New relationships and STIs
January 29, 2019 3:22 AM   Subscribe

I’m in a new relationship with someone awesome. She's revealed to me that she has herpes. This is not at all a deal-breaker and doesn't change how I feel about her in the slightest, but it’s also not something I’ve ever had to deal with. Seeking practical, real-world advice beyond what I can find on Google.

We’re both ladies. The extent of my knowledge/experience is that dental dams exist. I want to be informed, but I also want to know what I can do to make her more comfortable because she was afraid to tell me. I’m not clear on the questions I should be asking. Any/all advice appreciated.
posted by anonymous to Health & Fitness (18 answers total) 3 users marked this as a favorite
I don't have specific knowledge of this - but here is an informative/funny podcast:
I know there is medication...
Yay new awesome times.
posted by PistachioRoux at 3:33 AM on January 29 [1 favorite]

First question - have you, yourself, been tested for HSV? A lot of people have HSV-1 and/or HSV-2 and are unaware because they've not yet had an outbreak, or had a mild outbreak that they haven't recognized as such.

Often HSV is not part of an STI panel unless explicitly asked for. The cultural stigma of Herpes is way, way out of proportion to the actual reality of having it. Most of the time they don't test for HSV because it's so common. So, step one should be getting tested to confirm your status. If you already have HSV that'll simplify things for you.

Second question - she knows she has HSV, is she on anything to reduce viral load / prevent outbreaks? Assuming you're negative for HSV, if she's on an antiviral to prevent outbreaks that's going to seriously reduce the chances of her passing it on.

And then I would also ask her how often / if she has outbreaks. Some people have them frequently, some have them infrequently, or some people have one and then that's about it. Presumably some people never have an outbreak and only test positive for the virus.

You're at greatest risk during an outbreak, but people do shed the virus from infected areas even when they're asymptomatic. Knowing where she has outbreaks, if they are regular, could be useful.

In my opinion, for the vast majority of people, the worst thing about HSV is disclosing that you have HSV. I'll say again, the cultural stigma against Herpes is way outside its impact on most people's lives. I'm only hedging because I'm sure there are a few outliers who have frequent outbreaks and it's also possible to pass on during childbirth (neonatal herpes) which is rare, but can be fatal.

My advice here would be talk a lot about how this affects her. Maybe even go to a support group if you expect to be in a long-term relationship. You'll find that most of the stories are the same - finding out about it, and living with it, are in large part not that bad except for the having to disclose and people's misconceptions. Use dental dams and have her get on an antiviral if she can (and isn't already). The only reason I'd worry about transmission, TBH, is because if you break up and have contracted HSV then you're in the position to have to disclose and you'll find that not everybody is awesome about it.
posted by jzb at 4:59 AM on January 29 [16 favorites]

(Unfortunately all of the data I have about transmission is based on vaginal intercourse, so obviously take this all with a grain of salt. Also, I am not your doctor)

HSV (the virus that causes genital herpes or oral cold sores; there are two strains, traditionally one associated with each location, but they are increasingly showing up in the 'wrong' location so I'll lump them together for now) is by far most easily transmitted when a sore is actually present. The #1 thing you can do to prevent transmission is not have oral-genital or genital-genital contact during an outbreak. A lot of people say "who would WANT to when they have a painful sore?" but... well, you'd be surprised.

That said, there is some degree of "asymptomatic shedding," meaning times when the virus is present on the skin and can be transmitted even though there are no sores or symptoms in the infected person. This is theoretically the "highest risk" time for transmission because there are no warnings to avoid contact. Asymptomatic shedding can be reduced if the infected party takes antiviral medication: in other words, a daily maintenance dose of Valtrex. Valtrex is very well tolerated in most people, is now generic and pretty cheap, and has the added benefit of reducing outbreaks/symptoms as well as shedding. So a lot of people choose to go this route, and ultimately have partners who feel that is enough piece of mind that they don't need to also use barrier protection. If you abstain from sex when symptomatic and use maintenance Valtrex, the odds of transmission in one year (again, of vaginal intercourse) are on the order of 1 in ~1000 (that's actually probably an overestimate, but I'm working with magnitudes here).

