Ask Ms. Harm Reduction: I Have Herpes

by Ms. Harm Reduction on October 1, 2014 · 42 comments

in Ask Ms. Harm Reduction, Health

Visual approximation of Ms. Harm Reduction and her gal pals. (Photo via Flickr user gbaku at the Creative Commons.)

Visual approximation of Ms. Harm Reduction and her gal pals. (Photo via Flickr user gbaku and the Creative Commons.)

Dear Ms. Harm Reduction,
About six months ago I had my first ever genital herpes outbreak. I am a cis female and a full service provider. I don’t do bareback, but I do still continue to work. I am on herbal suppressive therapy (lysine, other immune boosters and stress management) and haven’t had an outbreak since the first one. I know it’s controversial, but I love my job and I don’t want to do any other type of work. I just want to know how to be as safe as possible. Also how big of a risk is this? Am I totally fucked up for working? For the record I would never work during an outbreak, but outside of that, is it ok? I was also wondering if internal condoms (female condoms) offer more protection because they cover external surface area?

Sexy Or Risky? Escort

Dear S.O.R.E,

Ms. Harm Reduction is told that herpes is the hardest STD for anyone to work with, including medical health professionals.  And no one wants to think of themselves as a fella’-infecting gash. Ms. Harm Reduction consulted with her cousin, Ms. Practical Sexual Health Solutions (yes, damnit, we’re a strangely named family—Pops was a bit off his rocker when he christened us!)  to give you the best dope on the problem.

Apparently, while it’s easy enough to treat herpes during an acute episode, it’s what happens after you face the music that’s difficult. One out of two things can happen: either the virus stays dormant or it doesn’t.

It seems like you’ve already taken the first step towards harm reduction with your herbal suppressive therapy. Your current course of action really forces the virus to stay dormant. Hot diggity dog, Ms. Harm Reduction is all the way behind you, honey! She condones your efforts and encourages you to continue on this course.

Here’s what my cousin told me to get old geezer me up to speed on herpes:

Herpes is a common sexually transmissible infection with one in eight people who have the virus that can cause genital herpes. Many people don’t even know that they even have the virus as it can take weeks, even years, before symptoms occur. Not only this, but during sexual health checks doctors will generally skip testing for herpes unless there is visible signs of an outbreak. This is because testing for the virus is difficult when not suffering from an episode – the doctor must interpret the level of antibodies, immunoglobulins and white cell markers in the blood for both HSV1 and HSV2. Fighting a cold and battling an episode can be hard to differentiate during this process, not only that but when the virus is dormant it’s virtually impossible to detect. To avoid declaring a false-positive or a false-negative, and to save on a costly test, and since the virus is traditionally contracted by direct contact (through a sore, blister, ulcer or skin split), doctors opt out of testing for herpes unless requested otherwise.

However, direct contact isn’t the only way the virus can spread. Sometimes the virus can be contracted between episodes (when there is no sores, ulcers, skin splits or blisters visible) during viral shedding.

But never fear, for Ms. Harm Reduction is here.

It is typically okay for hussies with the herpes simplex virus to work – it just takes a bit of tact. Typically, laws (where legislation relates to us gold digging broads and boys, as is the case Down Under) allow sex workers to work with herpes except during an episode, according to the Sex Work Act of 1994 in Victoria, Australia, for example.

For harm reduction to work you need to keep that darned virus in a dormant state. Your herbal suppressive therapy will keep on keeping an outbreak from occurring, but there are  other things a resourceful harlot like yourself can do to maintain your health and immunity levels. For example, Ms. Harm Reduction is told seeing an acupuncturist or chiropractor (for recommended maintenance care every 4-6 weeks), plus a healthy diet and exercise can make sure you’re in tip-top shape. (Sure, most of us gals and fellas don’t have health insurance, but there are many more progressive alternative health practitioners that offer group sessions for free or a very low fee.)  Even if the virus tries its no good best to flare up, your immune system will give it what for before it even has a chance to resurface.

