Herpes disclosure

[skeas.livejournal.com]

The recent post about herpes brought up some questions for me.

My question is: Is it always necessary for an infected person to tell a potential partner?

From a theoretical standpoint, YES! Yes, yes, yes! But consider a few scenarios:

You haven't had an outbreak since your first one--15 years ago. As most of us know, herpes is transmittable even when the infected person doesn't have a sore. However, plenty of us infected people just avoid sex/kissing when we have a sore, and the other partner is fine. Do you still let your partner know about an outbreak you had at 20, when you are now 35? Do you risk ruining the whole relationship (because people generally freak out when the word "herpes" in involved) over a nearly negligible risk?

You have oral herpes. Studies show that 80% of us have herpes antibodies, and might be carriers of the disease without even knowing it. Yet I've never, ever heard of someone fessing up before a liplock. Do you let everyone you are about to kiss know that you have oral herpes? I personally feel like everyone is aware of--or should be aware of--a certain risk that's involved with intimate behavior like kissing or sex. You could catch mono, a cold, the flu, herpes, et cetera. You do what you can to prevent it, but it's still there.

For that matter, is there a difference between disclosing about oral herpes (which you can write off under the more innocuous name of cold sores) and genital herpes? Do you have more of a responsibility to tell a partner about genital herpes? And why?

Comments

[skeas.livejournal.com]

I also think that it's theoretically a good idea for us to ask everyone we make out with, but sometimes we can be a little sloppy with our kisses (when drunk, for instance). Because the HSV test is more expensive and not many people have had it, most people probably don't definitively know if they have herpes anyway. I'm sure a good population of people with herpes are asymptomatic.

[llenn.livejournal.com]

but it's the gift that keeps on giving!

[marionravenwood.livejournal.com]

I don't think herpes is a big deal at all, but there's actually a very small chance of transmitting herpes through semen, without skin contact: "....Acquisition of HSV-2 resulting from artificial insemination with sperm obtained from a man with asymptomatic primary HSV-2 infection has been documented. (http://www.stdjournal.com/pt/re/std/fulltext.00007435-199901000-00001.htm;jsessionid=HJRpJkqqYhLc6NDhy6Zh8HJ5R6gd4wfLvBr5n8LzFNr9gnvnLL41!-1829525682!181195628!8091!-1)

[archangelbeth]

C'mon, you think Soppy Aunt Edith'll give you anything for Christmas but scratchy, dry-clean clothes that don't fit right and have pictures of little bunnies and misshapen kitties on them?

You're better off stopping with the oral herpes! O:D

[archangelbeth]

Fascinating -- I wonder if there was a sore/spot-for-shedding-virus-bits in the urethra, and the semen got contaminated because of passing through the urethra?

...sorry. Just-Woke-Up Medical Curiosity is activated!

[dictionaria.livejournal.com]

Oh! I hope you didn't misinterpret my meaning! I didn't mean to dismiss any information, just to say that HSV-2 can be passed when no outbreaks are present and that this happens in the majority of cases, but also allowing for commercial propaganda, as not citing my source for that information would be rather rude of me. Then the quote printed after brings up some studies on viral shedding that I thought were interesting.

My knowledge of HSV-1, if that's what you're referring to, is only anecdotal. I don't have any numbers on that HSV-1 and the two do appear to be different in terms of how easily they are transmitted and such. I don't have any numbers to dismiss there, so I'm assuming you're talking about the 70% thing?

Forgive me, while I'm not sure what or how you were interpreting my comment, I had no intention of dismissing any scientific information. I am well aware the fact that HSV is passed when there are no outbreaks and was trying to get this across. I suppose I worded it badly.

[frolicnaked.livejournal.com]

If honesty ruins a relationship, then the relationship sucked anyway.

Agreed, at least in terms of the specific scenarios here. I tend to think that the more any given individual learns about HSV, the greater the tendency for that person to consider the virus an irritating nuisance instead of EW, SCARY, THE WORST THING EVAR!!! Because of that, I think as long as a partner is willing to become educated about HSV, odds favor the couple being able to deal with it.

