Don't ask if you don't want me to tell

Thursday, April 01, 2010

Question

Your response to last week's column on herpes made me want to wrap myself in three layers of Saran Wrap and resign myself to macramé. Holy fuck!

It's bad enough that I feel like a complete virgin when considering multiple partners after so many years of monogamy. Now I have this whole bunch of new skills to learn. And how is all of this not going to feel like kissing in a space suit, in space? Visions of awkwardness and humiliation now plague me, thank you very much.

Here's a question: my previous partner and I were in a relationship for several years. One night, we had this wicked little foursome. We had a great time, but even though it was her idea to begin with, my partner got super-nervous. She had two restless, fear-filled nights and then woke up with a moustache of sores! We had been in all the same nooks and crannies, yet she had this ridiculous outbreak and I never did. Even after the moustache incident, long after the sores went away, we still had a great sex life. She didn't remember ever having a cold sore before, and, as far as I know, hasn't had one since. I've tried to get tested, but since I've never had a sore in my life, no doctors will bother with me. Correction: Mom says I had a cold sore when I was a little kid, but that was over 30 years ago.

So what's the deal? My feeling is that she didn't catch it that night, but that her nervousness caused the flare-up. Still, why am I not a viral culture myself? And how can I ever know if I have herpes if I haven't had a sore in at least 30 years, possibly my life? (Mom's memory can play tricks on her.)

Flustered Fifi

Answer

Are you sure you're ready to handle a non-​monogamous relationship? Because here's one of the primary tenets: don't flip out on someone when you ask them to tell you the truth and they do.

Lyba Spring of Toronto Public Health again: "Fifi wants you to make a diagnosis, Sasha. Exactly. I can't either. Was it a moustache of cold sores? Is Fifi immune? I can tell her this: 'nervousness' does not cause an outbreak in a person with no history of herpes. Stress can certainly provoke an outbreak in a person already infected. In terms of immunity, if a person has the type 2 infection, it's highly unlikely he or she will ever get type 1. But if the person has type 1, he or she can certainly get type 2 and then have both types recurring.

"I can also tell her this, which I picked up from a Web conference: During the first six months of infection, shedding can occur during 20 to 40 per cent of days; with longer-term infection, shedding may occur during 5 to 20 per cent of days. It is the shedding of virus -- and particularly asymptomatic viral shedding -- that is responsible for the transmission of genital herpes.

"Asymptomatic viral shedding is the presence of virus in the absence of clinical signs or symptoms. Up to 70 per cent of new infections can be attributed to asymptomatic shedding. Asymptomatic shedding occurs in virtually all HSV-2-infected patients, and shedding rates cannot be predicted on the basis of age, sex or reported history of outbreaks.

"Shedding of virus can occur from multiple genital sites, and 50 per cent of asymptomatic shedding events occur more than seven days before or after a clinical outbreak. And although viral shedding tends to diminish over the course of infection, the rate of decay is measured in years, and the potential of transmission persists. What this means is that the more partners Fifi (or anyone) has, the higher the risk of infection. Most people don't know they have it. Most transmission happens in the absence of a sore." Allergies to vaginal secretions have been reported, but they are rare. It's possible that your ex-girlfriend got a mild form of eczema that was aggravated by moisture and friction. A dermatologist could have assessed that.

And Fifi, if you don't want the truth, then quit asking for it. Seriously.

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