Confused

Friday, August 17, 2007

Question

I'm confused by the information that I've read about herpes. Does an individual with HSV-1, who has never had any symptoms, have a responsibility to tell his/her partner that he/she has the virus? Is it appropriate to ask a potential partner if they're infected or to ask them to get tested before you kiss them? I've yet to meet anyone who practices this. I had previously thought that I just had to avoid kissing people with open sores. Now I'm afraid to kiss anyone. Planned Parenthood claims that 50-80% of Americans have HSV-1. Why does the statistic vary so much?

Answer

A lot of people are confused about herpes because there are two types, and yet the areas of the body each virus infects overlap to some extent. I'll try to sort out what we currently know or believe about herpes, but you should always update medical information with the most recent authoritative sources.

HSV-1 usually causes cold sores in the mouth. HSV-2 usually causes similar sores in the genital region. In between outbreaks, the virus lives in the nervous system. Once you get herpes, it never leaves your body, and it may cause recurring episodes of mouth or genital sores.

HSV-1, however, can apparently flourish in the genital region. So it's important to avoid sexual contact with a cold sore. But here's the really unfair part: Some people can transmit herpes when they don't have any visible outbreak of the virus. A person who is asymptomatic (no sores) but has HSV-1 experiences viral shedding on 18% of their cold sore-free days. Type 2 sufferers have more frequent rates of viral shedding when they seem completely healthy. This phenomenon, called viral shedding, is apparently responsible for about 50% of genital herpes infections. Condoms are only partially successful in blocking infection because herpes may have infected skin around the genital area. If there's no latex barrier, and there's skin-to-skin contact, there's potential infection.

The percentage of people who have HSV-1 varies, according to www.bodyandhealth-canada.com, because the rate of infection differs by age group. In young adulthood, 50% of people in the U.S. have herpes type 1. By the age of 50, it's up to 80-90%.

The only good thing that can be said for HSV-1 is that it may provide some protection against HSV-2. If you do get HSV-2, the presence of herpes type 1 in your body reduces the severity of the infection. Taking valacyclovir also reduces transmission.

Only type specific tests like the Western Blot can tell whether you have 1 or 2. Most people have no idea whether they've got herpes. But I certainly appreciate it when somebody who does have it lets me know before we kiss or do anything else sexual. I'm not going to reject that person, but I would take appropriate precautions. For example, I'd want to get tested. If we both have HSV-1 (which is statistically most probable), we can go ahead and smooch; we aren't going to infect each other. When it comes to oral sex, I'd want to make sure we used latex or plastic barriers.

But this certainly isn't what most people do. Most people assume that kissing carries a low risk of transmitting an infection that could affect their naughty bits. And this is why so many of us have HSV-1—from Aunt Hilda planting a big smackeroo on the brand new baby. People who are conscious about protecting their health use condoms; few use latex dental dams or plastic wrap for going down on women or to cover areas of their body that may be infected with herpes or genital/anal warts. Men don't think about pulling the condom over their balls, but the fact is that testicles do get infected with herpes and with warts. If you want to prevent transmission of herpes, you wind up having to improvise, because Western civilization is doing its usual tap-dance of denial about sexual health. There is still an unconscious (or not so unconscious) assumption that people who are having sex deserve whatever punishment they get from the realm of King Syphilis and Queen HIV.

You do run the risk of standing out and being a bit of an oddity by being so hyperconscious of taking care of your partner. I think it's sweet of you to care, and I hope you run into dates who agree.

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