When do you tell someone you've got oral herpes?

August 10, 2009 8:16 PM

When do you tell someone you have HSV1?

So I used to think this was an easy question and now I’m not really sure.

Basically about four years ago I got diagnosed with oral herpes, HSV1. I’d never had a symptom. Never had one fever blister. Nothing. But a partner said she’d tested positive for oral herpes and that I needed to get tested. I’d been tested six months prior (I have great coverage and get tested for everything every twice a year) and had nothing. Now I was positive for it and I went to a specialist.

So for the next two months I went to an immunologist who had me on valtrex because he was having a hard time telling whether I was also positive for HSV2 or whether it was just a cross reactive thing. At the end of two months they figured that something else I was on was interfering with the test. They took me off and there was no more cross reactivity. I was positive for HSV1 but not HSV2. I asked if this meant I should change the dosage on the valtrex.

The doc said that I should stop taking it.

My specialist said with HSV1 it was no big deal and not worth the prescription. I went to my GP for a second opinion. Is this something you disclose to a partner? His opinion was even more cavalier than the immunologist. More people have it than don’t. It’s no big deal. His only admonitions were about condom use.

So I went about my life. I dated. I had a few relationships. And at some point I ended up with a girl who was a virgin (and for what it’s worth, it was something I didn’t know about till afterwards). We had regular sex with condoms and I performed oral sex on her without any protection

I’m pretty sure you can see where this is going.

Eight months down the road she’s sick for a week. She doesn’t call me. And when she finally comes over she says “you gave me herpes.”

Apparently she got it when I was shedding the virus and didn’t know it. And going down on her did an oral to genital transmission. I was her very first sex partner and I’d basically scarred her for life. We broke up and it shook me for a while. It shook me pretty hard.

I only really started not feeling guilty everyday when I saw on facebook a few months back that she’s happy in a relationship now and seems to be doing okay.

But immediately after, I ended up going back to an ex who I knew had HSV1 and I think I stayed with her for the next six months as a default position just to not have to face dating other people and trying to figure out how to deal with this. Unfortunately we were just as wrong for each other the second time and broke up again. And now, after a respectable distance, I’m ready to date again.

Only I’m not sure what the protocol is here. When is a good time to tell someone this? After the first date? Before the first kiss? Before sex? Do I stop performing oral sex? Am I overreacting? I don’t know how to go forward her and I’d like some advice.

posted by anonymous to health & fitness (25 answers total)

I think the big problem is not just telling people but having to educate them. If you tell someone you have oral herpes, they will probably not think it's that big of a deal if there's no cold sore present, and they may have no idea that they can contract a genital infection from it. Is it your place to make sure they are thoroughly educated about the risks, or to simply disclose?

The situation was probably as scarring for you as it was for your ex, and I'm glad you're starting to get over it a little bit. I think you should definitely tell people before you have sex with them, but as for kissing and incidental stuff, I wouldn't go overboard if I were you. Recently I refilled a woman's water glass at a restaurant and she immediately told me that she had HSV1 and that if I touched her glass, I should go wash my hands immediately. Her husband and kids didn't bat an eye, apparently this is everyday behavior for her (and no, she didn't have any visible sores or anything). I think you can probably strike a better balance than she did.
posted by hermitosis at 8:25 PM on August 10, 2009

Before the kiss. Maybe a kiss is an acceptable risk. Maybe it's not. But evaluating what is an acceptable risk is not your choice, it's the choice of the person you're kissing.

Which sucks for you. But better to lose out on kisses than go through the guilt and remorse you'll feel, and bad life choices you'll make ("I stayed with her for the next six months as a default position just to not have to face dating other people and trying to figure out how to deal with this") if you again inadvertently infect a partner with an incurable disease.
posted by orthogonality at 8:33 PM on August 10, 2009

If you have sex with someone, you have a responsibility to disclose any and all potential sexually transmitted diseases they may incur.

It sucks so much. It is the shittiest thing in the world. But oftentimes, honesty earns a deeper and more awesome relationship than anything else. If we all just told each other the truth, then maybe things could get back to normal, maybe we could start treating std's like we treat every other sickness.
posted by Baby_Balrog at 8:33 PM on August 10, 2009 [1 favorite]

What a horror story - I'm so sorry that this happened to you. My Peer Health Educator days are over a decade behind me, but back then they told us (to tell our peers at sexy and fun dormitory workshops!) that you should assume that everyone has HSV1 because not only do most adults have it, most children have it (because kids are filthy and mouth everything and it's a terrifically common virus). I wouldn't worry at all about kissing, and if you let a girl know before going down on her that you have had cold sores in the past and could possibly be sheddding (explain the whole deal, the fact that "cold sore" is a euphemism, that fact that the oral herpes virus can be transmitted to the genitals, etc.) you might come off as being a bit hyper-alert on the health front... but you will have satisfied your moral obligation and can carry on with the cunnilingus with a clear conscience.
posted by moxiedoll at 8:36 PM on August 10, 2009

Before you kiss.

