I have always been a bit of a worrier but since I got pregnant (I am in my first trimester), I feel anxiety ridden and depressed. Something happened this past week and I am not sure if I am right to be worried or not but in any case, I can’t stop thinking about it and feel sick to my stomach. I had a cold sore and one morning, after I touched it, I went to the bathroom and touched the toilet paper which I used after. Do you think I could have given myself genital herpes?

co-written by Ankit Dhawan and Ashley Bell

It is entirely reasonable to feel worried and anxious about your health, as deviations from a “normal pregnancy” can be frightening. The fact that you’re already concerned for the welfare of your developing baby suggests that you’re on your way to becoming a great mother.

Pregnancy itself is full of intense changes which affect your mood. Many women feel increased sensitivity, overwhelmed, stressed and anxious throughout gestation.[i] It is normal for many women to experience depression during pregnancy; this is known as prenatal or antenatal depression. Together, both antenatal depression and anxiety can act as precursors to postpartum depression; however, as it happens to be in your case, it is not a predictor if you experience this in the first trimester of pregnancy.[ii][iii] In order to contextualize, according to a study done in 2009, the prevalence of antenatal depression amongst women in Canada is as high as 29.5%.[iv] Therefore, don’t worry too much as your emotions and concerns are entirely valid.

To understand why it’s unlikely that you gave yourself genital herpes, you must first recognize the different strains of the virus and its transmission. Generally speaking, herpes is a generic name for a group of viruses. The one relevant to your question is from a group called “alpha- herpes viruses”, which is further categorized into herpes simplex virus (HSV) type 1 (HSV-1) and type 2 (HSV-2), and varicella-zoster virus (VZV).[v] HSV-1 primarily affects the mouth region, and is commonly known as oral herpes, whereas HSV-2 primarily affects the genital region, and is commonly known as genital herpes. However, genital herpes can also be caused by HSV-1, but the recurrence rate decreases further over time when compared to genital herpes caused by HSV-2.[vi] Both forms of herpes can remain dormant in your body and can cause recurrent episodes by reactivating the virus and transporting it back to the mucosal or skin surface through peripheral nerves in your body.[vii] Therefore, those infected do not often have the most classic and well-known characteristics including recurring lesions, blisters, and symptomatic viral shedding to the affected areas.[viii]  Although there is no cure for herpes, there are many medications available that can shorten the duration and make outbreaks less painful, including suppressive therapies for pregnant women.[ix],[x] Cold sores will typically go away without treatment within 7-10 days[xi]. However, if you have more concerns, it would be beneficial to discuss management options with your doctor.

Now, here’s the big question – How can herpes be transmitted? As you described, many people fear herpes transmission through toilet paper and toilet seats.[xii] However, research has indicated that HSV can only survive for a short period of time outside the host.[xiii] Therefore, it is highly unlikely that you have given yourself genital herpes, as it is nearly impossible to catch herpes from inanimate objects and non-bodily fluids. In order to acquire HSV, the uninfected individual is required to establish an intimate direct contact with the individual who is producing or shedding the virus.[xiv] For instance, this can occur through skin-to-skin contact during penis-vaginal intercourse in heterosexual males and females, or through saliva in oral sex and kissing. Due to an increase in the practice of oral sex in the past few decades, some studies have noted an increase in the diagnosis of genital herpes caused by HSV-1.[xv]

Some individuals develop cold sores or fever blisters, which are caused by recurring HSV-1 infections.[xvi] These cold sores are very common nowadays and most people do not recall how it was transmitted to them. Likewise, some of us may have experienced chicken pox in our lifetime, which is caused by VZV, and yet there is no “herpes stigma” associated with it. The general public often makes uneducated speculations, which cause those diagnosed with the virus to feel self-conscious and can lead to increased anxiety.[xvii] It is important that people reduce the stigma associated with herpes.

In one study, people described oral herpes as nothing more than an occasional nuisance similar to catching the flu.[xviii] Another set of studies used sexually transmitted infections (STIs) as a keyword on Google search engine; findings revealed that only 9 out of the top 29 websites were accurate in details about STIs acquired through kissing, which includes herpes.[xix] You can learn more about finding accurate information online by clicking here. It is best to consult your healthcare provider when in doubt, which would likely dispel any further anxiety about the presence of the virus.