Even furthermore, the majority of people who are infected with HSV are completely asymptomatic and blood testing for HSV is not part of routine STI screening (because it is so common and there is no curative treatment). If you and your partner are both positive for the same strain (HSV-1 or 2), then there is virtually no risk of "transmission." Therefore, another route to consider is that you both get a type specific blood test for HSV -- you'll have to specifically request this, but a reasonable well informed MD (maybe not urgent care...) should understand your justification. This is only accurate about ~10 weeks after transmission, so if your partner had her first outbreak more recently than that, you'd want to wait a while. Although it might feel scary to get a positive result, there's a significant chance that all this worry is moot because you already have the virus (and being tested won't change whether the virus is there or not).
posted by telegraph at 4:59 AM on January 29 [4 favorites]

In case you didn't find these in your earlier google searches (a while back I did a fair bit of research to put together a list of resources on sexuality - these are a few things that wound up on the original list and some extras).

Sex Nerd Sandra (podcast) and guest Patty Cason (nurse practitioner) on STIs.

The STD Project website has some info about coping with STDs in a relationship and avoiding infection.

WebMD: Frequently Asked Questions When Your Partner Has Genital Herpes

Scarleteen on herpes.

Planned Parenthood - How is herpes prevented?

More resources.

Also, your local library is very likely to have some helpful books. (I tend to start by seeing what they actually have, checking to see what's most recent and then looking at reviews, rather than starting with a list of books and then checking to see which ones the library has. YLMV).
posted by bunderful at 5:51 AM on January 29 [2 favorites]

Oh yeah - Oh Joy Sex Toy has a panel on herpes and links to several other resources.
posted by bunderful at 5:55 AM on January 29

This is NOT at all medical advice, but one option as you're figuring things out (learned about in clinic one day in medical school, rarely discussed out in the world):

1. Find out if she has HSV1 or HSV2. (PCP can do this.)
2. If HSV1--which is VERY common and usually responsible for oral herpes but increasingly is the cause of genital herpes (transmitted through oral sex)--find out if YOU have antibodies to HSV1.
3. If YES to #2, then your body has already been exposed to and created antibodies to HSV1.
posted by namemeansgazelle at 6:17 AM on January 29 [1 favorite]

I thought this article about the overblown stigma of genital herpes was helpful when I first got my diagnosis. I was one of those people who thought a standard STI panel included the test for herpes. As noted above, it does not. Some healthcare providers (Kaiser in Northern California, for example), discourage people from getting tested for herpes. I think that odd but apparently the attitude is that virtually everyone has been exposed so don't bother testing unless there is an outbreak.

I was a couple of years into a primary relationship when I found out on a visit to a health clinic that I needed to ask for a separate herpes test if I wanted one. I said yes, and that is how I discovered I had it. I did not have my first outbreak until maybe 6 months later. When my partner went to Kaiser to ask for a herpes test, his doctor said no. I encouraged him to explain to Kaiser that he would never have sex with me again unless he got tested first, because I wanted to know his status before we started having penetrative intercourse again. He was herpes-free and stayed that way during our relationship.

We were together for about 4 years, always always used condoms when we had penetrative sex, and never had penetrative sex during an outbreak. Of course, people do get herpes despite the use of condoms (or dental dams, I presume) but it appears to make it less likely.

Honestly, my outbreaks are not fun but they are not a huge deal either. It feels really challenging to disclose, so I include it in all my dating profiles upfront. The thing about herpes is that it is impossible to tell when any individual was infected. A huge percentage of the people who call themselves clean (so offensive) to indicate that they have no STIs are walking around with herpes but simply don't know it.

Also, herpes is not limited to cold sores on your mouth or sores on your genitalia. A friend of mine was infected on one hip. So read up, figure out what makes you comfortable, and keep in mind that how you approach the situation may change over time as you learn more. You say this is not a deal-breaker, which is great, but don't hate on yourself if you decide you do not want to risk it. It is okay to protect yourself by not having certain types of sex if you are uncomfortable with the risk.

