Oral Herpes

[sparr]

Let's talk about oral herpes, aka "cold sores", specifically Herpes Simplex Virus 1[1], which is the only incurable STD that is commonly transmitted by just kissing someone. Do you have it? If you said "no", you're probably wrong. If you've tested negative recently, you're still probably wrong. Statistics from various sources, including the CDC, place the HSV-1 infection rate among Americans between 50 and 98%.

I've recently found out that I probably have HSV-1. I've probably had it for at least a year. My experience with this discovery has driven me to significant research, and what I find appalls me. That is, I am not particularly angry at the infection rate or lack of a cure or vaccine, since the disease is almost entirely harmless, but at the mistakes in perceived infection rate and behavioral risk among the demographics that make up my social circles. I am angry at my high school sex ed curriculum for leaving me in the dark regarding this particular risk. I am unhappy with a pharmaceutical industry that manages[2] to get me to spend 30 seconds of my leisure time every day trying to avoid thinking about the issue, without imparting any actually useful information on the subject. I am especially angry at people whose unrealistic expectations shade their opinions of others[3].

When I found out, I notified every girl I have kissed with an open mouth. My sexual history, if you would call it that, only goes back a couple of years, so the list was mercifully short. Thanks to their frank responses, I now know that at least half of them already have it, and had it when we were together. Only one of them saw fit to tell me at the time, but I don't blame the others at all. How often do you ask someone about STDs before getting to first base[4][5]? I am now stating my status[6] before going that far with someone, as a matter of course. I have had no undesirable results from this practice so far, and recent experience has taught me that encountering a negative reaction at that point would probably be a good early indicator of problems anyway.

So, on to the point of this post, if informing my friends wasn't point enough... What do you think? If you think you don't have it, why do you think that? I'll remind you again that you're probably wrong. Are common social customs and assumptions/expectations with regard to STDs hypocritical[7] or unrealistic[8]? Is this post going to cause you to change anything about your sexual behavior, or at least think on the subject more often? Have you learned anything from it other than how verbose I am?

I hope some of you come away from this post, or the ensuing comment threads, better off in some way, even if that way is only knowing not to kiss me in the future.


[1] HSV-1 very rarely presents as genital sores, and HSV-2 rarely presents as oral sores.
[2] I haven't watched TV with commercials for more than an hour since the late 90s, but the concept of drug commercials is still common enough for this to be accurate in a more general sense.
[3] 10% of women with a single lifelong sexual partner have HSV-1, but of course having an STD means you must be a slut.
[4] If you do so more often because of this post, it will have served a purpose.
[5] I usually skip first and spend more time at second and third, for various reasons. Ignoring my specific case, this seems like a sound plan, in terms of STD avoidance.
[6] I am not certain that I have it. I haven't received my test results yet, and even then the false negative rate for HSV-1 is astonishing (50% or higher), especially in asymptomatic patients. But it seems safe to assume that I do, given my known exposure and the average infection rate. Even if I really don't have it, with 99% certainty I will have it within the next few years, despite falling in the bottom 10% of my acquaintances in terms of promiscuity.
[7] That is, do you apply the golden rule to STD information and risk?
[8] Expecting everyone to volunteer their STD status is unrealistic, both because no one actually knows their immediate status (at best, they know their status a few weeks or hours ago, depending on the STD), and because if it happened then STDs would (mostly) have already stopped spreading, except among people who consider the rewards worth the risk. Expecting everyone to answer honestly may be unrealistic, depending on how honest you think people are.

Cross posted to Livejournal, Facebook, and Fetlife.

Comments

[gailmom.livejournal.com]

I do routinely check std status, and share mine, along with how often tested etc before going to first base. I have been known to be casual about it (ie, not get into DETAILED conversation before close mouthed kissing) but I do check and share before exchanging spit.

No, I don't think I have it. Because of communication, because of testing, because I've never had a symptom.

I presume risk in everything I do. There is no risk free activity. It is always a question of risk vs reward. And no, this post won't cause me to change any of my behaviors or to think on teh subject more often. I think on the subject plenty, thanks.

[sparr0.livejournal.com]

Good to hear!

[cos]

Oral HSV-1 is generally not considered an STD because, as you said, it's usually not sexually transmitted*. The general assumption is, I think, that most everyone else already has it. So the typical case is, you don't know whether you have it or not, but assume you likely do, and assume the person you're going to kiss likely does as well, and that they don't know for sure either. But it doesn't carry the stigma of an STD, and it's fairly harmless. Combine all these things, and it's no surprise that people don't make a point of asking or telling about it.

