Monday, August 25, 2008

Those Three Magic Words...

So your partnter has told you those three words... no, not "I love you" - not yet, anyway.

They have said "I have herpes."

What now? Well, good news - it's probably not nearly the unpleasant or scary scenario you're thinking of.

Let's say the scenario is a woman telling you she has it:

A quarter of all women you sleep with are carriers of HSV-2, whether they share that with you or not. Most are asymptomatic and therefore go undiagnosed, as herpes is NOT included in standard panel STD testing. If someone is telling you that she has HSV-2, it actually means that she is less likely to spread it to you, since she will be on the lookout for mild symptoms that those who are undiagnosed may miss. It also means that she may be likely to be using daily valtrex or other antiviral medication, and/or condoms to further lower your risk.

The official studies done by Valtrex show that per year of regular sex, the average female to male transmission rates are extremely low, even without using condoms or medication. (which doesn't really help their cause!) Here are the stats:

If ONLY avoiding sex during signs of an outbreak: 4% chance of transmission per year of regular sex
If ALSO using condoms OR daily antivirals: 2%
If using condoms AND daily antivirals: 1%

So, if using all three precautions, there is a 99% chance per year that the virus won't be transmitted! And if the meds and condoms aren't preferable, a 96% chance ain't too shabby either.

For ladies being told that their man has genital herpes, all the same info applies, except the transmission rates are about double. That means you can get your yearly risk of contracting HSV-2 from him down to 2% at the lowest. Also pretty darn low.

And if you're thinking that a lifetime of condoms or dental dams during oral sex is unappealing... those precautions are actually pretty unnecessary. HSV-2 does not prefer to live in the oral area, and there are very few cases of HSV-2 being transmitted that way. When it does manage to happen, the chance it would ever recur is slim to none. Not something worth worrying about in a relationship.

You may also want to ask your partner if she or he has had a type specific diagnosis. It is possible that their genital infection is actually HSV-1 (the extremely common cold sore virus), in which case the chances he or she would ever transmit it, orally OR genitally, is almost zero, even if you are in the minority of people not already infected with HSV-1. My blog has lots of postings about genital HSV-1 if you're looking for more info on that.

I hope this posting helps someone out there who is looking for answers. Genital herpes truly does not have to stand in the way of a relationship. For thousands upon thousands of happy and enlightened couples in the year 2008, it is entirely a non-issue.

Sunday, August 17, 2008

Misinformation.

Sadly, misinformation is rampant when it comes to herpes. Many otherwise credible people are just not updated on herpes, I guess because it tends to be a taboo topic. A stigma. So it's another case where ignorance is bliss, even amongst doctors. And now The New York Times, who have recently published a comprehensive overview about genital herpes on their website which, sadly, is absolutely chock full of misinformation. Shouldn't this be illegal?

I'm going to clarify some of the misinformation in the article here on my blog, although I wish there was a way I could edit their site. It makes me sad that when newly diagnosed people, or those who have a new love interest diagnosed with it, go to google this virus, they will find lies on otherwise credible websites.

Women have an 80 - 90% chance of contracting HSV-2 after unprotected sexual activity with an infected partner and are 4 times more likely to be infected than men.

This is only referring to a partner who is having an active, obvious outbreak. What person in their right mind would engage in sex with someone who has open sores on their genitals? Why isn't it mentioned that there is only a 8% chance PER YEAR that a woman will become infected if she just avoids sex during outbreaks? Those odds are lowered to 4% if a condom is used OR if the man is on daily suppresive meds, and down to 2% of both of those precautions are taken. Again, that's PER YEAR. a very, very small risk. (And those numbers are halved when talking about female to male transmission!)

Shedding of genital HSV-1 is less common than with HSV-2, but transmission obviously still occurs, as evidenced by the rising prevalence of genital HSV-1.

Grrr. Actually, genital HSV-1 is almost always transmitted via someone's oral cold sores. The source of GHSV-1 is VERY RARELY another person with GHSV-1. I know it would be easily assumed that the cause of GHSV-1 is GHSV1, especially when the New York Times is assuming such, but it's not. It's cold sores.

