I’m going to start with a semi-confession: I have herpes. HSV-1 specifically. It’s a semi confession because I share this about as often as I tell folks about my allergies to random fruits and vegetables. That is to say, I tell people when it becomes relevant to our interaction. Otherwise, it’s one of a million random details most people don’t need to know about me.
So listen, I already know you came to read an article about cold sores, and maybe to find answers to questions like: “If I have cold sores, does that mean I have herpes?”, “Are cold sores a big deal?” or “Do I have to tell my partner I have cold sores?” I promise I’m going to get to those questions, but first, I’m going to tell you the story of how I came to have herpes.
The first thing we didn’t know is many STI panels do not include a test for herpes.
The first time I decided I was in a relationship worthy of being condom-free, I was 21. Wanting to be safe when my partner and I stopped using condoms, I followed the best women’s magazine advice available at the time. Wait three months, take a romantic trip to the health clinic, get negative results, and enjoy the cream pies your hearts desired. We’d already been dating exclusively for over three months, we got tested and thought we were good to go. Except, there were a few things we didn’t know.
The first thing we didn’t know is many STI panels do not include a test for herpes. Given the high population prevalence, low health impact, high rate of false-positives, and emotional impact of a diagnosis, testing for the herpes virus are explicitly not recommended by the US Preventative Services Task Force. At 21, neither of us were aware of what went into an STI panel. We simply assumed that no call to come in for treatment meant we were in the clear.
The second thing we didn’t know is the herpes virus can shed infectious cells without any sores present. Known as subclinical or asymptomatic shedding, it can happen anytime, especially in the days leading up to an outbreak. You know that tingle you get that tells you a cold sore is on the way? That’s a signal that you’re shedding potentially infectious cells.
The final thing I didn’t know was my boyfriend already had cold sores. I learned of his cold sores when he showed up for our Friday night fuckfest with a sore on his lip. I knew enough to take kissing and oral off the table, but I hadn’t known that I likely contracted the virus from him earlier in the week. On Saturday morning, I got to learn first-hand what “burns when you pee” means. I now had genital herpes.
A strange line gets drawn between oral and genital herpes, even though it’s the same virus at work for some of us.
If you live with herpes, passing it to a partner may feel like a nightmare come true. But, medically speaking, it’s not been bad for me. In 17 years, I’ve had *maybe* four outbreaks. I say maybe because after the third time I rushed to a doctor only to learn I had an ingrown hair or good old tearing of delicate tissue, I stopped looking for external confirmation. Initially, I took Valtrex, then the generic acyclovir on my doctors’ advice of “being on the safe side,” then based on conversations with my doctors and therapist, I stopped taking anything at all. I went nine years without an actual blip on my is-that-an-outbreak radar before taking another spin of the is it or isn’t it wheel this winter.
The emotional impact of herpes, however, is another story. In addition to awful treatment from my diagnosing doctor, I’ve had my share of fear, worry, and rejection. I know first-hand how scary it can be to disclose your sexual health – especially when it’s someone you want to accept you.
So now that you know where I’m writing from, let’s turn back to the questions that brought you here.
Is a cold sore herpes?
Yes. Yes, it is. Traditionally, and most commonly, cold sores are the stigma-free name for oral herpes. Traditionally, the majority of oral herpes infections are caused by HSV-1, and HSV-2 causes the majority of genital herpes infections. However, we do know that either strain can live in either location. Oral herpes is widespread, and there’s a strong chance you picked it up long before you had your initial outbreak. If anyone in your immediate family has cold sores, there is a strong likelihood you have HSV-1, too, even if you’ve never had symptoms.
Are you telling me I have herpes?
Yes, I am. But that is all I’m telling you. I’m not telling you your sexual life is over; I’m not telling you you’re dirty, and I’m certainly not telling you that anything about your life necessarily has to change. A strange line gets drawn between oral and genital herpes, even though it’s the same virus at work for some of us. Much of the stigma and judgment will not get applied to you, and as such, there seem to be different expectations around disclosure.