I'm not sure why the doctor told you to get off Valtrex--it works against both types of herpes. The problem is the literature surrounding herpes is a lot like the literature surrounding HPV. The disease itself isn't fully understood, transmission and infection rates aren't predictable or consistent between studies, it's difficult to tell if someone is "active" or not or infected or not (the blood tests don't give the full picture), and literature on prevention and severity of infection range from "This is the worst STD ever next to AIDS, ever" and "Everybody has it and it's totally not a problem so chillax, dude!"

The truth, of course, is somewhere in the middle. Because some people can have it and for whatever reason never transmit it to their partners, and others will transmit it to their partners but their partners won't have an outbreak, and some will transmit it and their partners will have an outbreak. And because for so long doctors thought only one type of herpes occurred orally and only one type occurred genitally--which we now know to not be the case--that adds extra confusion to transmission rates.

You are in the unfortunate position of being caught in all of this confusion, with doctors telling you to chillax, but you giving your partners terrible outbreaks, and never having an outbreak yourself.

I think the safest thing to do is go on the Valtrex, and tell your partners before you kiss. It is a terribly shitty road to take but it is the high road.

Also--Ken Dahl has written a great comic series called Monsters about his own contraction of herpes and how he deal with transmitting it to partners and disclosure and shame and whatnot. You can get it here or here and possibly other places, those are just the first few Google results. Warning, he's only through issue #3 so things are still pretty depressing. But what I read in the comics echoes a lot of the same things you're going through so it may be comforting in a way.
posted by schroedinger at 8:47 PM on August 10, 2009 [1 favorite]

As someone who quite possibly doesn't have it, since I've gone 30+ years with nary a cold sore, I would like to speak for the uninfected minority and say that "assume everyone has it" and "don't worry about kissing" is pretty poor advice (sorry, moxiedoll). Assuming I am not infected, I would very much like a fighting chance at staying that way. Or, at least, I would like to make an informed risk/benefit analysis re: your awesomeness before I snog you. It doesn't have to be a huge thing-- you're talking about HSV1, not OMGSYPHILLISGONORRHEAAIDS!!! -- but informed consent is totally 100% the way to go.

FWIW, if you were conscientious enough to have that conversation with me, I would think "wow, what a caring guy," not " wow, what an overprotective freak." And then we could set boundaries together on what is appropriate re: oral sex, etc. Again, yay for informed consent.
posted by somanyamys at 9:32 PM on August 10, 2009 [11 favorites]

Definitely tell them before there's any possibility of mouth-to-genital contact. Personally, I tend to think it's optimal for both partners to get a basic slate of STD tests before any mouth-to-genital or genital-to-genital contact.

However, I don't think it's necessary to tell them before kissing. I think we, as a society, have decided not to be too worried about oral transmission of HSV1. Otherwise, we would expect every responsible teenager to get tested for HSV1 before their first kiss--before even sharing a Coke with a friend--because odds are 50% of them are already infected. If you want to go above and beyond the call of duty, or if your partner seems especially worried about disease, then disclose before locking lips. But it doesn't seem reasonable to expect that, given that your prospective partner is just as likely to get infected the next week by sharing a slice of cheesecake with a couple of her best friends.
posted by fermion at 10:17 PM on August 10, 2009

I think we, as a society, have decided not to be too worried about oral transmission of HSV1

"We", white man? Like somanyamys, I don't have HSV1 or HSV2, and I pay extra money (about $200) to periodically get that re-confirmed with separate antigen-specific assays. (I do this because I have a horror of inadvertently giving an STD to a partner.)

Which I note the OP also did: "I’d been tested six months prior [to being told he might have been infected] (I have great coverage and get tested for everything every twice a year) and had nothing."

You may not be worried about oral-oral transmission, and that's cool for you. But my body, my choice. Please don't make that choice for me.
posted by orthogonality at 11:25 PM on August 10, 2009 [5 favorites]

Just a reminder that the OP is asking "when", not "if".