Pregnant women who are infected with either herpes simplex virus 2 (HSV-2) or herpes simplex virus 1 (HSV-1) genital herpes have a higher risk for miscarriage, premature labor, retarded fetal growth, or transmission of the herpes infection to the infant while in the uterus or at the time of delivery.

It would have been nice to mention that neonatal herpes is EXTREMELY RARE. It is almost always caused by a brand new infection - in other words, if you are 9 months pregnant and JUST contracted genital herpes. If you already have it, the only risk is if you happen to be having an outbreak at the time of delivery. This can be almost 100% prevented from happening with medication. But if it still does, a C-section would prevent transmission from occuring. Therefore, the only herpes threat to a baby would be an incredibly stupid doctor who is ignoring a blatant herpes outbreak. Since a quarter of all women carry genital HSV-2 and many others carry genital HSV-1, and women are not even TESTED for it when pregnant, it is safe to say that this is not much of a concern.

Not least among the damaging effects of genital herpes is its impact on the social and emotional life of patients. In one survey of patients with herpes, 82% felt depressed, and 75% were worried about rejection. Over 25% had suicidal thoughts. In nearly 80% of the respondents, the disease had a profound effect on their sexual lives. The patient must notify sexual partners, past and present, about their condition, a deeply humiliating experience. Guilt and anger are common emotions, and relationships may be shattered.

Does this article somehow know better than those with herpes do as to how they should be feeling? The statistics which are quoted here are most likely from a group of very recently diagnosed people, who are still uneducated, fearful, and buying into the irrational stigma. But once one gets educated and sees firsthand how little this will affect their lives, the reality is not nearly as harsh as is being painted here. It is also wrong to assume that it is "deeply humiliating" to tell others. Personal, and possibly a little embarassing, sure. But having genital herpes means that you share the same virus as 25% of the population. It also means you have had sex at least once in your life. What is humiliating about that?

The bottom line is that when it comes to herpes, we must cut through a lot of bullcrap to get to the truth. People say "talk to your doctor" when it comes to medical matters. Unfortuantely, my doctors gave me so much misinformation about herpes, I don't even know where to begin. One told me you can't get it if you used a condom, another claimed that only 1 in 10,000 cases of genital herpes are type 1, and a third stated that since I have type 1 genitally, it will travel up and "disappear." And these are DOCTORS specifically trained in sexual health!

So, sure, you can talk to your doctor about herpes, but understand that many were last educated about it over 20 years ago, when less was known. Even those who were recently educated might have only gotten a brief textbook lesson on it. (Including relative who recently finished nursing school, actually gets cold sores, and had no idea that they could be transmitted to others genitally.) Do not take their word as the bottom line. And do not take what you hear from friends or read on the internet as the bottom line, because many of them are relying on inaccurate and outdated sources.

If you are newly diagnosed with genital herpes or just looking for ACCURATE information, I highly recommend:
http://www.westoverheights.com/freebook.html
www.racoon.com
www.herpesdiagnosis.com
www.ashastd.org

Friday, August 15, 2008

An "innocent childhood infection," or an STD?

Isn't it funny how "diseases" are defined by how they are aquired ONLY in the case of those sexually transmitted?

HSV1 (more commonly known as the cold sore virus) becomes an STD ONLY if one is infected with it genitally. (Meaning that one managed to be extra cautious or lucky, and avoided getting cold sores for their entire life - which made them susceptible to getting type 1 genitally as an adult. How ironic.)

Another thing that bugs me - why does it suddenly become a "disease" once transmitted genitally? I have never heard anyone refer to someone with cold sores as having a disease. And cold sores are the same exact virus, but recur much more frequently and are way more contageous than is someone with an HSV1 genital infection.

So why is it being defined simply on how it was transmitted, but only when it was done so sexually? When orally transmitted, we don't call it a KTD (kissing transmitted disease.) I know a small number of people also get it orally from sharing forks and cups and whatnot, but the majority get it from kissing, even if it's an aunt's innocent peck.

