|Doctor, is this normal?|
Please welcome Dr. Andrea as she tackles her first two questions:
I am a 30something year old woman in an open marriage with a husband and a boyfriend, no other partners for me. My husband and I practice safe intercourse with other partners, but oral sex is unprotected. Both men get cold sores occasionally, I have never had one. To make a long story short, my boyfriend gave me herpes of some kind via oral sex. He had a cold sore, which he says he has been getting since childhood. Three weeks later, I had an outbreak (which at the time I thought was the world's worst yeast infection, but after the second outbreak two weeks later--not nearly as bad--I realized what was going on). I've never had anything dodgy down there except the standard yeast and urinary tract infections, so I was pretty upset. Anyway, I went and got the blood test... It came back as HSV-1 4.7 and HSV-2 3.33--both positive. Sooooo, I was super-double bummed out, because it is my understanding that HSV-2 is a MUCH bigger deal than HSV-1. Anyway, a little googling gave me some hope: a value less than 3.5 gives some realistic chance that its a false positive. Google tells me I should go get a Western Blot to confirm HSV-2, which I plan to do right after I get some health insurance (I went to Planned Parenthood and tried to explain all this but they were befuddled by my question, and claimed the Western Blot is only for HIV, which did not inspire confidence, and I left).
So my questions are: 1) Could he have given me both types of HSV? 2) How big a deal is this if it is HSV1 and the HSV2 was a false positive? What do I have to disclose to future partners? IME, once you disclose crotch rot of any kind, no matter what your excuses, nobody is interested in fucking you. I can't blame them, but if my chance of passing it along without symptoms is like .00001%, then that matters in what I decide to do. Obviously if it is HSV2, I have some problems, because my husband doesn't have it (to our knowledge) and I probably shouldn't be sleeping around if I know I do. I can't envision myself having condom protected sex with my husband for the next 50 years. Neither man has had any lab work done.
Thanks for your opinion!
Dr. Andrea: Thanks for writing in! Let me answer the questions piece by piece:
1. Yes he could have--so could your husband actually--from either oral or any other type of genital contact from themselves (perhaps they've carried the virus forever and didn't know, or had sex with someone recently who had a lesion or was an asymptomatic shedder) [***Oh and an important note for ALL readers: condoms only protect the shaft from touching your skin and mucosa directly but many many herpes outbreak locations are nowhere near the genitalia and are often just on the outside for females so those bits definitely have contact with the partner's skin (for example: labia majora, inner thighs, buttocks and cleft area, top of pubic bone, and of course, in or around the mouth/tongue/nose area)]. Both types of HSV can be asymptomatic, and there are VAST numbers of people that test positive WITH viral shedding but NO symptoms (shedding means the virus is in the skin and sheds bits of itself that if they touch another person may get into their skin and nerves and make themselves at home)... and since they have no idea they pass it on and on and on...
2. With all the oral/regular flip flopping that goes on in our beds, at this point in history it really doesn't seem to matter whether you have HSV1 or HSV2 in normal situations--both can occur in both places. HSV1 seems much worse from a doctor standpoint since it can cause lethal encephalopathy (brain inflammation) especially in people with weakened immune systems, and babies or old people, with lasting damage to the brain. The thing is, most of us are exposed to HSV1 when we're babies since 70+% of humans have the virus and it rarely causes issues in healthy people, unless under stress a 'cold sore' pops up, which might be unattractive, but doesn't seem to freak everyone out quite as much as HSV2. HSV2 can cause a viral meningitis (usually with the first outbreak only) that is usually just a seriously awful headache, neck stiffness, and high fever, but rarely causes any lasting damage. Somewhere around 35% of people may have HSV2 now, although the estimates are all over the place since blood testing catches many people that have been exposed but have fought it off and don't have shedding, OR shed without symptoms, and those that have symptoms often don't seek treatment or tell anyone out of embarrassment etc...
Now for the 3rd question/issue... your chance of passing it without symptoms is low, yes, but larger than 0.00001%. Partially because you shed before and after the lesions are present, so it's hard to know 100%. The risk goes down if you take daily suppressive medication, but still isn't zero. So, yes, you DO need to tell partners. And I would suggest both men and you having total lab work done (including G/C/Chlamydia, syphilis, HCV- much more deadly than HSV, and HIV of course) so you all know where you stand and can make educated decisions about further open-relationship involvements (which means new partners in ya'll's group need to be told--and should really be tested also). I personally think all new partners should do lab work in the interest of honesty and knowledge of risk, especially since not everyone wants to disclose every indiscretion they've ever had and lord knows people like to say things they WISH were true but aren't, especially with touchy subjects like this...
That all said... HSV is NOT the end of the world. It isn't 'crotch rot' per se, in that it doesn't smell bad or cause infertility (that we know of) or for things to fall off (some infections do!). It can be painful, annoying, and it can be embarrassing to discuss. But just like with the 'protection/birth control' discussion, talking about this stuff is NECESSARY and if we're all adults here, we should be able to say the word herpes out loud if we're going to be getting naked with each other anyway. Honestly, SOOOOOO many people have this stuff, it needs to be understood and the shame lifted so we can all protect ourselves better. Two people with different versions of the virus can re-infect each other over and over too, so even if both people have it, daily suppressive therapy (or at the very very least herbal suppression (unproven) and immune system optimization are needed) is the best idea.
Now, for the sensitive part. It may seem upon being diagnosed with this, that the fun free sexual world is over. People can and do end up feeling dirty, perhaps violated if the partner didn't tell them