To go with this tactic, you also, as the Bard says, need to know thyself, darling. Say the virus trickled past your clever defenses—it will most times show symptoms before an outbreak even occurs. If you keep a smart eye out, you can detect these symptoms. For example, flu-like symptoms may occur, or your puss may feel itchy, tingly, painful or swollen. Try to remember what happened before your first outbreak, because your gorgeous bod will normally react in a similar sequence of events. Try to think in retrospect: have you had a big night at a bash or gone on a bender, are you worrying your little head about something, are you otherwise ill, have you been slacking with your preventive measures? If you tick any of these boxes, you know your suspicions may be well-founded.

If you suspect an episode is on the verge of occurring, stop taking those calls and shut up your boudoir, pop some anti-viral medication, and increase your herbal suppressive therapy to add new fangled helpful and herby things like vitamin C or astragalus. This will make sure that the virus will be knocked out before an outbreak even happens. If you learn to distinguish the sniffles, from a UTI, from thrush, from an actual episode well enough, you can put a kibosh on outbreaks without even stopping your hustle. This literally means you have not endangered anyone’s health, dear, no fooling. You only need to stop working for a few days when you’re just not quite sure to allow your body the chance to recuperate should it be under attack.

With faithful use of jimmy hats—er, condoms—which is the best protection for herpes, there’s only a very small chance of spreading the virus. Those female condoms Ms. Harm Reduction keeps hearing about can also offer an extra layer of protection, but unfortunately, honeys, this isn’t too practical. During vaginal or anal sex the female condom will prevent skin-to-skin contact, which is how the virus spreads, however, during oral sex the dam, Ms. Harm Reduction reckons, won’t be any fun for either party. Condoms are your best bet—with the use of lubrication. Keeping everything nice and wet reduces the risk of trauma to the skin of your puss or his johnson (or his puss and your johnson, or any variation thereof) which has been shown to reduce the spread of herpes.

Ms. Harm Reduction thanks you for your question and hopes she’s been of help. Also, remember, stress is always in the mix when events like this occur, so cooling it and pampering your beautiful self sometimes will not only ensure good health but also greater quality of life. Ms. Harm Reduction wishes you luck and happy hooking!

{ 38 comments… read them below or add one }

Akynos October 1, 2014 at 12:10 pm

When did those suffering from this go from 1 Web in 4, to 1 in 8? And doctors are now giving this as a part of routine STI screening.


Robin D October 1, 2014 at 5:51 pm

The more concerning thing is only a small percentage of infected people know it.


Leigh Alanna October 2, 2014 at 2:40 pm

Is that so? My last screening was pretty recent, and I definitely had to ask very specifically for it. This may be a thing that varies from practice to practice.


Caty Simon October 2, 2014 at 3:22 pm

I had to ask specifically for it as well.


Bella Robinson October 2, 2014 at 3:49 pm

Herpes is spread by direct skin-to-skin contact with someone who is infected. You can get herpes from someone who has sores on his or her lips, skin or genitals. But, most of the time, herpes is spread when someone does not have any signs or symptoms. The herpes virus can still rub off a person’s skin even when he or she has no sores that you can see.

Mrs Harm reduction states she always uses condoms yet she has herpes.

So it seems Mrs Harm reduction is not only given out bad advice, + she doesn’t seem too concerned for all the clients she may be infecting, who then go home and infect their partners. One can pass along herpes without even having intercourse, and anyone that is a sex worker that is infected should be disclosing this information to their clients.


Caty Simon October 2, 2014 at 3:55 pm

Uh, Ms. Harm Reduction is a made up persona, and she did not state that she had herpes. If you’re talking about me, I don’t have herpes.
Actually, most of the time herpes is spread when someone is directly having an outbreak. If someone is vigilant about keeping their virus dormant, to the point of being able to identify the symptoms of the beginning of an outbreak, their risk of passing herpes along is very low. I was in a long term relationship with someone who had herpes, and we followed these and other rules (although of course we also used latex gloves for an extra level of safety), and to this day I haven’t contracted it.
Oral herpes, that is cold sores, is a different matter, though it can be transferred genitally as well. 80 percent or more of the population has cold sores, and yet people still kiss their clients without disclosure. That is again, because the risk of transference without having an outbreak is very low. It’s not about “not caring about clients,” it’s about a risk benefit assessment for someone who, for whatever reason, needs to keep working.