Note that your note #1 is somewhat misleading. Either HSV-1 or HSV-2 can infect either site (oral or genital). Either one of them will *only* cause sores on the site it infected. So, an oral HSV-1 infection will *never* cause genital sores (nor will an oral HSV-2 infection). The more accurate thing to say is that HSV-1 prefers to infect orally, and HSV-2 prefers to infect genitally - that is, each one of them is more likely to transmit when in contact with its preferred site, than its non-preferred site.

Also, it's believed that a significant percentage of the population get oral HSV-1 from their parents.

* Edit: That's not universally true. If someone has genital HSV-1 (unusual) and you give them head, and you don't already have oral HSV-1 (also possibly unusual), then you could get it that way. So it may in some cases be sexually transmitted, but that accounts for a very small percentage. Regardless of that small possibility, people still don't think of cold sores as an STD, and it doesn't carry STD stigma. It's also possible to transmit the other way, but having an HSV-1 infection gives you significant immunity against getting another one, so most people - who already have oral HSV-1 - have resistance against getting a genital HSV-1 infection. (it's not 100% resistance, so infection is still possible, so bringing up the topic before you have unprotected oral sex is a good idea)

[sparr0.livejournal.com]

s/people/reasonable, informed people/

Part of my impetus for prompting this discussion was a very bad breakup caused by my (probably) giving HSV-1 to a partner.

[attilia-auborne.livejournal.com]

Eww, I am sorry Sparr that sucks. That person doesn't deserve you.

[vvalkyri.livejournal.com]

That all said, while HSV1 prefers to infect orally, it does infect genitally and can (not usually but can and does) be pretty devastating in that case.

I can think of several stories over the years where an HSV1 genital infection was anything other than 'no big deal,' and caused long time problems.

Need to get to work...

[cos]

That's why I added the edit. However, it cannot infect genitally from kissing.

[vvalkyri.livejournal.com]

Yes, this is true. Few people use barriers for oral sex, though, and especially not for cunnilingus. HSV1 is no longer particularly unusual as a genital infection.

[vvalkyri.livejournal.com]

Oh, didn't see the edit - was replying to a tracked comment. Yeah the concern is more on receiving oral sex.

[ilahni.livejournal.com]

I have never had cold sores or any sort of painful, itchy or strongly suspicious symptoms, but I figure that it's likely most people have oral herpes and that I am among that population. I look at this kindof like I looked at HPV, which I also figure I had since I have had abnormal cells on my cervix. At first I was angry at someone for giving it to me, but I got over it quickly and realized that most people likely don't know. With modern health care, most STDs are treatable or manageable, depending on the symptoms and the person. For me the abnormal cell removal was relatively hellish but since then I've had no symptoms or problems. Also, given the false negative rate for herpes testing, though I've never had positive tests for 1 or 2, one can never really be sure. One person I have wanted to play with informed me before anything began that their partner has HSV-2, and asked if I was ok with that. It caused me to have a long, long discussion with myself, others, the people in question, and ask myself what matters to me and weigh the options. Also, multiple others that I know have HSV-2 and some didn't know until years after the infection, despite negative testing. For some, the tests worked and they had symptoms. Symptoms may have been as minor as what seemed to be an ingrown hair, if at all, so it's hard to determine just how symptomatic anyone is at any given time or where they may or may not be shedding a virus.

I must say that at first I was very worried about any contact with anyone that had even peripheral chance of having HSV-2 and to a lesser degree, HSV-1. I was also uninformed and had that general fear of infection well up in me.

However, I had already made partner notification about HPV a regular part of any meeting with a potential lover, and I've only had one person get pissed off (after I told them I had it, they said ok that it didn't matter at all, then got angry at me later for a bump that they said was my fault). Thankfully, out of my life now.

Anywho, I practice full disclosure, and it happens before any genital contact, any oral/genital contact, and often before kissing but I haven't always been 100% though now, yes. It's become easier the more I share the knowledge, and it has actually opened up more opportunities because then the person has been more comfortable being honest with me once they realize that I am not going to view them as a lesser person. I've found that there's always the possibility someone has something transmissable, and if I'm going to play with someone, there's always a chance that I may be infected. But it's a level of mental comfort I have come to with myself, and not everyone has that. That doesn't mean I have indiscriminate sex, quite the opposite, but rather that I choose not to judge someone solely on the fact that they may or may not have an STD, as they likely do even if they say they don't. Also, I am more than willing to get retested and provide the lab results to any partner that requests, and go with them if they want to get tested together. Hooray for protection...of course it not being super effective is suckass. I often have been known to use lab gloves when playing someone, and it's never been a problem. And given that I do some naturally dangerous play, I generally use medical sterilization methods with my toys or confine their use to specific people.

Anywho, if I can't talk honestly with a person in the beginning, I don't find any relationship with them worth pursuing. Through my own research, I have become more comfortable with the fact that herpes is likely in any given person and it's not my goal to make anyone uncomfortable at all. I'm glad that you are being honest and open and getting as many facts as you can.