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

[beloveddoll.livejournal.com]

I had never even thought of telling someone I kissed that I have had cold sores in the past. I barely think about it until I get that familiar bump and start to panic because it hurts! But, my friend had never had cold sores and when she questioned her then partner about the bump near his lip, he said it was a pimple. Turns out he knew he had a sore and didn't want to tell her! She ended up getting sick and having massive fever sores on her lip and cheek.

Now, I try to think about it at all times when in the realm of lip lockin'. My boyfriend has never had a cold sore...and I had to tell him that I get them sometimes when i get sick. If I had genital herpes, I would most definitely tell my partner.

[skeas.livejournal.com]

I was like you and never thought of telling people I kissed that I had herpes. I mean, I'd had a sore in 8th grade and by the time I was kissing, I was in 12th. I didn't even remember it. About a year into my relationship with my boyfriend, a sore popped up, and my boyfriend was suddenly questioning why I hadn't been forthright with him from the beginning.

[laurapalmer813.livejournal.com]

I would tell a potential partner about genital herpes, because I'd rather have that up front. I'd rather have him leave me before we ever got intimate, than leave me after we'd been having sex and I had to fess up because I got an outbreak, because that would be a terrible betrayal of trust.

As for oral, I don't know. I'd probably tell him if I had a cold sore that he should stay away from my mouth. Otherwise I wouldn't unless it came up in conversation. I've never had one, but I think cold sores are the sorts of things that wouldn't always be on my mind.

[skeas.livejournal.com]

I'm just wondering why not telling a partner about genital herpes would be more of a betrayal of trust than not telling someone about oral herpes. Aren't they (basically) the same disease? Is it because we treat genital herpes like a terrible, incurable disease and minimize oral herpes by calling them "cold sores"?

Should we be perpetuating that? Is genital herpes truly more terrible than oral?

[laurapalmer813.livejournal.com]

Its not that I wouldn't tell - its just that I've never thought of cold sores as a huge deal, so I probably wouldn't think about it until the subject came up. I have no idea how similar they are, because I've never dealt with either one. There is definitely more of a social stigma about having a sore on your vulva than one on your lip though.

[jocelina.livejournal.com]

I think that people tend to view HSV-1 as a less troublesome virus because often people become infected with it when they're fairly young and their bodies have plenty of time to build up an immunity to it, so their outbreaks during adulthood tend to be relatively mild (one or two cold sores) whereas adults who contract HSV-2 can have more severe genital outbreaks, at least at first. Initial outbreaks of HSV-1 can be quite unpleasant too (especially for children, according to this NYT article (http://health.nytimes.com/health/guides/disease/herpes-simplex/symptoms.html)), but since most people who have it likely experienced their first outbreak a very long time ago, they may not take this into account when evaluating the risk of passing it on to a partner.

Interestingly enough, one of the most serious (and fortunately very rare) possible complications of herpes, herpes encephalitis (http://professionals.epilepsy.com/page/viral_herp_enceph.html), is usually caused by HSV-1, at least in adults (in newborns, though, it's generally caused by HSV-2).

I think you're right that our collective perception of HSV-2 is a bit out of whack. I can understand why people wouldn't want to have to deal with having it, of course (I know I would much prefer not to contract either type of HSV), but I think that some of that negative association is based on the social rather than the medical repercussions.

[as-she-melts.livejournal.com]

There is no difference between the two physically, and there shouldn't be a difference socially. I don't believe that stigmatizing a disease is the way to go, but I would much rather have "cold sores" demonized along with genital herpes than continue on with the uneven judgement that currently goes on. Admittedly, this is because I'm still really pissed about having some chick's "cold sores" on my vag after my ex messed around with her.

The terms "cold sore" and "fever blister" infuriate me, and we (as a society, not meant as a dig at anyone on this thread) either need to call oral herpes what it is or come up with some cute little euphemism for the genital herp. I have totally had enough of being judged for something I had no part in--yet doctors/pharmacists/friends/ignorant loud people still assume that everyone with an STD is a slutty slutty slut or otherwise did something to deserve it. The guttoral disgust and automatic judgement of people who have genital herpes comes from sex-shaming anyway--it's for the same reasons that STD/STI-free people are referred to as clean* and it's especially worse for women, who aren't supposed to have a healthy (read: fun and possibly even outside of marriage and not only for procreation) sex life to begin with. The judgement comes from a place of sex-negativity, and does nothing to consider people who were lied to, cheated on, raped, infected by people who didn't know, etc etc etc. Ending those negative attitudes would only serve to increase understanding and knowledge of how disease spreads, why it's not all that different from other diseases, and why it's not acceptable to pass judgement on those who have it. Besides, if a child can get oral herpes from an affectionate relative (and pass it to a partner through oral sex later in life... at which point it becomes... gasp... genital herpes), maybe it's time to reconsider just how "terrible" a disease it really is.