Finally, if you want to be a good date/partner type, talk to your own healthcare folks and do your own research. It's not really fair to your awesome new sweetie or yourself to make her your primary source of information about herpes. Thanks for the Q, OP. Congrats on your new relationship.
posted by Bella Donna at 7:00 AM on January 29 [3 favorites]

Something that hasn't been mentioned and that your partner should be aware of (and you too if you turn out to be a carrier) is the possibility of self-inoculation. Basically it's the accidental transfer of the virus from an infected area of your body to an uninfected area of your body.

Additionally any area of skin could potentially become infected (not just mouth and genitals), but mucus membranes or any area of broken skin are more vulnerable. See: ocular herpes, herpes gladiatorum. If this spooks you, you can use latex gloves as well dental dams.

I'd had oral herpes for a quarter century before any doctor bothered to mention this stuff to me. Now if I have an outbreak I'm even more vigilant about hand washing than before and I often opt to wear my glasses rather than my contact lenses just to reduce contact with my eyes.

In any case, the vast majority of adults are infected with some type of HSV. In my province 89% of women age 40-44 test positive for HSV-1, and 21% test positive for HSV-2. It's so incredibly common and most people have no symptoms and usually don't even know they're infected.
posted by Secret Sparrow at 9:47 AM on January 29 [1 favorite]

The two of us brought herpes into our relationship 35 years ago. One had genital outbreaks, and the other oral outbreaks. These are also two different strains. With attention to symptoms, proper abstaining from certain activities, and flexibility about to have fun during outbreaks, we still each only have our own viruses. It also helps to determine how to avoid triggering outbreaks.

You can remain virus free, too.
posted by Midnight Skulker at 10:21 AM on January 29 [1 favorite]

I was in this situation with a former partner, though we're straight cis folks, but I did a ton of reading (and never contracted HSV). The CDC in the US is a good resource.

First, yes, there are two kinds of HSV, HSV1 and HSV2. Traditionally we've thought of HSV1 as oral herpes (cold sores on and around the mouth) and HSV2 as genital, but HSV1 is also presenting genitally. I'm guessing she has genital herpes. Does she know if it's HSV1 or HSV2?

The next thing is that you might actually have HSV1 or HSV2 yourself. Sometimes people have it and have either never had an outbreak or thought it was something else. There are a few ways to get tested for HSV. The more common is a swab from the sore during an outbreak. However, there are also two blood tests you can get, called the IgG and IgM. These tests look for antibodies to HSV; the idea is that if you have the antibodies, you have HSV. If you already have it, then you don't have to worry about protecting yourself from it. (When my partner got HSV, I went ahead and got these blood tests to confirm that I did not have it myself. You have to ask your doctor specifically about this.)

The CDC advises against including HSV tests in standard STI panels. However, there are times when the CDC says a blood test can be useful:
"If you have genital symptoms that could be related to herpes,
If you have (or have had) a sex partner with genital herpes, or
If you want a complete STD exam, especially if you have multiple sex partners."

So know this information and talk to your doctor about it when you go to ask for the tests. The big thing to know, if you ever intend to be pregnant and carry a child to term, is that it can be transmitted from mother to baby and neonatal herpes can be life-threatening.

The next thing to know is if she's on a daily antiviral to reduce outbreaks. This also limits the time she would be shedding the virus without sores, which is when you're most likely to get it.

Here's the thing, though: you can get it when she doesn't have an outbreak because people with HSV don't always know when they are shedding, which happens at times even when there isn't an outbreak. But, transmission is less common among women who have sex with women.

Good luck. I'm glad she shared this with you.
posted by bluedaisy at 10:55 AM on January 29

Something that hasn't been mentioned and that your partner should be aware of (and you too if you turn out to be a carrier) is the possibility of self-inoculation. Basically it's the accidental transfer of the virus from an infected area of your body to an uninfected area of your body.

That linked article is talking primarily about molluscum contagiosum and HPV, and is vague at best in it's scare-language warning about HSV.

