General Question

alterego's avatar

Herpes: a question that may affect the rest of my life...

Asked by alterego (121 points ) February 18th, 2009

Let me first say, I am paranoid about contracting herpes. It is unpleasant, incurable, and makes me a much less desirable sex partner. The reason herpes is particularly scary to me is that it is so common: one in five American adults is infected. As a result of this fear, I always screen potential partners for herpes. It’s a deal breaker.

I recently went out on a first date with someone who, in reply to my herpes inquiry, assured me that she had no venereal diseases. The date went quite well, ending with a long and intense make-out session.

A few days later, I received an email from her, disclosing that—while she did not have genital herpes—she was indeed a carrier of herpes simplex virus-1 (HSV-1), which occasionally manifested as cold sores.

While I was technically asking about genital herpes (HSV-2), I feel like not mentioning HSV-1, is a pretty egregious omission of truth. After doing some internet research, I’ve learned:
* HSV-1 is a lifelong condition, like HSV-2
* HSV-1 can be transmitted even when it’s not flaring up (no cold sores present)
* HSV-1, while usually relegated to the mouth and lips, can be spread to the genital area during oral sex

While I was not particularly aware of or concerned about HSV-1 before, I have become more so now. Since HSV-1 can be transmitted when cold sores aren’t present, there’s a slim chance I’ve already contracted it (I had some bumps appear on the inside of my cheek the day after the date, but they have since cleared up). If I’ve already contracted it, I suppose there’s less risk moving forward in the relationship, though it seems like a creaky start.

If she had disclosed her HSV-1 before the first date, I’m not sure what I would have done, but now that we’ve met each other and like each other, it’s even more complicated.

Should I be concerned about HSV-1? It is apparently even more common than HSV-2. There’s a possibility I’ve developed immunity to it, but how would I know for sure? What is the likelihood I’d contract it if we avoid contact during breakouts?

I pride myself on being disease-free and the prospect of saying “I have herpes,” even if it’s HSV-1, is daunting.

Thank you for taking the time to understand my situation. I appreciate your thoughtful answers, dear Fluther.

Observing members: 0 Composing members: 0

65 Answers

shilolo's avatar

I’m an Infectious Diseases doctor. Let me try to allay your fears. HSV-1, or the primary cause of cold sores, is very common. I don’t know if you were tested in the past (for both HSV-1 and HSV-2) given your self-stated paranoia, but many people are silent carriers of HSV-1. All it takes is for a doting aunt or uncle to give you a sloppy kiss as a child and there you go. Or, during teenage-college years, you pick it up from a partner. That said, HSV-1 primarily causes classic cold sores, which, while unsightly, are fairly innocuous. Furthermore, having sores in your mouth the very next day is inconsistent with the HSV-1 life cycle, so I doubt highly that you contracted HSV-1 from her (at least not on that basis).

I’ve counseled many people about this, and my take is that it shouldn’t be a deal breaker. The risk of transmission when she is asymptomatic is very low (though not non-existent.) Moreover, although you have taken great strides to protect yourself, it is quite possible that unless you demand blood testing a priori from all potential partners, that you could easily encounter someone who, unknowingly, has HSV-1 or HSV-2 (asymptomatically). So, practice safe sex and certainly ask away, but don’t let a fixation on HSV run your life.

psyla's avatar

I would be sure to always wear full-body biohazard gear like shilolo wears in his icon picture.

Judi's avatar

@shilolo ;
It is so great to have real experts top answer these questions. You’re great!

dynamicduo's avatar

My comment is exactly the same as shilolo’s last line. You seem to be letting your fixation on this issue dominate your life. HSV-1 is common enough and without serious negative effects. Plus, what are you going to do if you have caught it? There’s no anti-HSV-1. The fear you have regarding HSV-1 is not proportional to its actual risk. A therapist may be able to help you understand where your fear truly stems from.