Overall, it is okay to be worried in such stressful situations. Use support systems that work for you, be it confiding in a family member, going to a support group or a healthcare provider. Today, media plays a big role in what we learn and how we perceive things. It is important to ask questions when in doubt.


 

[i] Öhman, S. G., Grunewald, C., & Waldenström, U. (2003). Women’s worries during pregnancy: Testing the cambridge worry scale on 200 swedish women. Scandinavian Journal of Caring Sciences, 17(2), 148-152.

[ii] Misri, S., Kendrick, K., Oberlander, T., Norris, S., Tomfohr, L., Zhang, H., & Grunau, R. (2010). Antenatal depression and anxiety affect postpartum parenting stress: A longitudinal, prospective study. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 55(4), 222-8.

[iii] Norhayati, M., Hazlina, N., Asrenee, A., & Emilin, W. (2015). Magnitude and risk factors for postpartum symptoms: A literature review. Journal of Affective Disorders, 175, 34-52.

[iv] Bowen, A., Stewart, N., Baetz, M., & Muhajarine, A. (2009). Antenatal depression in socially high-risk women in Canada. Journal Of Epidemiology And Community Health, 63(5), 414-416.

[v] Mahendiran, Shavitri, Burkhart, Craig G., & Burkhart, Craig N. (2010). Herpes: Issues under the cold sore. Open Dermatology Journal, 4(1), 101-104.

[vi] Engelberg, R., Carrell, D., Krantz, E., Corey, L., & Wald, A. (2003). Natural history of genital herpes simplex virus type 1 infection. Sexually Transmitted Diseases, 30(2), 174-7

[vii] Gupta, R., Warren, T., & Wald, A. (2007). Genital herpes. The Lancet,370(9605), 2127-37.

[viii] Delaney, S., Gardella, C., Saracino, M., Magaret, A., & Wald, A. (2014). Seroprevalence of herpes simplex virus type 1 and 2 among pregnant women, 1989-2010. Obstetrical & Gynecological Survey, 69(12), 726-728.

[ix] Sarnoff, D. S. (2014). Treatment of recurrent herpes labialis. Journal of Drugs in Dermatology: JDD, 13(9), 1016-1018.

[x] Public Health Agency of Canada. (2013). Genital herpes simplex virus (HSV) infections. Retrieved from http://www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/section-5-4-eng.php

[xi] Sarnoff, D. S. (2014). Treatment of recurrent herpes labialis. Journal of Drugs in Dermatology: JDD, 13(9), 1016-1018.

[xii] Posner, T. (2000). The ‘Herpes’ phenomenon: Media myths, meanings, and medicines. Science as Culture, 9(4), 445-467.

[xiii] Pirtle, E., & Beran, G. (1991). Virus survival in the environment. Rev Sci Tech, 10(3), 733-748.

[xiv] Mahendiran, Shavitri, Burkhart, Craig G., & Burkhart, Craig N. (2010). Herpes: Issues under the cold sore. Open Dermatology Journal, 4(1), 101-104.

[xv] Scoular, A. (2002). Using the evidence base on genital herpes: Optimising the use of diagnostic tests and information provision. Sexually Transmitted Infections, 78(3), 160-165.

[xvi] Mahendiran, Shavitri, Burkhart, Craig G., & Burkhart, Craig N. (2010). Herpes: Issues under the cold sore. Open Dermatology Journal, 4(1), 101-104.

[xvii] Bickford, J., Barton, S., & Mandalia, S. (2007). Chronic genital herpes and disclosure… the influence of stigma. International Journal of STD & AIDS, 18(9), 589-592.

[xviii] Posner, T. (2000). The ‘Herpes’ phenomenon: Media myths, meanings, and medicines. Science as Culture, 9(4), 445-467.

[xix] Yen, Sophia. (2010). “Reputable” but inaccurate: Reproductive health information for adolescents on the web.(FEATURE). Knowledge Quest, 38(3), 62.