It's my understanding that if you already have a particular strain occurring in one location, and have developed the antibodies (that is to say, this isn't your first outbreak/occurrence) that strain of HSV will not self-inoculate into another area.

From the AAFP journal:
"Autoinoculation to different areas of the body can occur (e.g., by touching an open lesion on the mouth and scratching the genital area), but this process usually is prevented by circulating antibodies.14 Auto-inoculation is most likely to occur soon after primary infection, when antibody titers are still increasing."

So for example, if two people have both been getting cold sores on their lips since they were kids, and an antibody test confirms it's HSV-1, it is very unlikely you'll re-infect in another location (genital, anal, or ocular).

If however, someone doesn't have HSV at all has a hot and heavy makeout sesh (kissing, fingers, oral) with someone who has a cold sore, then that first exposure could easily turn into having simultaneous mouth and genital outbreaks in the newly infected person.

More info about HSV transmission and re-infection from the STD Project.
posted by ApathyGirl at 11:48 AM on January 29

The cultural stigma of Herpes is way, way out of proportion to the actual reality of having it.

I wish people would stop saying that. Herpes can infect your eyes and make you go blind. It can affect your spine and many other organs. And it is serious, serious shit for someone with a suppressed immune system. No, it doesn't make someone a leper, but it's a lot more serious than people want you to think. Yes, it limits their dating options, but that is not the end of the world and no, everyone doesn't have it, like some people would like you to think.

Dating someone with herpes is risky, but less risky if she takes anti-virals and you use dams and gloves. Whether or not you want to take that risk is up to you.

Ask yourself how you would feel if you ended up catching it and you guys later broke up. Ask yourself how you'd feel dealing with less likely complications from it. How you'd feel if you developed lupus at some point and couldn't take immune suppressants because you had herpes.

Is it worth it to you to take a risk? You can both do things to lessen the odds of that happening, so it's up to you.
posted by liminal_shadows at 11:48 AM on January 29 [4 favorites]

I wish people would stop saying that. Herpes can infect your eyes and make you go blind. It can affect your spine and many other organs. And it is serious, serious shit for someone with a suppressed immune system.

Lots of things are "serious, serious shit for someone with a suppressed immune system." A common cold can be serious for a person with a suppressed immune system.

Herpes can impact your eyes, or your spine, but given all the people who carry the viruses vs. people who actually have those reactions / complications, I stand by the stigma being way out of proportion to actual reality. If you have numbers to suggest that these are more common than I understand, please share them and I will consider revising my opinion that the stigma is outsized to reality.

I read a story not that long ago about somebody who wound up with a rare blood infection that required amputations because "of a dog lick that led to a rare blood infection." Few people, though, are worried about capnocytophaga despite the serious impact it had on this poor person.
posted by jzb at 12:30 PM on January 29 [3 favorites]

Ask yourself how you would feel if you ended up catching it and you guys later broke up. Ask yourself how you'd feel dealing with less likely complications from it. How you'd feel if you developed lupus at some point and couldn't take immune suppressants because you had herpes.

HSV infection alone is not a contraindication to immunosuppressive therapy. Many people with HSV take immunosuppressive agents for autoimmune diseases like lupus or even for solid organ transplant (the doses of which are typically much higher). The point is well taken that for a small subset of patients who experience uncommon complications the downsides of HSV infection can be more significant than the stigma alone, but this specific scare tactic is unnecessary fear mongering that is not based in reality.
posted by telegraph at 5:34 PM on January 29 [2 favorites]

I have genital HSV-1 and I've dated and fucked in the queer community. I am also in the subset of sufferers with rare, recurrent and painful symptoms. So, as a "not-quite-leper" with "limited dating options" who "might make you go blind!" let me weigh in.

Dating someone with herpes is not risky.
Dating someone who shames you is much worse.
For 99.5% of carriers, the stigma is far worse than the health implications.

Your acquisition risk is minimal if you follow a few simple rules. (I'm assuming she has genital herpes and you are not a carrier.)