MissAnthrope's avatar

I, too, am extremely paranoid about contracting herpes. It’s simply that it’s an incurable disease, it’s got a stigma, and I really just don’t want it. I already have to deal with a host of other physical ailments and I’d prefer to not have another. I also am aware of the details and of how commonly it occurs. I had a full STD test for my peace of mind a couple of years ago and was surprised that despite all the kisses I’ve received in my life, I tested negative. My goal now is to keep it that way. :)

Since the doctor addressed the medical aspect of it (I’m so glad you’re with us, shilolo, thanks!), I want to address how she handled it. Really, the determination has to be made by you about how you feel about it. You said you liked her, so maybe you don’t mind. Personally, I would really not like the fact that she lied about it and then didn’t disclose the information until after she could have transmitted it to you. If she has HSV-1, she knows that’s herpes. She should have said yes.

Vinifera7's avatar

I got HSV-1 as a small child. There was nothing that I could have done about it. However, it’s not that big of a deal. Every now and then I feel a tingle on my upper lip and soon a small bump appears. If you use a prescribed ointment (like one containing Acyclovir) as soon as possible, and keep applying it, the sore won’t get very large or painful and will go away quickly.

Normally outbreaks appear if your body is under more stress than usual, so don’t stress out about getting HSV-1!

psyla's avatar

I must question shilolo’s credentials. In a previous post, he was unaware that Vitamin K promotes calcium absorption. We Flutherers have absolutely no way to verify that shilolo is who he says he is, despite the truth of his information.

elijah's avatar

I don’t think you have a right to expect a woman on a first date with you to answer those questions. If you are so paranoid maybe you shouldn’t of had an extreme makeout session with a complete stranger. If a relationship advances to a physical relationship (sexual), then of course she should be up front about any serious diseases you could be affected by. But a cold sore?? You can get that from anyone. She shouldn’t have to label herself a diseased woman on a first date.

davidshoukry's avatar

@psyla just because shilolo is a doctor does not mean he knows every last thing about the science of medicine. Do you know absolutely everything about the industry/field you work in?

psyla's avatar

Another blatant error which lends credence to my assertion that shilolo is not a doctor is that the proper term is an “Infectious Disease doctor”. No real doctor would dummy down this term, as it is self-explanatory. shilolo refers to himself as an “Infectious Diseases” doctor.

MissAnthrope's avatar

elijahsuicide – It is a transmissable, incurable disease. Just because it’s not deadly doesn’t mean it’s okay to not disclose the possibility you might give it to someone, no matter how embarrassing it may be for you personally. It’s unethical not to, considering the person has to live with it indefinitely.

psyla – Didn’t I just see a post from you saying you thought the government was behind 9/11? I think I will take your opinion with a grain of salt.

shilolo's avatar

I think psyla is being a bit sarcastic, but, that is just my unedumacated opinion.

psyla's avatar

Hold the salt. My comment that Bush caused an accidental nuclear blast in the White House basement that required him to send the Phoenix Project team back into the past to allow 9/11 to happen (so that Bush would not be blamed for an East Coast nuclear holocaust), was surely a jest.

alterego's avatar

@psyla please take your personal attacks and conspiracy theories elsewhere.

Everyone else: Another fear is that if I proceed with the relationship, my kisses will always be a little less passionate, because in the back of my mind, I won’t be able to stop thinking: “herpes, herpes, herpes”.

I’m not really looking for a serious relationship (read: marriage) right now. I’m going out with people to have a good time. I just don’t want to get into a situation where I can’t fully enjoy the physical part, since that’s largely what it’s about for me.

I also have a longer-term fear that a few years down the road, every time I have a cold sore outbreak, I will think back to this moment and experience regret.

elijah's avatar

@AlenaD is a freaking occasional cold sore. Not HIV.

psyla's avatar

I got the boot.

Vinifera7's avatar

@elijahsuicide
It’s still technically HIV.

Woops.. thought you said HSV.

MissAnthrope's avatar

elijahsuicide – I’m somewhat saddened for you that you have such a cavalier attitude toward herpes. You can have all the incurable diseases you like, if that’s your wish and you don’t care.. but keep ‘em to yourself. :)

MissAnthrope's avatar

psyla – My bad. I read it as the rantings of a crazy person. I apologize if you are indeed sane and reasonable.

psyla's avatar

I would say dump the girl. I would also be wondering what herpes tastes like at every kiss. Get another STD workup to place your mind at rest. Do not kiss people who have herpes anymore.