Robin D October 2, 2014 at 4:49 pm

And HSV1 outbreaks are super common in daycares, what, ban daycares? Chastise owner and parents of daycares for existing? Actually it gives you some protection against contacting herpes genitally, so there’s that.

The lysine is very good at suppressing the virus and viral shedding as is prescription medication and regular use of condoms.

Maybe more to the point, when more people are infected than not, but only a small percentage know it, this is the kind of thing you see – people scaremongering about the dirty others instead of taking responsibility for themselves. People are FREAKED OUT about partners with herpes, then if they get tested for it they usually discover they are already infected. Certainly once you are an adult. Almost all clients never get tested for this, many never get tested for anything. They should look at the logs in their own eyes big time.

Sex workers tend to be on top of their sexual health. This escort sure seems like she is, though it would be better to add prescription medication also. It’s very effective. There’s two parties to those transactions and they know they are assuming some risk – often they really want to be assuming more. It is just the nature of things that sex workers have to take more precautions when it comes to clients than the other way around, hell that’s why sex workers need BDLs.

But sure keep it up with the crazy fantasies about those “other” dirty whores.


Evie October 3, 2014 at 11:45 am

Ok, we get it. You disagree with Ms. Harm Reduction and all that she stands for. You comment on every column. You have been heard. But clearly, the majority of T&A readership have no problem with non-judgmental – and even supportive, gasp! – advice for problems most would be too afraid to seek help for because of attitudes like yours.

So keep commenting, keep enforcing a hierarchy where only “clean” sex workers are deserving recognition or care. Almost everyone else in society agrees with you. I’m just happy T&A is not one of those places.


Tori October 6, 2014 at 7:12 pm

THANK YOU Evie for saying what has been on my mind every single fucking time I read Bella Robinson’s posts on T&A.

Ms Harm Reduction’s columns are much needed in a world where, unfortunately as you pointed out, Bella Robinson’s comments and thoughts are widely pushed and accepted.

And as a sex worker, thank you T&A for providing amazing advice to sex workers through this column and your other columns. Never stop!


Bella Robinson October 2, 2014 at 4:09 pm

So Mrs harm reduction is advocating for people infected with herpes to keep working and not disclose this to their sex partners.

” A significant number of HSV-2 positive people have never had symptoms like blisters and sores, which means that many people may be transmitting the virus to others unknowingly, and because they’re asymptomatic they’re unlikely to get tested Even if they do get tested, a positive blood test doesn’t help patients … can’t be passed on unless they have an active herpes outbreak — a dangerous misconception ..”…/how-many-patients-spread…/


Caty Simon October 2, 2014 at 4:26 pm

Again, difference between someone who’s between outbreak and someone whose virus is dormant b/c of a medication regimen who’s also not showing symptoms.


Caty Simon October 2, 2014 at 4:50 pm
Has stats for just unprotected sex, no condom, no antivirals, but no sex during outbreak, for transmission at 10% from males to females and 4% from females to males. So assuming the use of condoms and antivirals or other virus dampening regimens, that’d put the already small probability at extremely low.
In fact, I saw on another site that if you have HSV1 genitally and avoid sex during outbreaks and take antivirals, the transmission risk was about 1% . That’s certainly low enough for it to be ethical not to disclose.


Caty Simon October 2, 2014 at 4:52 pm

B/c apparently using condoms halves the risks, whereas taking antivirals halves it AGAIN.


Robin D October 2, 2014 at 4:56 pm

Yep, she clearly quoted about someone transmitting “unknowingly,” who does not know they have the virus! That’d be your unconcerned hobbyist or random person on the street (the majority of them, actually), definitely not this lady who wrote in knowing she has it and taking precautions. What?


Estelle Lucas October 2, 2014 at 10:22 pm

Hey Bella,

Thanks for your interest and concern about Ms Harm Reduction (not Mrs because, let’s be honest, she’s a strong independent lady that don’t need no man). We love feedback and really appreciate you taking the time to let us know your thoughts.