We don't call malaria or lyme disease ITDs (insect transmitted disease) or typhoid fever a FTD (feces transmitted disease.)

But we do need to forever label those who happened to aquire a common infection during, god forbid, a sexual scenario - no matter how "innocent" that scenario was, including between husband and wife?

I'm not buying into it.

Tuesday, August 12, 2008

Posting revised

I completely edited the earlier posting Type 1 - To Tell or Not to Tell?
based on some new conversations I have had and knowledge I have gained. Let me know what you think.

Saturday, August 9, 2008

Wake up call - Cold sores are sexually transmittable.

If you get cold sores on your mouth from time to time, chances are that at some point in your life, someone has mentioned to you that cold sores are actually herpes. They probably reassured you that, no, not that kind of herpes. You may have been led to believe that genital herpes are totally different, and are type 2 herpes, while cold sores are type 1.

While it is true that a case of genital herpes is commonly type 2, especially if the outbreaks are recurrent, a genital herpes outbreak can also be caused by type 1, a.k.a. the common cold sore virus. It is transmitted from the mouth of the person who gets cold sores, to the genitals of the person they give oral sex to.

For some reason, people are not being told that cold sores are sexually transmittable, not even by their doctors.

Cold sores are in their own category as far as STDs go, because they are not an STD, but they do have the potential to become one for someone else. This can happen even if the person giving oral sex is not having a cold sore at the time. (Herpes is a virus and can be contageous even when you're not having symptoms. Most people who have type 1 orally are contageous about 18% of the time.)

The majority of the population already has type 1 orally and is almost 100% immune to getting it on their genitals. This is because their body already hosts the virus, and has produced antibodies against it throughout the entire body. Most people are exposed during childhood, by relatives or by another child.

But the minority of the population who somehow manages to escape childhood without being exposed to this pesky virus have the potential to get type 1 orally or genitally as an adult.

Just because you have never gotten a cold sore, it does not mean that you don't already have type 1 orally. For some people, the virus just goes dormant and never causes a sore - you may have it and never even get a cold sore in your life. For others, it continually reactivates and causes sores on the mouth, especially after getting too much sun or when you have a cold or fever (hence the terms "cold sore" and "fever blister.")

For those infected genitally, most get an initial or primary genital outbreak soon after exposure, which may resemble a classic type 2 outbreak. But luckily, after that, most will never get another recurrence. The virus will go dormant and stay dormant, because type 1's home territory is the mouth. While type 1 can infect the genital area, it does not prefer to live there. (Despite that, some will get a recurrence about once every two years on average, while an unlucky few will get regular recurrences more similar to a pattern of type 2 herpes.)

The source of a genital type 1 herpes infection is almost always a person who gets cold sores on their mouth. Very rarely is the source someone else who has it genitally, since they are only contageous 0-5% of the time.

More than half of the population has type 1 herpes. It is estimated that more like three quarters of people have it by adulthood. And by age 50, a whoppping 90% have it.

So, if you get tpye 1 herpes genitally (GHSV1), you may feel that you are somehow dirty or tainted. The reality is, you are actually much less contageous than the majority of the population!

While people who get GHSV1 fret and freak out and worry about passing this virus on, those with cold sores usually carry on without a second thought. But they are actually the ones with a much higher potential to give someone an STD.

Even those who are aware of this usually remain too embarassed to bring it up to a new sexual partner.

So what the heck is the solution? If you have type 1 orally, you can't live in fear of giving oral sex. If you are type 1 negative, you can't live in fear of recieving oral sex. Most people are unwilling to use dental dams or condoms for oral sex, so it's a risk we take. If it happens to you, luckily GHSV1 is usually not recurrent, and is not highly contageous. So for many, it can be initially traumatic, but then becomes a non-issue.

It is no one's responsibility but your own to know about the risks and educate yourself about type 1 herpes. Understand that most people are not educated about it, so you need to be your own advocate. Consider having a talk about type 1 herpes with your partner, whether you have it orally, genitally, or not at all. Cringeworthy, but the right thing is not always the easiest thing.