way that they treat you? Remember what you have to offer. That is valuable. What are they bringing?

Shift dating from trying to win the attention of your new interest to evaluating whether your new interest is worthy of your time and attention. Just because you have herpes doesn’t mean you have to just take what you can get.

You can help yourself recenter in a few ways. Spend some time with friends who make you feel most like yourself. Take some time out to do things you love, even if it means not seeing the person you’re dating that week. Do a little journaling about your feelings and what you think of the person you’re dating. What doubts do you have about them? What do you enjoy? Are you happy with the effort they're putting in?

You can disclose at any point along the way (before sex) that you decide. Most of my clients disclose within the first few months, some on the earlier side (within a few dates), some on the later. Some people are very private and want to know if they want the relationship to become serious before they disclose. Some just want to know enough that they believe the person will respond kindly, regardless of whether they continue dating. Others disclose when they know they are ready to have sex.

Even after thinking everything through and deciding it’s time to tell, you probably will feel nervous and maybe a little insecure. That is okay and totally normal. If you are making a choice and not just reacting, you are taking a step toward intimacy by being vulnerable, and that is a mature and beautiful thing. That is the DNA of a real, healthy relationship. I hope your new romantic interest meets you there, but if not, I hope you will give someone else a chance.

I’ll be continuing this series over the next few weeks, including my usual posts about succeeding in relationships, self-esteem, and mental health. If you find these posts helpful, you can sign up for my newsletter here.

Other Posts In This Series

Talking About Herpes Part 1: Rejection (It Might Not Really Be About Herpes)

Talking About Herpes Part 3: Eight Common Questions Women Diagnosed with Genital Herpes Ask

Talking About Herpes Part 4: My Favorite Herpes Resources

I am a licensed mental health counselor in New York City with a psychotherapy office in Murray Hill, Manhattan. Find out more about me here.

DISCLAIMER

Please remember that we are continuously learning new things about herpes. I will try to keep this post updated but remember that research may come out today that changes what we currently know about herpes. Information on this website is not intended to replace professional medical or psychotherapeutic advice.

Lets Talk About Herpes Part 1: Rejection (It Might Not Really Be About Herpes)

I know it might be hard to believe, but there are a lot of people out there who are not going to be bothered that much by you having herpes. I know because I’ve watched many, many women over the years find partners who just didn’t think herpes was a big deal—and I don’t mean that they searched and searched and finally found one partner who accepted them—I mean that they got out there and dated, and disclosed, and had boyfriends, and lived their lives. I also know because there are great writers out there like Ella Dawson who have disclosed their status publicly and the dating pool has not dried up for them.

Some of these women found their dream partner and are still in a relationship with that person today. Others are still dating, sorting through frogs trying to find their prince. (Note: just because someone accepts herpes doesn’t mean they’re your prince).

But rejection does happen. If you’re out there dating, there’s a chance you’re going to experience rejection at some point. I don’t want to sugar-coat it. I believe “the odds” of finding partners who are ok with herpes are better than you might think, but yes, there are still people who aren’t going to be able to get over the idea of dating someone with herpes.

**The fact that these people are probably putting themselves at risk for herpes anyway is frustrating and a topic for another day.**

I have been working with women with herpes for many years. As a therapist, I find that those who struggled with dating before contracting herpes feel particularly vulnerable. They often feel it was hard enough to meet someone before herpes and have difficulty imagining how they’re going to find love now.

Some people have a pattern of attracting partners who tend to disappear when things get real or serious. Others seem to attract committed partners with ease. This pattern, no matter which one you fall into, tends to stay the same after a herpes diagnosis. For women who tend to be attracted to partners who don’t want to commit, they may experience rejection after disclosing a herpes diagnosis. It then may feel like the rejection was about herpes but really it’s the same pattern that was happening prior to contracting herpes. Things got real and your new romantic interest bailed.

I want you to know that this is not about being pretty enough, cool enough, smart enough, fun enough, sexy enough, or being worth it. It’s about intimacy and security and what we expect from relationships. It often goes back to experiences we had when we were very young, usually related to our relationships with our parents or primary caregivers (though not always). Sometimes these relationship dynamics are subtle. Your parents might have been really great, but there can be subtleties in the patterns that occurred in these relationships that can predict the kinds of partners you’ll be drawn to as an adult, not just the kinds of people you are attracted to but also how you engage in relationships that might be self-defeating without you realizing it.

The good news is that you can correct course. 

You may have heard of secure and insecure attachment. Some of us have secure attachment styles. We feel fairly secure with ourselves and in our relationships. We’re drawn to others who provide love, care, and stability. We feel confident in what we need and deserve and we don’t stick around with partners who treat us poorly. Others of us have insecure attachment styles. We find ourselves feeling familiar with uncertainty in relationships. We may long for intimacy and commitment but when we actually have it or it is offered to us, it is uncomfortable. We tend to be drawn to and excited by partners who are just out of reach. If you find that everyone you like doesn’t like you and the people who like you, you don’t like, there’s a good chance you fall into this category. 

If this is you, my guess is that you don’t want to stay there. The bad news is that herpes can’t be cured. The good news is that we can do something about our relationship patterns. Healing this pattern doesn’t happen overnight. Occasionally people have an “aha” moment and make a quick shift, but most of us have to do some hard self-examination. Change isn’t easy, but change can really be worth the hard work.

So how do you fix the pattern?

1. A lot has been written about attachment. Herpes isn’t easy, but what I want for you is to not blame herpes for something else that is underlying. Knowledge is power. Learn more about attachment and reflect on how it applies to you. Here’s a great article you can start with. And an excellent podcast.

2. John Gray, the author of Men are from Mars, Women are from Venus (is this aging me?) suggested to individuals who tend to be attracted to partners who are bad for them to start dating like you are playing darts. If you always shoot too far to the left, start trying to shoot a little too far to the right. The more you practice, the closer you will get to the center of the board.

3. My favorite thing about psychotherapy is that it really helps us to examine the nuances of our relationships. A psychotherapist can help you see the subtle ways in which you continue to repeat patterns in your life and help guide you through new ways of being and to heal from old relationship hurts.

4. I can’t say enough about group therapy, specifically a psychodynamic oriented group focused on relationships. In NYC, I facilitate a group specifically for women with herpes. But even a general psychotherapeutic group focused on relationships can help you with these patterns. Group is special because you form relationships within the group and this becomes a lab for you to examine the kinds of connections you experience with others. Before joining a group, make sure you ask the therapist if the group deals with relationship issues and uses relationships dynamics within the group to support this process. You can search for therapy groups in your zip code here. 

I have watched genital herpes be the thing that helps women I work with finally start untying the knots of their struggles with relationships, insecurity, and self-esteem and come out on the other side more secure and confident than they were before herpes. No one wants herpes to be the thing that pushes us forward, but life throws everyone curveballs and we can just take it or we can use those experiences as the springboard to launch us into something better.

Would You Like to Work with Me?

I am passionate about helping individuals overcome shame about genital herpes and get on with their life. I offer in person therapy in NYC and virtual therapy to those in Florida and California. Please contact me for a complimentary phone consultation to see if we might be a good fit. 

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ABOUT MELISSA

I am a licensed mental health counselor in New York City with a psychotherapy office in Murray Hill, Manhattan. Find out more about me here.

DISCLAIMER

Please remember that we are continuously learning new things about herpes. I will try to keep this post updated but remember that research may come out today that changes what we currently know about herpes. Information on this website is not intended to substitute professional medical or psychotherapeutic advice.