So with your comments, I’d just like to clarify a few things. Yes you’re absolutely correct when you say that the virus can be spread when no signs or systems are present. This is called ‘viral shedding’ and Ms Harm Reduction had covered this when quoting from her cousin. But you’re not absolutely correct in assuming that this constitutes for a ‘thou shall not work’ stamp for sex workers.

There’s a few reasons for this. Firstly, there is without a doubt that many sex workers work while having herpes. Unfortunately it’s not something that goes away. That doesn’t mean the sex worker should go away. So sex workers really need some practical solutions to deal with this issue. This is the idea before this column and Ms Harm Reduction does not condone anyone’s behaviour – she merely provides vital information about how to play with the cards you’ve got.

Secondly, when you dismiss sex workers with STD’s, what you’re doing is furthering stigma and discrimination so often felt by sex workers. This isn’t a good thing. This is especially not a good thing when the STD in question is so very unlikely to be caught on.

Thirdly, we’ve actually had this column looked over by medical health professionals to cross-check if all the information was correct. A lot more handier on the topic than google, wouldnt you agree?

Lastly, in areas of the world where sex work is legalised/licensed, it’s perfectly okay in the eyes of the law to work with herpes. It’s only during an outbreak that it becomes an issue. That’s when people are truly at risk. If you look at what Ms Harm Reduction has said, she has suggested not working even with the slighting inkling that an outbreak is on the verge.

I completely understand how this can seem like a grey issue. Automatically and instinctively one would think ‘no! You can’t work with herpes, that’s dangerous!’ But if you look over the information and churn it over with an analytical eye, you’ll see there’s not much to worry about. When you throw condoms, anti-viral, herbal regimes, active lifestyle, diet, all of these sorts of things, the herpes virus will literally have to climb so many barriers to have a go. This is science at work – and you cant argue with that.

A sex worker who has done all the things Ms Harm Reduction has suggested has done her fair share when it comes to duty of care for her clients. Everyone needs to take responsibility for their actions. This includes clients. A client needs to take responsibility that they ALWAYS have a risk when having sex, no matter what precautions you take. Whether you like it not, sex is not ever fully risk free. There is always a chance to catch an STD or impregnate someone from a slipped condom or a broken one. Each party needs to accept this risk when having sex or seeing a sex worker. The burden of responsibility is not solely a sex workers. The only other alternative is abstinence. And that is hardly a solution.

We are happy to get you into contact with one of our medical health professionals if you’d like to discuss this to further detail and ease your mind.

Once again, thank you for your feedback, it’s always much appreciated,

Much love,


Caty Simon October 2, 2014 at 4:23 pm

Oh, okay, I see what’s going on. We’re discussing two different cases. There’s a difference between someone who’s just not in an outbreak and someone who’s on a medication regimen which makes their virus dormant and is also not showing symptoms. In the LATTER CASE, there’s almost no risk of transmission, and that’s the case we were discussing in TAS, the case the questioner presented.


Robin D October 2, 2014 at 4:52 pm

I think you mean medication that suppresses the virus/viral shedding, not an immuno-suppressant, which would be the opposite.


Caty Simon October 2, 2014 at 5:00 pm

Ah, sorry, let me edit that. Thank you.


Emma October 8, 2014 at 9:12 am


I would like it if you told this worker to go to a Doctor to get diagnosed and start daily suppression treatment. Great if the worker was told to visit a Sexual Health clinic who see these problems all day and can give better advice than a GP.

Also it is worth noting that more people are getting genital herpes from HSV1 (which typically causes mouth ulcers).


Robin D October 8, 2014 at 3:15 pm

Agreed I notice (very effective) prescription medication was missing from the recommendations, hopefully they live in a city with a cheap clinic.


Mechanistically Unsure October 3, 2014 at 5:41 pm

What’s the mechanism by which chiropody affects the virus?


Caty Simon October 3, 2014 at 7:20 pm

Good question–Estelle? I’d guess that it improves the immune system generally just as acupuncture does?


