DEAR DR. NERDLOVE: I recently learned that about half of adults have HSV-1, the virus that has oral herpes. Unfortunately, the virus can spread through really common activities like kissing or sharing a drink. In fact, a lot of people are infected as children through non-sexual contact like getting a kiss from a grandparent.
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Also, a lot of people with HSV-1 are asymptomatic. So they might spread the virus without knowing it.
To make matters worse, testing for HSV-1 has a false positive rate of 50%, so me or a partner getting tested won’t help us know if we unknowingly carry the virus.
I’m reluctant to kiss people now. And, considering I’ve kissed a fair number of people, I might be an asymptomatic carrier.
How do I reasonably protect myself against HSV-1 if I don’t already have it? Do I just not worry about it unless they have symptoms?
Slip of the Lip
DEAR SLIP OF THE LIP: Alright SOTL, let’s start with the important part right at the top: herpes, and oral herpes in particular, is a skin condition. That’s it. That’s all it is.
HSV-1 is the cause cold sores around the lip and mouth. An outbreak can be unpleasant – cold sores are uncomfortable, sometimes outright painful and they’re unsightly – but unless you’re a newborn infant or you are immunocompromised, you have little to worry about.
According to the World Health Organization, around 67% of the global population under 50 has HSV-1, and the vast majority were likely exposed in childhood. So, regardless of how many people you’ve kissed, the odds are that if you’ve got it, you’ve had it for most of your life already.
Many of the people who are carriers of either form of the herpes-simplex virus are asymptomatic and don’t know they have it at all, and many people who are symptomatic have an initial outbreak that’s so minor that they don’t notice it at all or mistake it for something else. Many people have outbreaks so infrequently that it simply never becomes an issue, and some simply don’t have outbreaks at all.
Considering the ubiquity of HSV-1, trying to avoid it entirely while also seeking out a conventional romantic relationship is impractical at best. The easiest way to protect yourself from being exposed to HSV-1 is… well, to never have any contact with other people’s lips or saliva, ever, under any circumstances, from birth to earth. The most realistic way of protecting yourself from being exposed to HSV-1 is to not kiss someone who has a cold sore, use their lip balm or other cosmetics or not put your mouth on items that’ve come in contact with their lip or saliva during an outbreak. The herpes virus can shed even when there are no symptoms, that’s still when it’s at its least contagious. You’re much less likely to catch it than when there’s an active outbreak than if everything is clear.
While there’s no cure for herpes, there are effective treatments that reduce the frequency and severity of outbreaks and help decrease the likelihood of transmission. Most of the time, they’re prescribed for people who have frequent or painful outbreaks and who want to reduce the likelihood of transmission. But unless you (or your partner) have regular outbreaks of cold sores, a doctor is less likely to recommend prescription medication. There’re a number of over the counter medications that ease the symptoms of oral herpes and promote faster healing, and you can reduce the frequency of outbreaks by reducing stress, avoiding sun exposure and wearing sunscreen. Otherwise, do your best to stay in good overall health; illness is one of the common triggers for an outbreak.
But to be quite frank: other than the inconvenience and the discomfort of a cold sore, it’s really not something to worry about. The ubiquity of the virus means that you likely have been exposed already and it hasn’t actually affected you in any serious way. The fear and stigma of herpes in general far outweighs the effects, and this goes double for HSV-1. While it’s not 100% harmless (neonatal herpes, while rare, can be very serious), it’s more unpleasant and inconvenient than anything else. If you or your partner have a cold sore, then yeah, kissing, oral sex, etc. is off the table until the sore heals up and goes away. But if there’re no symptoms? Then don’t worry about it; all you’re going to end up doing is stressing yourself out for no real purpose and making the people who do have it feel even worse.
Good luck.
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Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, doc@doctornerdlove.com