Yes, really I do rant like a crazy person sometimes, so good insight on your part. I am feeling rather sane today. As an aside, nowhere in Fluther did I ever say that the government caused 9/11. Due to the Patriot Act, I was especially careful not to say that. Again, I profess that shilolo is not a doctor and I plead with you… Dump the girl & get an STD workup!

elijah's avatar

@AlenaD I don’t care if your saddened by my attitude. You are being an over the top extremist. I have no diseases to pass so rest assured I won’t be polluting humanity. I clearly stated that she has a responsebilty to tell him anything serious before sex.
Maybe he should sue her for putting his life in such grave danger.
There is nothing wrong with his personal preferance of not dating someone with herpes but then if he is gonna freak out over the possibility of a cold sore he should keep his mouth off strangers.

MissAnthrope's avatar

elijahsuicide – You are missing the point and getting unnecessarily defensive. It’s fine, we can agree to disagree.

shilolo's avatar

@alterego It sounds like, for you, this is going to actually be a deal-breaker. You should know, however, that even if you find someone who is HSV negative like you are, that you will not be protected for life. Say your partner gets an innocuous kiss from a friend, like European style, which inadvertently transmits HSV-1 to her. Before she knows it, she’s kissing you, and you get it.

My point here is not to scare you, but just to point out that, as much control as you attempt to exert over this situation, that some things are out of your hands (and lips).

alterego's avatar

@shilolo I really appreciate your expert advice.

While I understand that many things in life are out of my hands and not worth worrying about, in this particular case, I feel like the decision is very much in my hands.

If I can attribute the condition to an external force, at least I won’t experience regret.

I should add, my feelings about disease are much closer to @AlenaD than @elijahsuicide. I currently never get cold sores and, while clearly not the end of the world, I have no particular desire to start.

All that said, I’m still undecided.

psyla's avatar

A European style kiss like French or a European style kiss like English? Someone with herpes should act demure, refrain from swapping spit, & cultivate shyness until finding the right time to talk about infections.

elijah's avatar

I’m sorry if I’m coming off defensive, I just think something this small isn’t a major dealbreaker. Responsibility is a two way street. You can’t solely blame the person passing the disease when you actively put yourself in the position to recieve the disease.
@alterego I’m not trying to make it sound like you don’t have a right to try and avoid it, you absolutely do. But I’m just saying you might miss out on someone who could be amazing because of a possible cold sore. I can understand your fear of disease, but this isn’t life threatening.

psyla's avatar

Yes, but it’s very itchy.

shilolo's avatar

@alterego You haven’t said if you have been tested yourself, recently? If not, you might want to know your own HSV status too, since you could be a silent carrier yourself (you needn’t have had cold sores to be HSV-1 positive).

elijah's avatar

@psyla Is it? I never had one but I assumed it was like a pimple.

shilolo's avatar

@elijahsuicide Most people who suffer from HSV cold sores can feel them coming on before they actually develop on the surface. HSV lives in your nerves (technically, the nerve body or ganglion far, far away from the mucous/skin surface), and when it reactivates (usually in the setting of stress), the virus travels down the nerve ending to cause the little eruption at the surface. That traveling/eruption often causes a tingling/itching sensation immediately before the actual cold sore appears.

Oh, and the whole process if Vitamin K dependent, right psyla?

Judi's avatar

@shilolo ;Can you be tested when you’re not in an outbreak? Don’t they test by culture?

psyla's avatar

Poor nutrition can indeed be a factor that leads to herpes outbreaks so an infected person should eat healthy and take vitamins, including vitamin K if not taking the medication Warfarin. During a herpes eruption, sufferers describe the pustule as having intense sensation. Psychologically, it feels like the eruption is far bigger & more noticeable than it really is. I love you shilolo.

shilolo's avatar

@Judi. Yes. There are two types of tests. One type (the one to which you refer), is to culture an actual vesicle to see what type of virus is causing the lesion. The other (more common) type of test is a simple blood test to look for antibodies against either HSV-1 or 2. This test can discern between an acute infection and a past infection on the basis of the presence or absence of different antibody types. So, anyone can be tested at their whim for prior HSV infection with a blood test. During an outbreak a test may show only IgM antibodies (the early type) and not IgG (the late type) whereas indication of past infection would be absent IgM antibodies but positive IgG antibodies. Does that help?