Definitely before oral contact. But I wouldn't do it right I off the bat. If there is going to be a kiss at the end of the first date, I would look for a time where you are sharing personal information that is of a more intimate nature. But if there is no kiss, I would wait for the second date. That way it won't seem as overwhelming.
posted by Vaike at 11:59 PM on August 10, 2009

You're getting a huge amount of incorrect information here.

• By the time we're adults half of us have HSV1; by the time we're in our 30s it's already 70%.
• You probably got HSV1 as a child or infant. You lick a toy that's already been licked; a kid touches another kid's mouth that has spittle on it and then touches their own. You had one primary outbreak when you were tiny and have never had one since, just like most people.
• Most herpes infections occur when you are ASYMPTOMATIC--with HSV1 or HSV2. Meaning you don't have any sores. You're still shedding virus.
• My limited reading on the subject suggests there's definitely less evidence for Valtrex for HSV-1 transmissions, most of the data is on HSV-2.

posted by gramcracker at 2:03 AM on August 11, 2009 [1 favorite]

This sounds like a total nightmare.

On the one hand you've got a really common minor disease which the majority of people over 30 share yet don't know about.

On the other hand you obviously don't want to spread it to anybody else that doesn't have it.

It's got to be a bit of a mood killer though explaining you have herpes before even going for a kiss... and when you consider that people kiss strangers in nightclubs all the time.

I don't have to much advice apart from I feel for you! Hope it works out.
posted by aTrumpetandaDream at 2:53 AM on August 11, 2009

there's no way u have an obligation, as some have implied.
there's no way u need to tell ppl about it before u kiss.
i cant agree that it has the same weight as a life threatening std, and it is your choice.
just the same as u dont tell ppl you have a cold probably, unless they ask you after u cough.
the way i see it, if u care about someone, you would probably discuss it with them.
simple as that.
posted by edtut at 4:09 AM on August 11, 2009

Oh geeze.

Another non-infected person chiming in to say that I'd want to be told before the kiss. If you aren't brave enough to do that, you'd better tell future partners before oral sex.
posted by PhoBWanKenobi at 4:58 AM on August 11, 2009 [1 favorite]

just the same as u dont tell ppl you have a cold probably, unless they ask you after u cough.

Also, you should tell make-out partners if you have a cold, too.
posted by PhoBWanKenobi at 4:59 AM on August 11, 2009

Just for the record, are you sure you gave her genital herpes? Might you have given her oral herpes? I'm just wondering. And might she have already had it and it just had an outbreak at an inconvenient time?

For the "definitely disclose" people, I'm wondering this: if 70% of people over 30 have oral herpes, are you getting confessions from 70% of your kissing partners that they have it? After working in a doctor's office for many years, I can tell you that people getting tested for Herpes is exceedingly rare, so the percentage of people who know they are asymptomatic carriers is very small. Do you ever share a glass with someone? Do you ask them then?
posted by sully75 at 5:18 AM on August 11, 2009

I have, and have had for my entire life, HSV-1. I got it as a child, probably from sharing a glass with my dad. My mom, who's been married to the guy for 40 years or so, has never had a single sore that I've seen my entire life. I might be a terrible person but I can't think that I ever told anyone I had cold sores as a prelude to a sexual encounter; of course, you also can't exactly hide it when it's happening. And I never thought of it as like, OMFG HERPES, since basically everyone has it. I do live in terror of giving myself ocular herpes (cold sores+contacts=terror).

What happened between you and her was a horrific accident of epic bad luck, and there kind of is not any good answer here. No matter what you do it will be odd and unsexy, and some people will freak out because OMG THEY DO NOT HAVE THAT!! When, in fact, they do and they do not know it. And, most people are not going to include the idea that they do or do not have HSV-1 when they say they have a clear STD screen. My GYN did not include that when she gave me my last screen years ago before I got married. I am not under the impression that this was an abnormal way to proceed.

The best thing you can do is learn what triggers you to start getting them, and stay off of that kind of food or try to find an antidote for that sort of stress in your life. I don't know about you but I can tell when one is coming on and I start Lysine bombing, which, I don't know, people argue about whether it really works, but I can stave off the issue when I do that, so it's worth trying, IMHO. If you aren't about to break out, then I dont know what to tell you. The Mayo Clinic does not say you should feel like you need to openly communicate about your Cold Sore Status; you can compare and contrast this to their advice on what most people refer to as actual Herpes.
posted by Medieval Maven at 5:42 AM on August 11, 2009 [1 favorite]

I've gotten occasional cold sores since I was a small child (presumably HSV-1, but I've never bothered to get it tested). The closest anyone has ever come to asking me about it is the "so, anything I should know about?" conversation right before sex. I've always mentioned it, and no one has ever cared. My sense is that the vast majority of people already have oral herpes and don't think of it as something that needs to be mentioned in connection with sexual health. Whether that's right or wrong, I don't know, but I do think you are making more of this than 99% of the people who get cold sores once in a while.
posted by Forktine at 6:11 AM on August 11, 2009

comment from someone who would prefer to remain anonymous.