Robin D October 3, 2014 at 8:44 pm

Caty, I’m sorry, but it probably doesn’t. The virus I think usually goes dormant at the base of the skull which wouldn’t generally be a chiro target. But idk. Lysine absolutely does affect the virus – outbreaks and shedding…probably also vitamin D because of general immune function. So those were good things to say. You seem to be getting a lot of responses on twitter irritated with the “woo” but whatever. Lysine is effective and prescription medication is effective in keeping it in check.


Estelle Lucas October 3, 2014 at 10:42 pm

With the chiro (and acupuncture + any other holistic work), it’s all preventative. Since the virus has a tendency to activate when you’re run down, being treated holistically helps your body remain in a state where it can fight off the virus.

A lot of people ‘don’t believe’ or don’t subscribe to these sorts of treatments. And I can understand that because it’s doesn’t fall directly under the Western medical umbrella that we’re taught to trust wholeheartedly. But the practitioners have a medical responsibility to tell you if what they’re providing you will help with your condition. No chiro will claim to be the healer of herpes but they would all assert that they can help maintain your body at a high health (subject to overall health).

It’s all about maintaining a high level of health, any sort of holistic care won’t work if you cant commit to an active regime. So no, when you have a suspected outbreak the first thing you do SHOULDNT be ‘see a chiro’ but if you’re trying to be super healthy, that’s one of the methods of achieving that. Let’s also not forget a number of factors would be at play before someone actually succumbed to an outbreak – stress and tension being one of those things that chiro can directly help with. It’s all about balance and maintenance and keeping in mind everything has a domino effect on the human body. It would also help the person think in retrospect if they suspect an outbreak: ‘I’ve been on my lysine and vitamins, but I haven’t exercised this month and I havent seen the chiro in two months, and I havent be eating all that well either. I’ve been really stressed out this week. Maybe I should take some anti-virals, not work, and monitor the condition of my genitals – just incase’

Hope that answers your question,
xx E


Robin D October 3, 2014 at 8:32 pm

Also, this virus is no more than an irritation in the vast majority of cases. Which is why most people have it without knowing it (HSV1, HSV2, or both).


Maureen Coffey October 8, 2014 at 5:06 pm

Indeed, herpes seems to be as prevalent as e.g. Escherichia coli – the bacteria all of us have in our intestines. It breaks out (as rashes/shingles etc.) during times of stress and it might well be that the above person(s) go through times of stress at times. Stresses can also be: workload, nutrition, financial or relationship worries etc. In most of us the herpes viruses just lie dormant anyhow and it is highly questionable if we need anyone to transmit them to us if we already have them.


Robin D October 9, 2014 at 4:25 pm

Oh gosh it’s not QUITE that common! Common but not actually 100%, so. It is, however, about the same prevalence as H. pylori in the stomach, which can cause ulcers and cancer.


Robin D October 9, 2014 at 4:27 pm

(but usually doesn’t – 10-20% get ulcers, 1-2% get cancer).


Josie October 9, 2014 at 5:03 am

There seems to be a *lot* of comments here that are confusing HSV (herpes) with HPV (the virus’s that can cause cervical cancer, warts, or nothing at all, etc.). That’s concerning in this community… Maybe a follow up post is in order?


Caty Simon October 9, 2014 at 9:47 am

Commenters–would you be interested in an Ask Ms Harm Reduction post detailing the difference between HSV and HPV?


Robin D October 9, 2014 at 4:15 pm

Uh what? Where did you see that? Because I just looked back through all the comments and don’t see any about HPV, just HSV1 and HSV2. Maybe the person who said 1 in 4 have it? Because that is actually about right for HPV.


Piper October 10, 2014 at 1:17 am

Stripper, here. I hate to be all shame-y, but really, having my eyes opened to the lack of disclosure by sex workers alone (let alone the general public, by far much less educated about STIs) — this is why I haven’t been able to have sex or date much in years. Years. Really. I’m so scared of contracting herpes, whether at work or out on some personal romp, and losing my job. I know many, many of my non-sex-work friends have it, and have no problem finding willing partners (with disclosure, they tell me). Still, if I did get herpes and have any symptoms at all, I’d immediately be fired and humiliated by the staff and the coworkers I’ve grown close to over the years. I make killer money, and I live in a small enough city that I wouldn’t be able to find another place to work in my home city if that happened. I could literally lose my house, my car, and everything I’ve worked for if I contracted an STD and anyone found out. So in the meantime, I have so much more in common with my customers than they could ever know: I don’t get laid, either.