Judi's avatar

I just wonder why they doctor had to scrape and agrivate that healing canker sore to find out that it wasn’t herpes. I’ve never had an actual cold sore, but if it’s anything like a canker sore the pain can consume your entire being! They flair up under stress like a herpes and my husband never had them until he met me. @shilolo ; do you know what causes that?

psyla's avatar

It’s because a nerve is inflamed. Nerves carry pain signals so when the nerve itself is in pain, look out!

shilolo's avatar

@Judi Ah, the notorious canker sore. No one really knows what is the underlying cause of canker sores, but they aren’t thought to be contagious. Perhaps with modern virus identification techniques, we might discover a new viral cause, but, to date, no one knows for sure.

Judi's avatar

@shilolo that article about virus identifying techniques was great. Writen so even a science impared person like me could read!

shilolo's avatar

@Judi. Yes, that interview was well written. I know Joe DeRisi well, and he is doing some remarkable stuff with the Virochip (and other incredible technologies that are the stuff of science fiction). In fact, I use the same robot and computer software he uses for his “chips” to make my own DNA “chips”. Fun stuff.

Jeruba's avatar

@shilolo, can’t you transmit herpes to the genital area if you, uh, kiss somebody there when you have a cold sore? and possibly even for a time either before or after the cold sore becomes visibly active? Isn’t it possible for two faithful partners to contract genital herpes in this way? I remember hearing or reading something to that effect.

La_chica_gomela's avatar

@shilolo – what percentage of the US population is estimated to carry Simplex 1? I could have sworn I remember reading somewhere that it was more than half of the population.

shilolo's avatar

@Jeruba. Yes, you can, though it tends to be rare since HSV-1 (the oral, cold sore virus) prefers to live in the trigeminal ganglion of the face. We make a (somewhat artificial) distinction between HSV-1 and HSV-2, with HSV-1 -> cold sores, and HSV-2 -> genital sores, but there are a significant number of cases of the reverse, that is, HSV-1 -> genital sores and HSV-2 -> oral sores (though this is less common). The good news though is that overall seroprevalence rates for both HSV-1 and HSV-2 are declining.

augustlan's avatar

It’s so nice to have a real, medical doctor on this site. :)

shilolo's avatar

@La_chica_gomela The most recent NHANES study found an HSV-1 seroprevalence of 58% (so, you are right). Likewise, the data for HSV-2 is 17% (almost 1/5th of the US population).

shilolo's avatar

@augustlan Sometimes it feels like I get treated like this here. Ce la vi.

syz's avatar

I’m still stumped that someone so paranoid about herpes would make out with a virtual stranger on the first date.

shilolo's avatar

@syz Lust trumps trust ;-)

andrew's avatar

@alterego Allow me to frame this comically.

Mouth herp is totally different, socially speaking, than genital herpes. Even if you DO find out that you contracted HSV-1, AND you are a visible carrier, then all you need to say when you’re asked “are you clean” is “Yes… Oh, and sometimes I get cold sores” and bulk up on your L-Lysine tablets.

I dated a woman seriously for nearly 3 years who would get active, large, visible cold sores on her mouth. She took L-Lysine every day, she had maybe 4 or 5 outbreaks, but the hardest part was not kissing her when she had a cold sore. I’ve never had a cold sore in my life.

Casual dating is inherently risky—and only you can deal with how you view this girl’s mouth herpes, but it seems (to me) that ultimately you’re blowing this a little out of proportion. I agree with @syz, if you’re that concerned about herp, you need to get a blood test before you hook up.