That said, NO, I absolutely do not see a difference in disclosing oral vs. genital herpes. It is the exact same virus, only in a different location. It can easily be passed from one location to the other, through oral sex or even by one individual (i.e. touching oral herpes blister, then masturbating/emptying menstrual cup/whatev).

*I realize that this is not a safe-space friendly term, but I have included it for the sake of illustrating the social stigma of STD/STI infections.

[archangelbeth]

One thing is that you can get a cold sore from your Soppy Aunt Eidith smooching you when you're a baby or kid. It's not quite the same thing as "you have to be having sex to transmit it." And chances are, just about anyone you meet was exposed from a parent or grandparent, or other relative going smoochies on the baaaaby.

On the genitals, though, well... It takes a bit more "effort" to get it there in an innocuous sort of way, I guess. So there's the whole "OMG SEXXORS!" aspect to deal with.

My sleepy two cents, anyway.

[dictionaria.livejournal.com]

Well, I know that there's virtually no chance of contracting oral herpes when no outbreak is present, but I understand that the majority of people who get herpes contract it when their partner has no signs of an outbreak. (70% according to that commercial, which is urged on by profits, but viral shedding is apparently more likely with HSV-2.)

You're more likely to spread HSV-2 when showing no signs: "According to Spruance, people with recurrent oral HSV-1 shed virus in their saliva about 5% of the time even when they show no symptoms. In the first year of infection, people with genital HSV-2 shed virus from the genital area about 6-10% of days when they show no symptoms, and less often over time. (Both of these figures reflect shedding as detected by viral culture.)" (http://www.herpes.com/hsv1-2.html)

That article goes more in depth and covers some more technicalities, but with statistics like that out there, not telling a partner about HSV-2 seems like a bigger deal, while the majority of people have HSV-1 anyway. It's mostly social stigma, though, they say.

[sandi1743.livejournal.com]

actually we know that HSV can be passed when there are not outbreaks - the numbers that you are dismissing were all done on shedding studies and were published in peer reviewed journals.
check out the work of Anna Wald's group as she is one of the leaders in HSV transmission.

[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.

[heysmilepretty.livejournal.com]

"You do what you can to prevent it, but it's still there."

Exactly; you do what you can to prevent it. For a lot of people, the right of knowledge of a partner's past sexual history is indeed a factor in preventing it. But that "right" is also a responsibility; if someone doesn't ask a person he or she is kissing whether or not they have oral herpes, that's his/her own fault.

[emilia-romagna.livejournal.com]

So, before smooching on anyone, we should ask whether they have herpes or not, regardless of appearance of symptoms? Theoretically, its a good idea, but practically, seems a bit much to me. It also seems like this would put all of the responsibility on the person that may get infected. I think a better practice would be to make it the responsibility of both partners to open a dialog about potential or actual risks.

[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.

[suicidekitty911.livejournal.com]

you could also use an IUI or vaginal insemination to get pregnant.

[frolicnaked.livejournal.com]

... but then you risk the chance of catching it from your spouse and passing it on to your child.

True, nothing is risk free, but sources suggest that the risk of this happening is relatively low. Planned Parenthood (http://www.plannedparenthood.org/sexual-health/std/herpes.htm) says:

"Most women who have herpes don't need to worry. Rarely does a woman with recurrent herpes pass the infection on to her newborn."

Generally, according to the American Academy of Family Physicians (http://familydoctor.org/online/famdocen/home/common/sexinfections/sti/091.html#ArticleParsysMiddleColumn0013), the only time of "big concern" is during birth:

"The baby is usually safe in the uterus. When the baby passes through the birth canal, it may catch herpes. Your doctor may do a cesarean section ("C-section") if you have an outbreak at the time you go into labor, so the baby won't have to go through your birth canal."

However, if the mother isn't experiencing an active outbreak at the time of birth, Herpes.com (http://www.herpes.com/pregnancy.shtml) (citing the American College of Obstetricians and Gynecologists) lists the standard of care as vaginal delivery.

[laurenmarie.livejournal.com]

honestly, i've asked boyfriends if they've ever had cold sores before. I'm 23 and have never had one, so either I'm immune, asymptomatic or i've never caught the virus. so i'd be kind of ticked off i was told no they did not have it and then popped up with one/i got one.

[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.

[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.

[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*