If smooshing mucus membranes with anonymous or semi-anonymous strangers is a regular part of your sexual expression, it would be smart for you to assume you’re always at risk for HPV, HSV, or the common cold.
Do I have to tell my (prospective) partners?
This is where things get complicated. In North America, we’re cruel around STI status. They’re the butt of many jokes, the source of stigma, and honestly, why people sometimes break up with or refuse to date someone with an STI. Even the language of being “clean” implies a different category of “sexually dirty.” How unfair is that?! With all the shame and stigma around herpes, it’s no surprise most people don’t want to share this information. And in all honesty, I don’t think it’s my place to tell you how to live your life, but here are some things to consider:
The Consent Factor
A key point of informed consent is knowing what you are risking. For most people, this would include potential exposure to STIs. THAT SAID, if smooshing mucus membranes with anonymous or semi-anonymous strangers is a regular part of your sexual expression, it would be smart for you to assume you’re always at risk for HPV, HSV, or the common cold. From there, take whatever precautions you need to make these encounters fit your risk profile.
The Asymptomatic Shedding Factor
There is a significant lack of research on HSV-1, in both genital and oral locations. This makes seeking medical advice on the subject complicated. Some doctors will tell you it’s rare to pass on the virus outside of an active outbreak, and therefore no need to disclose your status. However, studies show asymptomatic shedding of HSV-1 does happen, and this may be tied to increases in cases of genital HSV-1.
If a partner were to experience your lack of disclosure as a breach of trust, that could be much more damaging to your relationship than any pesky infection.
The Inevitability Factor
Your magical dancefloor make-out buddy may not be in your life long enough to ever see you with a cold sore, but in a long-term relationship, this changes. Stress is a major trigger for many people’s cold sores, and you know that’s stressful? Moving in with a partner. Planning a wedding. Having a baby. LIVING THROUGH A GLOBAL PANDEMIC IN LATE STAGE CAPITALISM. Meaning, you definitely don’t have to disclose in every situation, but it’s unlikely that you’ll make it through life without folks knowing you get cold sores. If a partner were to experience your lack of disclosure as a breach of trust, that could be much more damaging to your relationship than any pesky infection.
If and when you share your status with your partner, here are some dos and don’ts to help you out:
- Do be direct. Now isn’t the time to mix metaphors or dance so delicately around the subject that your partner isn’t sure what you’re talking about.
- Don’t reject yourself first. Lots of folks understand that colds sores are a common condition with few medical concerns associated. This person might well be okay with the news (or already know they have HSV-1).
- Do tell them when they’ll have time to process the information.
- Don’t shame yourself. HSV-1 is a medical condition. It doesn’t change your worth as a date, a lover, or as a human.
- Do try to stay in alignment with your values. If you didn’t tell someone and you’re stressing that you should have, fess up and apologize for not disclosing when you think you should have. It’s 2020; no one needs that guilt in this year, or ever.
What if my partner tells me they get cold sores?
If someone has taken the time to share their positive status with you, please treat the disclosure with the respect it deserves. Knowledge is always the best way to protect your sexual health, and by being with someone who knows their status, you’re likely to be at lower risk than a partner who as no idea what their status is.
No matter what you decide, thank the person who has enabled you to take care of your health and proceed with respect.
Before you make any decisions, take a bit of time to separate what parts of your reaction might be driven by stigma and prejudice. Try to approach your next move with curiosity. What does this disclosure mean for you? Understand that swapping fluids always comes with a risk, most often from the common cold, so how does a potential transmission of cold sores bother you? If you don’t know what having HSV-1 could mean for you, do some investigation. Google studies and articles, consult with your local county health unit or family doctor.
No matter what you decide, thank the person who has enabled you to take care of your health and proceed with respect.
In the end
The decision to disclose or not is highly personal. Think about consent; think about health and risk management, but above all, think about your values. You’re always the person you come home too. Keep that relationship good.