"Your post could have been written by my ex-boyfriend. I am that girl who got HSV-1 on her genitals, from oral sex, the very first time. I've given this issue a lot of thought, both as someone who's still not sure if she should be mad about it, and as a someone who has HSV-1 and worries about when to tell potential partners.

In my case, my ex and I suffered from a huge lack of information -- he didn't know that he had HSV, and I didn't know that I didn't. You, unfortunately, don't have the luxury of getting to claim ignorance.

The way I see it, as others have posted already, tons of people have oral HSV infections. Most people, in fact. The stigma associated with a cold sore is minute. Besides the fear of spreading the infection, the health implications are equally minor. There are over the counter drugs for treating oral herpes. People don't like to seem to talk about it anymore than they like discussing genital herpes, but in my opinion and my experience, our society treats genital herpes as a Serious Condition and oral herpes as a given. (For reasons I don't understand, all of the friends I've told about my HSV status are relieved to hear that it's HSV-1... as though being associated with oral herpes makes my condition less awful)

What I'm trying to say is, kiss away. Fuck, practically everyone has oral herpes. Get back on Valtrex because it's a relatively cheap way to buy yourself some piece of mind (it will decrease likelihood of transmission), but I don't see any compelling reason to inform someone before a kiss besides the fact that you've had exceptionally bad luck.

That said, you absolutely must inform your partner before performing unprotected oral sex on them. Not only must you inform, you must educate, because most people don't know that you can get genital herpes from someone with oral herpes, or that you can get it even when your partner doesn't have any active sores. Explain the options: unprotected oral sex with the risk of genital herpes, dental dams, both of you going on Valtrex, etc. If it's someone you intend to be with for the semi-long-term, you both should go get typed blood tests to confirm each of your HSV statuses and make more informed decisions. And until you've done that, just don't go down on her."

posted by jessamyn at 6:15 AM on August 11, 2009 [1 favorite]

For the "definitely disclose" people, I'm wondering this: if 70% of people over 30 have oral herpes, are you getting confessions from 70% of your kissing partners that they have it?

I have a good friend who dated someone who had oral herpes, who warned him before they kissed. It wasn't a problem at all.

Later, though, he had a casual partner perform anilingus on him without informing him that they had oral herpes, and he didn't know about it until he had an outbreak there. Which was a problem.

The fact that the majority of people don't say anything doesn't make the majority of people right.
posted by PhoBWanKenobi at 7:05 AM on August 11, 2009 [2 favorites]

I'm gonna chime in as another uninfected person who would want to know before kissing. I figure if I risk unprotected sex then - since I know better - I have to accept at least some responsibility for anything I get (this doesn't lessen the responsibility of the infected party to disclose if they know they have something, of course; I might be an idiot if I risked it, but the other party would be a ratbag of a different kind for denying me my choice). Kissing, however, there's no way to do in a protected manner. And, maybe it's just me, but while I've seen plenty of material warning people how to protect themselves from herpes when under the banner of "STD", but of oral-to-oral transmission there's less education, which makes it entirely likely someone with their sights on kissing an infected person lacks the knowledge to even consider whether doing so is going to land them a virus that's going to impact on their sex lives forever. To me that makes it more important for the more knowledgeable party to disclose at this point.

That's me, anyway; I couldn't hold myself in very high esteem if I did anything less.

I don't envy you your position: it's a shit one, and, worse, it's clear from your anguish over all this that your own, very admirable, desire to do the right thing is going to make this more difficult on you than for anyone who think it doesn't matter. That sucks. FWIW, if anything, I'd respect someone more who disclosed pre-kissing. Yeah, I might hold back on the kissing a short while, while things were too early to tell, but if I liked the person enough I bet it would become something I'd be willing to negotiate. Someone just kissing me and hoping they get away with not telling me, though, is someone I wouldn't be forgiving. Lies and lack of consideration are a bad start to a relationship. imho.
posted by springbound at 7:42 AM on August 11, 2009

fuck herpes, seriously. i hope it catches herpes.

