Welcome to Ask a Cleveland Sex Therapist. Want to ask Matt a question that could be tackled in a future column? Click here. Now, onto this week’s topic.
As an AASECT Certified Sex Therapist, another part of my job that doesn’t get highlighted often is my role as a sex educator. My job is to not only be a therapist for clients, providing them an open and non-judgmental space to explore their concerns, but also educate them on the complexity of human sexuality. If there’s one topic that consistently brings up fear, shame, and silence in my office, it’s herpes (HSV). Whether it’s the panic after a first outbreak, the anxiety before a new sexual relationship, or the stigma that’s been quietly growing in someone’s mind for years, herpes has a unique way of making people feel “less than.” For many, even the word “herpes” can bring up memories of fear-based sex education, jokes at someone else’s expense, or misinformation that’s been passed down for decades. But here’s the truth: herpes is incredibly common, manageable, and absolutely does not define your worth or your sex life. My hope with this post is to start to dismantle the layers of shame that keep people suffering in silence.
Herpes is caused by the herpes simplex virus, most commonly HSV-1 and HSV-2. HSV-1 typically causes oral herpes (cold sores), while HSV-2 more often causes genital herpes, though either strain can infect either area through oral, vaginal, or anal sex. According to the CDC, over half of adults in the U.S. have HSV-1, and around 1 in 6 have HSV-2. These numbers are likely underestimates because many people who carry the virus don’t even know it. Most infections are asymptomatic, meaning a person can carry herpes for years without ever experiencing a single blister or sore. For those who do have symptoms, the first outbreak is often the most intense, presenting as small sores or blisters, itching, and sometimes flu-like symptoms such as fatigue, swollen lymph nodes, or fever. After this initial episode, recurrences can happen but are typically less severe and may become infrequent over time.
Understanding how herpes fits into the larger picture of sexually transmitted infections helps reduce the fear and mystery around it. Sexually Transmitted Infections (STIs) fall broadly into two categories: bacterial and viral. Bacterial STIs, like chlamydia, gonorrhea, and syphilis, are typically cured with antibiotics. Once treated, the bacteria are eradicated from the body, though reinfection can occur with new exposures. Viral STIs, such as HSV, HPV, HIV, and hepatitis B, behave differently. They can’t be “cured” in the traditional sense because the virus remains in the body. However, viral infections can be effectively managed through medication, regular monitoring, and safer sex practices.
Unfortunately, receiving a herpes diagnosis often sets off an emotional chain reaction. Shame, guilt, fear, grief, and even feelings of unworthiness can surface. For many, this reaction is not actually about the virus itself but about what our culture has attached to it. Media and outdated sex education have long painted STIs as something to be feared, mocked, or associated with “promiscuity.” God, I hate that word. But as someone who is diagnosed with HSV-1, and is currently writing this with a cold sore, I too struggle with how people perceive me when they see it on my lip. But the reality is that herpes can happen to anyone who engages in sexual contact, even a single encounter. The virus doesn’t care about your relationship status, the number of partners you’ve had, or how “careful” you were. Skin-to-skin contact, even without penetration, can be enough.
One of the major drivers of herpes stigma is the lack of accurate, shame-free sex education. Many of us grew up with fear-based or abstinence-only programs that taught STIs as cautionary tales rather than medical realities. If I could quote the seminal film, Mean Girls, “You’re going to want to take off your clothes, and touch each other. But if you do touch each other, you will get chlamydia… and die.” Pretty intense (and inaccurate) messaging to say the least. Herpes, in particular, was often presented as something “permanent” and “scary,” with little explanation about how common it is or how people can live healthy lives with it. Others never learned the difference between bacterial and viral infections, or that herpes can be transmitted through skin-to-skin contact even when someone has no visible sores.
This gap in education leaves people unprepared not only for the possibility of infection but also for how to support themselves or partners if it happens. After a diagnosis, one of the most empowering steps you can take is to have open conversations with partners. Disclosure can feel terrifying, especially the first few times, but it’s an important part of building trust and maintaining mutual care in your sexual relationships. But these conversations are risky as people may be too scared to want to continue the relationship for fear they may “catch it.” Practicing disclosure conversations with a therapist, friend, or even in the mirror can help make the process less intimidating. It’s helpful to remember that you are sharing medical information, not confessing a crime.
There are also practical ways to reduce transmission risks. Using condoms or dental dams during oral, vaginal, or anal sex lowers the likelihood of transmission. Taking daily antiviral medication can further reduce risk, sometimes by as much as 50%. Avoiding sexual activity during outbreaks, when the virus is most active, is another key strategy. While herpes can be transmitted when no symptoms are present (through what’s known as asymptomatic shedding), most transmissions occur during symptomatic periods. When a cold sore shows up, I take the medication I am prescribed and once it goes away, I am back to being sexually active.
A herpes diagnosis does not mean the end of your sex life. My goal in writing this post is to hopefully reduce the shame some of you may be experiencing and provide some education that is needed for everyone. By replacing fear with accurate information, we can create a healthier and more honest sexual culture. You are not your diagnosis. You are a whole, complex, worthy human being, and you deserve relationships and sex that reflect that truth. Shame often thrives in silence, so the more openly and compassionately we can talk about these realities, the less power shame holds.
Matt Lachman is a Licensed Professional Clinical Counselor and Supervisor, AASECT Certified Sex Therapist, and owner of Cleveland Sex Therapy, located in the heart of Gordon Square. Since opening Cleveland Sex Therapy in 2019, Matt has been dedicated to promoting sex positivity and inclusivity in his work with individuals, couples, and polyamorous relationships. When he’s not helping clients navigate their sexual and relational journeys, you can find him enjoying a cold brew at Gypsy Beans, sipping a cocktail at Luxe, or relaxing on his couch watching reruns of Happy Endings. Ask a question of your own here.
Disclaimer: The advice provided in this column is intended for generalinformational purposes only and should not be considered a substitute for professional therapy or mental health treatment. Each individual’s situation is unique, and the insights offered here may not address the complexities of your specific circumstances. If you’re experiencing challenges related to your mental health, relationships, or sexuality, I strongly encourage you to reach out to a licensed therapist or mental health professional for personalized support. You’re not alone—help is available.
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