And I can understand an initial EW GROSS NO! reaction, especially if it came from someone who didn't really understand herpes, but if someone stayed with that kind of reaction... Well, I don't think "refusal to learn," to put it more or less bluntly, is a character trait that's compatible with who I am. If that's what ruined a relationship for me, I'd have to question whether it was a relationship worth keeping anyway.

[jocelina.livejournal.com]

True. Last year Aunt Edith gave me a hat that looks just like a wicker trivet.

[evr1bugsme.livejournal.com]

I don't really think that's fair because some people CAN have repeatedly bad herpes outbreaks. Does Valtrex or similar (if you have medical insurance) prevent this in all or most cases?

I know that herpes can be an irritating nuisance, but why would I assume it would be that when it can also be very painful and uncomfortable? I think it's important to have complete information and a realistic idea about the risks of herpes, but I certainly wouldn't judge not wanting (what could potentially feel like) chicken pox in your crotch as a "failure to learn."

[suicidekitty911.livejournal.com]

oh my. i was completely unaware of that. that's really interesting, thank you for sharing that!

*thinks*

[frolicnaked.livejournal.com]

Aunt Edith always gives me pants... and we know how I feel about pants! ;)

[deadlychameleon.livejournal.com]

If the person actually knows they have herpes. It's very possible to have and not know. I'd guess the vast majority of people that carry it don't know they have it. Honestly, with both HPV and herpes, condoms aren't terribly effective. I also wonder if maybe some strains are worse than others, so that people who notice have a really bad strain? So, all things being equal? If anyone told me they had them, unless I REALLY already liked the person... I'd probably exit stage left. Nonetheless. If you know, you tell. Some people won't care. Others might have immune issues (non-HIV related) where such things could be dangerous.

But yeah, I'd rather know up front than freak out when they mentioned it months later.

[deadlychameleon.livejournal.com]

Oh, I should add that I actually *ask* potential partners about STIs, so they'd have to actually lie, not just "not tell me".

[frolicnaked.livejournal.com]

Honestly, with both HPV and herpes, condoms aren't terribly effective.

While condoms certainly aren't foolproof at preventing HPV transmission -- and while I don't believe there are exact stats on HSV transmission -- using condoms does reduce the rate of transmission (http://www.vaginapagina.com/index.php?title=Human_Papillomavirus_%28HPV%29#How_can_I_prevent_HPV.3F) by 70%.

I also wonder if maybe some strains are worse than others, so that people who notice have a really bad strain?

As far as I know, there are only two strains of herpes simplex (http://www.vaginapagina.com/index.php?title=Herpes_%28HSV-1/HSV-2%29#What.27s_the_difference_between_HSV-1_and_HSV-2.3F), HSV-1 and HSV-2. I'd guess, then, that whether someone shows symptoms or not depends more on factors other than the strain of the virus -- perhaps individuals' immune systems and/or sheer dumb luck account for lots.

[deadlychameleon.livejournal.com]

While condoms certainly aren't foolproof at preventing HPV transmission -- and while I don't believe there are exact stats on HSV transmission -- using condoms does reduce the rate of transmission by 70%.

I'm aware, though one suspects that the placement of the lesions is a significant factor. However, the rate of transmission for other agents such as HIV or Hepatitis is much lower than 70% with condom usage, since it's fluid not skin-based transmission.

As for the strains... well, technically there probably are sub-strains, or whatever you'd like to call them, variations within the pool of viruses that present similar symptoms. There are a lot of different strains of HPV, over a hundred,

http://health.rutgers.edu/hpv/

with a few strongly associated with abnormal cervical cells. It seems likely that some strains would be more associated with nasty visible outbreaks as well.

More than one type for genital herpes as well. (http://bodyandhealth.canada.com/channel_section_details.asp?text_id=1370&channel_id=1020&relation_id=10877)

There are many sub strains of HIV as well.
http://www.avert.org/hivtypes.htm

[deadlychameleon.livejournal.com]

I'm kind of with evr1bugsme on this one. If it's very early in the relationship... again, all things being equal? It would depend, if they say, oh, I had one minor/possible outbreak 5 years ago, but I haven't noticed anything since, that's different than "I have constant outbreaks and am in serious discomfort a lot". It's not just fear of infection, it's also a factor that's going to impact our sex life at that point.