What I’m trying to say is mouth herp, in the grand scheme of VD, is not the biggest deal. And I think you might need to re-evaluate your risk tolerance before you continue on the casual dating path.

You probably have HPV too, btw.

shilolo's avatar

@andrew Great answer, except, with prevalence rates at ~60% for HSV-1, it is hard to call it a Venereal Disease in the sense that many people are infected from non-sexual casual contact. In the 14–19 age range, seroprevalence is ~40–50%, suggesting that many of these teens are positive (or becoming positive) with minimal sexual contact. Many were likely infected as infants/toddlers/children by their parents and close family members. My point being, the majority of people have HSV-1. It is the minority that are uninfected.

andrew's avatar

@shilolo Yes, I absolutely agree with you. That was meant to read along the lines of “mouth herp, when viewed in the context of other social diseases which you could have gotten, is really not a big deal”.

La_chica_gomela's avatar

@alterego, so there’s a greater than 50% chance you already had it, buddy. just like the rest of us.

lovelace's avatar

Wow! It’s been a while since I got on and a lot’s already been said. However, if you’re not trying to get into a real relationship (marriage) with the young lady, let it go. You’re right! If physical relations is what it’s mostly about for you, you will definitely be miserable. Accepting something like herpes or anything that freaks you out will take some true feelings. These are the feelings that come from real relationships. I think that if you continue to deal with her, you’re going to have to fall in love with her to stay with her and that’s not what you want. Have fun and be free! if that’s what you want to do and require blood tests!

hungryhungryhortence's avatar

@shilolo: Great information to have

@Andrew: I’d be mad as hell if the person I’d directly asked about transmitables gave me an “all clear” response. I’m one of those people who does ask the questions and goes to careful lengths to keep free and clear of STD’s. I refuse to settle into the “social norm” that says just because it’s so damn common that I should not make a big deal about exposure and transmission. Sorry but I’ve lived a long time not to get screwed over by someone’s else’s interpretation of what’s I’ve clearly asked.

andrew's avatar

Right. Mouth herp isn’t an STD—was my point.

shilolo's avatar

Well, some mouth herp can be an STD. You have much to learn young Skywalker….

andrew's avatar

Right.. mouth herp being HSV-1… and some silly guy recently told me “it is hard to call it a Venereal Disease”

shilolo's avatar

@youngskywalker Mouth herp is most likely HSV-1, though some is HSV-2. If you want the graphic details, I would be happy to explain further…. I hear mouth HSV-2 is called “the Paris Flu”. Go figure. :-P

Shegrin's avatar

@shilolo , isn’t it true that humans carry a bit of HSV-1 around with us naturally? like how armadillos have leprosy?

shilolo's avatar

@Shegrin What do you mean by carry it around naturally? Not everyone is infected, but those that are have genetic material of HSV-1 around indefinitely.

Shegrin's avatar

I’ve always heard that humans are born with trace elements of diseases and infections like herpes and other STD’s, as well as e coli and salmonella. I would love to know that it’s not true. My best friend and I argue about it frequently.

shilolo's avatar

@Shegrin You are correct. It isn’t true. What is true is that once colonized, there is a lot more “germ” DNA on/in you than human DNA. We are, in essence, symbiotic organisms with our bacteria, yeast and viruses.

patg7590's avatar

hmm…looking for a concrete answer to what @Jeruba asked previously…

can’t you transmit herpes to the genital area if you, uh, kiss somebody there when you have a cold sore? and possibly even for a time either before or after the cold sore becomes visibly active? Isn’t it possible for two faithful partners to contract genital herpes in this way? I remember hearing or reading something to that effect.

@shilolo said yes, but wasn’t too concerned about it… How plausible it it really?

mclaugh's avatar

i don’t know why people freak out over HSV-1 and HSV-2 that much, but no one freaks out over HPV… HPV is a transmissible disease, just as herpes is and alot of times the carrier is assymptomatic. HPV has no cure and it can lead to all types of cancer…

Response moderated
wallarookiller's avatar

Herpes simplex 1 is so common it’s not even funny. In fact chances are you already have it but haven’t had any symptoms.

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