Caty Simon October 10, 2014 at 8:11 am

You know that sex workers are actually one of the most safer sex adherent (and thus STI free) populations, according to many, many studies? Plus all the anecdotal evidence I’ve ever encountered. I personally haven’t even given a blowjob without a condom for almost fifteen years. And it’s the civilians I hear about not even disclosing to their *partners*.


Robin D October 10, 2014 at 8:34 pm

The idea of losing a job as a stripper for something shared by the majority of customers and probably coworkers is bizarre…

And yeah, civilians don’t even disclose to their partners, nor think they have to bother to get tested or use protection, which is on them.


story October 14, 2014 at 2:57 pm

one of my family members has genital herpes. she has no idea from whom she contracted it. she’s had it for decades and has had two children since getting it. she has had multiple partners since getting it and has never infected any of them due to vigilant self-awareness (she says she feels sluggish and a tingling down there before an outbreak). several years ago a medical professional suggested that some research showed that the nightshade family (potatoes, tomatoes and bell peppers) were linked to outbreaks. especially when she is stressed or feeling like her immune system is depressed, she avoids these foods and has had fewer outbreaks since.


Robin D October 15, 2014 at 4:32 pm

Yeah a family member of mine does too (and had three children without issue or passing it on).


Nick October 28, 2014 at 10:31 pm

There are a few things in the original post that aren’t quite right.

First, this statement: “one in eight people have the virus that can cause genital herpes”. In the U.S., 15.7% of people between 14 and 49 have HSV-2, while 53.9% have HSV-1 ( Either virus can cause genital herpes. If you dig into the data you’ll see that the percentage of infections go up with age: if your clients are men and women between 40-49, 25.6% will have HSV-2 and 63.6% will have HSV-1. Unfortunately these stats aren’t broken down by gender. There are a lot of fake numbers on the web about herpes prevalence: e.g., the numbers on are not correct. There are also numbers floating around that say 80% of people have it, or it’s really almost 100% if you had a fine grained test: these are also not correct.

Why does it matter? Because the chances are good that your clients already have herpes (though it matters which they have, and which you have: HSV-2 grants some immunity to HSV-1, but not the other way around). Once you have a given variant and it’s established, you can’t get reinfected in another site: basically, you can’t catch it twice. So that’s a potential angst reducer.

Second, this: “testing for the virus is difficult when not suffering from an episode”. There are older blood tests that can produce unreliable results, but all modern tests give very high sensitivity (“do you have herpes?”) and specificity (“do you have HSV-1 or HSV-2?”). A good reference is at Note these tests only work after the infection is established: it will take several months before enough antibodies are present, but six months is more than enough time.

The reason most health care professionals don’t screen for herpes isn’t because it’s hard to detect: it’s because many people have it, many people don’t know they have it, there’s nothing really to do if you do have it, and when patient find out they have it they freak out and treat it like a sexual death sentence ( But as another poster pointed out, herpes isn’t a big deal: it’s common and it’s not going to kill you.

But it’s worth getting a test to figure out whether you have genital HSV-1 or HSV-2. It’s unfair but if you had to pick a HSV to work with, HSV-1 is the one to hope for. I don’t know of any studies of genital-to-genital or genital-to-oral transmission rates for HSV-1 (there are plenty for HSV-2). But you’ll have less asymptomatic viral shedding with HSV-1 than HSV-2 (, and no shedding means no chance of infection. There also aren’t any studies on the effects of antivirals on HSV-1 shedding, but most people assume it helps.

For more info, there are two fantastic books on herpes that are worth seeking out: Terri Warren’s “The Good News About the Bad News” and Charles Ebel and Anna Wald’s “Managing Herpes: Living and Loving with HSV”. I’d highly recommend either.

Best of luck.


Caty Simon October 6, 2015 at 9:13 pm

Thank you for this!


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