Q&A on Herpes, Sex Ed, and Stigma

Merissa Hawkins, MPH, is Clinical Strategy Manager here at Nurx, where she builds out our new services as they make the journey from idea to reality. She is also a former Sexuality and Health college instructor, and often the person that non-medical members of Team Nurx go to with questions on birth control, STIs, herpes and more.

While growing up, she dreamed of being the Indiana Jones of global health — traveling the world solving complex health problems. But while earning her Master’s degree in Public Health she discovered that there are plenty of problems she can take on closer to home. For starters? The shame and stigma that still surround sexual health for too many people, and the barriers and stumbling blocks that the US healthcare system places between patients and compassionate, high-quality care.  

How did you wind up teaching sexuality and health at a college?

When I was in grad school one of the ways I covered my tuition was teaching a class, and they offered me Phys Ed or Sexual Health Ed. I couldn’t confidently do a jumping jack at the time, so it was an enthusiastic “yes” to sexual health. The university was in a rural part of Indiana, and most of the college students, even juniors and seniors, didn’t know the names of reproductive anatomy and barely understood how babies were made—just the most basic stuff that you would learn in middle school in many other places.

I quickly realized that these students really needed help outside of class, so I wrote my phone number on the blackboard and told them that if they ever needed me to pick up Plan B, act as an Uber/Lyft, talk about a stressful/questionable situation, or anything – I would be there. I ended up driving a few students home from bars late at night when they felt unsafe and stocked up on Plan B so I’d have it for them when they asked, and coached students through difficult relationships. Through that teaching experience, I became really passionate about sex education and reproductive rights.

When you were teaching sex and health ed, what were students most embarrassed to ask? 

People would often start with “What if my friend did . .” but, newsflash, they often weren’t talking about their friends. I would get lots of questions about STI symptoms and emergency contraception access. There was particularly a lot of hesitation when talking about or admitting they had sex without a condom. Students were always very stressed about the potential lecture or stigma they may receive – though of course I never handled it that way. I constantly told people that we’re all human and even the most well-educated health educator isn’t always perfect, and that’s okay. Just know what to do when you’re in that situation and move forward. 

Some providers say that often patients who are diagnosed with herpes are more upset by that than patients who are diagnosed with HIV. Why do you think people are so scared of herpes?

Herpes and HIV don’t have too much in common other than they can’t be cured, but HIV has a strong history and community around it while herpes really doesn’t. Herpes doesn’t have much in terms of cultural support or public education, so if you tell somebody that you have herpes that person may have a lot of misconceptions about what it means. There is a lot of miseducation out there.  

HIV used to be a lot scarier, but over the past few years, there has been so much more awareness about PrEP and the fact that Undetectable equals Untransmittable, which means that people living with HIV who have controlled the virus through medication can’t pass it to their partners. Communicating about HIV status has become much more normalized — now we need that to be the case with other STIs! 

How do you recommend somebody disclose a status, whether herpes, HIV or anything else, to a sex partner? 

Be direct and honest, and stay calm. Know your facts about whatever health topic you’re discussing, and give the other person the space to have whatever reaction they are going to have. Do not casually bring it up as you’re leaving for dinner or right before running off to work — be sure you are in a space to give the person enough time to ask questions and think about it. Don’t apologize, but do respect that the other person may need time to process it. 

What would you tell somebody newly diagnosed with herpes who is freaking out? 

Generally, I like to approach things with facts. I’d share how common it is, and that it doesn’t label you in any way. It doesn’t mean you’re sleeping around. It could be something you’ve had since you were a kid and you’re getting an outbreak now due to recent stress. I’d make sure the person understands that there are easy and safe ways to manage it, with and without medication, so that it won’t become a major issue in your life.

On the flip side, what’s your advice to somebody who doesn’t have herpes and wants to avoid it? 

Keep in mind that condoms won’t fully protect you against herpes, because it’s transmitted by skin contact, not only semen or vaginal secretions. If you see bumps on your partner, stop and ask about them about it. And if you know your partner has herpes and you don’t, then avoid sex during an outbreak because the chances of transmission are much higher. If your partner has herpes you can ask them how they feel about taking a daily antiviral like valacyclovir to lower the chance that they’ll transmit it to you. Also, there aren’t scientific studies on this, but it’s possible that going natural with your public hair could offer some protection, by reducing skin-to-skin contact and because waxing or shaving could lead to irritation or tiny skin abrasions that would allow the virus to enter. 

Why is telehealth like Nurx a good way to get herpes treatment?

Because it’s private, convenient, and our medical team really understands herpes and doesn’t approach it with any stigma or shaming. Unfortunately, there are many doctors who feed into the stigmatization of herpes, or overmedicalize it a lot, thinking that everybody has to take daily meds and that you have to be hyper-aware of it. Or they might speak to you with a vocabulary that is very patient blaming. I get incredibly excited about the opportunities telehealth creates for patients to manage their health on their own terms, without gatekeepers.

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