Letters to the Editor
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Wrong and ridiculous
The quality of Dr. Cary's columns varies, but today's topic is that rare combination of extreme factual error and fatuous advice.
He quotes the Mayo Clinic website as saying that herpes is "highly contagious" whether there is a sore or not. Someone needs to do a story on why the Mayo Clinic would post information that the Centers for Disease Control flatly rejects, as does the STD Hotline, 800-235-8619.
Even the Hotline changes its story from time to time. Not so long ago, they said that in the absence of a lesion, the only risk of infection was by a "shedding" of the virus, which happens (they said then) about 3-6 days A YEAR, and even then the quantity of the virus is so small in comparison with a full outbreak that infection does not automatically result. Lately they have doubled the number of shedding days.
But the point is that between outbreaks or shedding, the risk of infection is zero. Of course, during an outbreak, the risk is very high.
The Terri Warren web page gives a much better perspective of the risk, but she makes the mistake of advising people to get tested. Many physicians regard herpes tests as unreliable because about 25% of those who tested positive report that they have never had a lesion. So most physicians I know diagnose by visual observation of a lesion and do not test. Since the test looks for antibodies, the argument is that although the virus resists our bodies' defense systems pretty well, sometimes the defense works and there is no virus left even though there are antibodies.
Still, Ms. Warren, analyzing the actual risks of unprotected sex with an infected partner, concludes: "So you can see that the numbers get very low!"
Then there is the great trapdoor in all herpes presentations: Type 1 herpes, the cold sores around the mouth. The sores are pretty much the same as those occurring in the genital area, sometimes worse. The chief mode of transmission is kissing, which is why around 70% of everyone in America has it. Either type of herpes is transmissible to any mucous membrane on the body, or open wound. That means that Type 1 is transmissible to the genital area, and Type 2 to the oral area.
There is a lot of oral sex in society, particularly between new lovers.
There is no question that at first glance, there is a very persuasive ethical argument for prior disclosure of known herpes infection to a prospective sex partner. But if that is true, should not also the 70% of us who have Type 1 abstain even from kissing others without warning them? If so, that is a whole lot of disclosure that needs to go on out there.
One of the reasons that doesn't happen is that as time goes on, outbreaks typically become much less frequent, recurring usually in periods of unusual stress. You may have had several cold sores in college, but if your life is reasonably well-ordered, you can go for decades after without any. That is true also of genital herpes.
Another reason is cultural awareness. All know that if you kiss people you can catch anything from a cold to some kind of death plague, with cold sores and mononucleosis scoring in the middle somewhere. Since that awareness is universal, disclosure is superfluous, even if you know you've had cold sores and know that you've got that virus for life.
So if the circle you are travelling in has a high awareness of the facts regarding genital herpes, including the facts that one out of five prospective sex partners has it, there is arguably less ethical compulsion for prior disclosure. As I understand it, it is common among swingers for there to be no prior disclosure of herpes (but otherwise as to other STDs), and those who are intimate with others not their spouse either use condoms or assume the risk of herpes.
Now we're closing in on the real issue. If oral and genital herpes are basically the same (except that oral herpes is much more pervasive) but are treated differently as to social norms, what's going on? Answer: It's about sex! Fear and taboo get all mixed in with the medical facts.
The campaign of fear of genital herpes began with a lurid cover story in Time magazine on August 2, 1982, "Today's Scarlet Letter", which sensationalized the issue, stigmatized everyone with herpes and scared the bejesus out of everyone else. Even though shortly afterward the news media were reporting on AIDS, the scarifying stigma of herpes remained.
But it's still just cold sores, folks. And not many of them.
Still, because most people expect some kind of heads up about it, some form of disclosure is required by the Golden Rule.
How to do that? I first recommend ignoring Dr. Cary's fatuous approach, which is so laughably unrealistic it shows only that Dr. Cary hasn't been dating in a long time.
Just insist on using a condom the first time, and at some convenient moment after, raise the subject. Some will protest that you should have disclosed prior. Respond that it was safe with a condom and refer them to the STD Hotline. And then grill them on their own oral cold sore history, and if they are infected, point out that they have a disclosure obligation, too, to the extent that they engage in oral sex. This will probably confuse them, and they will have to think through the issues logically. And that's good.
And perhaps person by person over many years, such conversations will mean that herpes will no longer be a scarlet letter.