Valtrex is slated to go generic this year, meaning it should be far easier for those who need it daily to stay on it. for most with HSV1, in both locations, daily dosage should all but eliminate outbreaks as long as you stay on it. and, as has been mentioned, it also significantly lowers the probability of transmission especially during asymptomatic shedding. it's one thing to be responsible and refrain from contact if you are symptomatic, but there's just no way to be sure you're not shedding at any given time without active sores.

i hope that at some point that everyone will just start talking about this shitty little skin infection that almost everyone already has and then it will be ok to talk about and not be looked at like you belong in a leper colony. unless, like some here, you get tested and KNOW you don't have it, you very likely have at some point in your life been in contact with it. testing for this, given it's proclivity for moving around quietly, should be much more common.
posted by ninjew at 11:18 AM on August 11, 2009

Just to be clear, and for what it's worth, it doesn't sound as if you know that you have oral herpes -- only that you have HSV1. You might well have HSV1 genitally. Since you have had no outbreaks, you have no way of knowing.

Also, all of those who are confident that they are uninfected should make sure that they have actually been tested for herpes. Many people have been shocked and horrified to discover, after the fact, that when they asked to be tested for "all" sexually transmitted diseases, herpes was not included. And, as should be clear by now, absence of discernible symptoms does not mean absence of infection.
posted by Dolukhanova at 11:58 AM on August 11, 2009

You may not be worried about oral-oral transmission, and that's cool for you. But my body, my choice. Please don't make that choice for me.

I understand where you're coming from, here. But I don't think you'd be in any danger from me or the OP, because you would clearly ask us about HSV-1 status before any kissing happened, and we would give you an honest answer.

I just don't think it's reasonable that the OP should be obligated to spend the rest of his life interrupting intimate moments to have awkward conversations about disease--conversations that might require him to spend quite a while educating the other party about what "oral herpes" actually entails--while the majority of the rest of the population, blissfully ignorant about their HSV-1 status, are merrily snogging away without preamble. And all because he was responsible enough to get himself tested.

If you are making an effort to avoid being infected with HSV-1 through kissing, presumably you are already having any prospective makeout partners (or dessert sharers, or what have you) get tested, since they might have HSV-1 and not know it. Anyone who's worried about being infected will ask, and the OP will tell them. If a new partner doesn't ask about it, I don't think it's reasonable to expect him to take on the burden of educating them about HSV-1 on the off-chance they are still uninfected.
posted by fermion at 2:21 PM on August 11, 2009 [1 favorite]

I think Fermion has it. I can't see how doing more than current public health guidelines suggest is someone's moral responsibility.

And I think also the idea that people know that they don't have herpes: are you absolutely sure that you've been tested as the above poster mentioned? Generally the 3 common STD tests are HIV, Chlamydia and Gonorrhea. Herpes is a really rare test, usually just after an outbreak.
posted by sully75 at 8:50 PM on August 11, 2009

I have never, never had anyone tell me in the context of pre-kissing them that they may have HSV-1, only that they think they might have or be getting a 'coldsore' *right now*.

I have had one person tell me that they DIDN'T have it, and would tell people off the bat, as he assumed almost everyone else had it but wanted to keep his status uninfected.
I know of one other person who does the same thing.

Given that record, and that the majority of people might have it, and that in New Zealand people don't generally get tested for it (so they have no idea), I've picked up the assumption that it's actually one of those things you bring up if you DON'T have it and would like to stay that way.
Majority rules etc.

So, obviously this is only one of those awful social situations because we haven't established the social norm here.
I do think we should go by the assumption that unless you've had a recent 'clean' test, you should assume you have it. People who just THINK they don't have it because they haven't had an outbreak, are probably wrong.

It really sucks to be the original poster - especially because, without an outbreak, you're not likely to shed the virus much after the initial infection (negative-status guy got around a lot and he still doesn't have it, he only avoids contact during outbreaks).

Tell people upfront before you kiss them that you get coldsores if that worries you (I don't have coldsores now, but I do get them). Then they've got the choice, if they haven't got it already. Progressing further, use saran wrap for oral sex.

You can usually only be infected in one spot, oral or genital, so, try extra hard not to give them genital herpes, and keep them informed and make their own assessment as to oral herpes.

(This is extra callous, but until they come up with a vaccine - I'd actually happier that I got HSV-1 orally in preschool, than have to be taking a risk that 70% of the population could infect me genitally when giving me oral sex. That would just SUCK!)
posted by Elysum at 6:56 PM on August 16, 2009