[frolicnaked.livejournal.com]

To me, "painful and uncomfortable" really does fall under the category of "irritating nuisance." It rarely causes extra complications in people who are otherwise healthy. As for Valtrex, the Vulvapedia says this (http://www.vaginapagina.com/index.php?title=Herpes_%28HSV-1/HSV-2%29#Suppressive_treatment) about suppressive treatment:

This means taking medicine every day to help prevent symptoms. Suppressive therapy greatly reduces the number/severity of outbreaks for most people. It can prevent outbreaks altogether for some. It can also greatly reduce asymptomatic shedding (the recurrence of virus on the skin without sores). Studies are underway now to find out whether or not suppressive therapy can help prevent transmission as well.

And I didn't say anything against making an informed choice about herpes. Rather, I said refusal to budge from an initial EW GROSS knee-jerk reaction, without being willing to become educated about the issue, is a trait that's not compatible with what I'm looking for in a partner. It doesn't mean I expect everyone to share the same preferences.

[frolicnaked.livejournal.com]

As for the strains... well, technically there probably are sub-strains, or whatever you'd like to call them, variations within the pool of viruses that present similar symptoms.

Do you have a source that shows this actually occurs with herpes? This page (http://bodyandhealth.canada.com/channel_section_details.asp?text_id=1370&channel_id=1020&relation_id=10877), the one to which you linked, still only mentions 2 strains of the virus.

I'm also aware that risk reduction of transmission of STIs such as HIV or hepatitis is more effective than risk reduction for HSV or HPV. And I realize it's likely a personal judgment call, but I don't think I'd call reducing the risk by 70% not "terribly effective."

[frolicnaked.livejournal.com]

And you're perfectly entitled to your own relationship preferences. They simply don't happen to be ones that I share. :)

[deadlychameleon.livejournal.com]

Actually, this page does refer to multiple strains of genital herpes, it's just not terribly clear.
Studies have shown that a person with genital herpes can catch a new case of genital herpes, but other studies have shown that this happens only rarely. In most cases, if a person with genital herpes catches genital herpes while with a partner, they are catching it from themselves - having a recurrence. Type-specific antibody against your own strain of virus makes it very difficult to catch a second infection of the same strain from a different person.

This Harvard study also discusses different HSV-2 strains and possible resulting anti-viral resistance:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=154092

I would be surprised to find out that there aren't many different sub-strains of such a common virus.

[frolicnaked.livejournal.com]

Actually, this page does refer to multiple strains of genital herpes, it's just not terribly clear.

Well, no, not exactly. Given that genital herpes can be either HSV-1 or HSV-2, it's really not very clear at all what they're referring to there. I assumed they referred to "genital herpes" as a reaction site, not necessarily as a specific strain of the virus.

But thank you for the second link.

[tacky-tramp.livejournal.com]

Do you risk ruining the whole relationship (because people generally freak out when the word "herpes" in involved) over a nearly negligible risk?

Yes. You explain your situation, educate the person about the negligible risk, and then allow him/her to make the call.

If I were involved with someone, and found out that s/he'd withheld this information from me, it would be over instantly. Other people don't get to manage my STI exposure through silence and lies.

[frecklestars.livejournal.com]

Personally (and this is only me; I'm an honesty freak, almost to a fault): I would tell them about anything and everything. I wouldn't make a big production over it, but I would tell them. I like my partners to know almost everything about me (obviously not all at once). But my current SO knows everything in my medical history, plus familial and personal history. It's just a thing with me: because I've had a partner lie to me in the past about things he didn't think were important (i.e. unprotected sex with unknown partner, past possible sores, etc), I'm a bit of a freak about honesty in relationships. (Thankfully I did not get anything from said partner.) So basically, this whole thing is personal choice. If you don't think it ought to be known, then don't tell. *shrug*

[ladylucia.livejournal.com]

Herpes Simplex Type I is more fatal in the case it spreads to your eye or brain whereas Herpes Simplex Type II is just incurable at this point but is not potential of being fatal.

[thesourie.livejournal.com]

i know this is old but i *love* this comment so much