One, don't trib or give her oral/anal sex during an outbreak. You can still fuck her with gloves. For maximum safety, go first and do her last. If you mix it up, wash like a surgeon with soap and water in between rounds, and slap on fresh gloves every time. Maybe she'll want to abstain from sex during a breakout? Or maybe she'll be super horny (hello virus survival tack -- they don't tell you that in the handbook!) Anyway, let her set the pace. There's no need to forgo intimate touch!

Two, the safest sex you can have is with gloves and dental dams. But dams really suck and gloves (though smooth and shiny!) are overkill in most situations. As long as you don't have wounds on your hand or wrists, you're fine fingering her. Keep your nails trimmed and filed, and both of you stop shaving your pubes! Pubic hair is protective and razors cause micro-tears in the skin. You can use plastic wrap as a large surface area for tribbing. Or cut open condoms for a makeshift dam.

Three: ANTIVIRALS!! They will cut the transmission risk in half as well as reduce symptoms if she has any. Acyclovir and valacyclovir are extremely safe. I've been taking them for years, no side effects, which is rad because I'm sensitive to everything.

Four, she can ride your thigh like a pony without worry. There isn't good data on herpes transmission among women, because there's no good data on queer sex at all. However: herpes is a virus that likes warm, moist climates. It does not survive long when exposed to air. It lives in the nervous system and activates at odd intervals. (That's when you shed asymptomatically or have breakouts.) It is transmitted from mucosal layer to mucosal layer, like between cunts, assholes, mouths, eyes and nose canals. Transmission requires wet, direct contact and friction! The thick dry skin on the rest of your body is safe. That includes skin next to your genitals, like asscheeks and inner thighs.

Theoretically you could say, fist her really hard, pick up some shed virus in the swirly gel of dislodged tissue cells trapped in her cunt juice, rub your eye or something, and get oral herpes. THE CHANCES OF THAT ARE SO VASTLY SMALL IT WOULD MAKE INTERNATIONAL MEDICAL JOURNALS. Therefore, don't freak out! Unless she has an active outbreak, Terri Warren at Westover Heights Clinic says mutual masturbation is not an issue. Use coconut oil or quality glycerin-free lube like Sliquid to reduce abrasion. Keep peace of mind by not sharing toys. Or, put fresh condoms on between use.

Five. The trickiest activities are unbarriered tribbing, rimming and oral sex. This is a personal call. I don't even put it on the table unless my partner is emotionally aware and at low risk for autoimmune issues. I give her the information; I wait until she asks me to remove the barriers. It's hard to gauge transmission risks because some people shed asymptomatically much more than others. So, it's less a "1 in 1000 chance" per year and more "is she a frequent or an infrequent shedder?" Hard to say.

Six. If in doubt, touch yourself first and her last.

MeMail me to talk if you like. There are a lot of subtle emotional issues I won't spell out here. Thanks for being supportive!
posted by aw jeez at 9:10 PM on January 29 [6 favorites]

Theoretically you could say, fist her really hard, pick up some shed virus in the swirly gel of dislodged tissue cells trapped in her cunt juice, rub your eye or something, and get oral herpes. THE CHANCES OF THAT ARE SO VASTLY SMALL IT WOULD MAKE INTERNATIONAL MEDICAL JOURNALS.
Loved your work but just to be crystal clear that what aw jeez is talking about here is only true if the fisting occurs when no outbreak. If during an outbreak, noooooooo! HSV keratitis (eye infection) is quite common, easy to catch and disastrous for vision. But easily prevented if no one fucks your eye while they have an outbreak of genital herpes!
posted by chiquitita at 4:19 AM on January 30

For this and other STIs there is very detailed info at the CDC's website which discusses research. For most STIs they have a more simplified 'public' page with the kind of basic info you likely see in pamphlets on a doctor visit, and another, much more useful and detailed page for medical practitioners which will discuss things like transmission risks with much more detail and nuance.
posted by twoplussix at 12:55 PM on January 30

yes chiquitita thanks for the clarification! no skin to skin contact with affected areas during an outbreak.
posted by fritillary at 5:06 PM on January 30

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