When you hear the word “herpes,” there are likely two phrases that immediately come to mind: “cold sores” and “genitals.”
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But there are only two—HSV-1 and HSV-2—that can be tested for via blood culture, says Alyse Kelly-Jones, M.D., an ob-gyn at Novant Health Mintview OB/GYN. “The rest are studied more in research, but you can’t really test for them right now to see if you have them.”
In the past, HSV-1 has been most commonly associated with oral herpes—cold sores and blisters on or around the mouth, according to the Centers for Disease Control and Prevention (CDC)—while HSV-2 is connected to genital herpes, says Dr. Kelly-Jones. But don’t be mistaken: She emphasizes that you can get either strain in the genital area.
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At least, technically it does—but there’s a catch. “It’s probably more behavioral than an actual risk because, say you had chlamydia as a teenager—that doesn’t put you at risk for herpes as a 30-year-old,” says Dr. Kelly-Jones. “But maybe it’s your behavior that puts you more at risk. If I have a patient who tests positive for herpes, I’m going to then test them for other STIs.”
Still, HSV-2 in the genital area has been linked to an increased risk for HIV, says Dr. Kelly-Jones. “We’re not completely sure why, but it may be that there’s some local inflammation and breaking down of the skin, and that can make the HIV virus easier to enter the body,” she says.
“As you age, the virus loses some of its ability to kind of be a badass,” says Dr. Kelly-Jones. “You’ve been fighting it for a long time, and you have less of a chance of asymptomatic shedding.” This means you’d be less likely to actively have an outbreak without knowing it, making you less likely to pass along the virus.
It’s a phenomenon known as prodrome, says Dr. Kelly-Jones, and it happens when a patient experiences symptoms before a lesion appears. “Some patients recognize them, and what happens is the herpes virus lives in the nerve root in your spinal cord. When it reactivates, it comes down that same nerve root and causes the lesion in one specific area. So patients will report itching, tingling, and burning [before the outbreak even occurs].”
If you notice those symptoms, Kelly-Jones says you can begin treatment right away. “It probably won’t prevent the lesion from happening, but it can decrease the longevity and severity of the outbreak,” she says. And, of course, you should abstain from sex.
When you’re not having an outbreak, it’s okay to have sex—so long as you use a condom. Consistent use reduces your risk of passing along the virus by about 30 percent, according to a study in the Archives of Internal Medicine. (Check out the LELO Hex Condoms from the Men’s Health store. They’re comfortable, since they’re super thin and lubricated.)
That said, remember that condoms break and not everyone knows how to use one perfectly. And because the virus is spread by skin-to-skin contact, that means that any slip-ups could leave an uninfected partner at risk. That’s why it’s important to talk to your doctors about medication, too.
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Yep, this is possible. If you touch an open sore on your oral herpes and it comes in contact with your genitals, you could infect yourself. It’s not common, since people generally develop antibodies to prevent it, but it is possible. It’s known as autoinoculation, and it’s what happens when you reinfect yourself with the virus, according to the University of Maryland Medical Center.
It can spread to other places, too. If you touch an open herpes sore and then touch your eyes, it could trigger herpetic keratitis, a viral infection of the eye, according to the American Academy of Ophthalmology. The best thing you can do? Not touch any open sores. If you do, immediately wash your hands and avoid touching any body parts until you do wash your hands.
One of the most commonly-prescribed drugs to treat a current outbreak is Valtrax and, depending on if this is your first outbreak or a repeat occurrence, treatment can last for three to 10 days. (It’s longer if it’s your first time, says Dr. Kelly-Jones.) But there are also daily suppressive therapy options, like valacyclovir, that offer symptom relief for patients with frequent or severe outbreaks.
According to a study in the New England Journal of Medicine, taking it consistently can slash your risk of infecting a partner by about half. And with more options on the way—a recent JAMA study looked at an experimental drug that’s not currently available in the U.S., pritelivir, and found that it reduced the frequency of outbreaks and the number of days the infected person shed the virus—there’s hope that it will become more manageable.