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Herpes Hypochondria
January 21, 2018 10:45 AM   Subscribe

I've had life long struggles with hypochondria but recently an extreme focus of my anxiety has been around contracting herpes. Despite my bouts of panic stricken googling and webMD searches, I am realizing that I do not have accurate facts about symptoms, signs, transmission, etc. Looking to be educated / pointed towards quality resources so I can have a fruitful conversation with my doctor. Looking as well for any thoughts on how to deal with my anxiety.

For context, I am a straight single male in my late twenties. I have never in my life had unprotected vaginal sex and I do my best to abstain from giving or receiving oral sex due to my anxiety.

There are instances in which I have (knowing the risks) succumbed and went ahead with oral sex, or, like most recently (which is prompting this post) not communicated my wish to avoid oral sex well enough to the partner I am with - resulting in her going down on me with no protection.

These "instances" are followed by days of panic and near constant trips to the bathroom to inspect my genitals, noticing "red spots" or "bumps" that could be herpes, as well as endless google image searches so I can prove to myself I know what I am looking for.

In the throes of some of my previous panics I've see doctors and dermatologists, had swabs and blood tests performed. Thankfully none of the test results have ever suggested herpes.

But these past experiences are not helping me when a fresh panic sets in. How should I be thinking about actual transmission via oral sex? I've never kissed or received oral sex from someone with a cold sore - is that the standard of safety?

Would also love to hear any anecdotes from those who may have navigated similar fears.

(And yes, because I know someone will ask or suggest, I am currently in therapy for my hypochondria and other anxiety related issues.)
posted by anonymous to Health & Fitness (15 answers total) 2 users marked this as a favorite
 
Lots of people have HSV-1, like ~2 out of 3 people. Realistically the impact is that you might get a cold sore once or twice a year. HSV-2 is slightly more rare, but still ~1 out of 6 people have it -- "About one in six people ages 14-49 in the United States have genital HSV-2 infection. However, most people don’t know they are infected because their symptoms are too mild to notice or mistaken for something else.".

Realistically there's very little bad that will actually come of having HSV-1 or HSV-2. Acyclovir is very effective at treating outbreaks in the rare chance that you have an outbreak that negatively impacts your quality of life. So yeah, therapy, because there's not much to be logically concerned about.
posted by so fucking future at 10:56 AM on January 21 [3 favorites]


My advice is: don't. Don't research any more. Don't look for definitive signs and symptoms. Don't calculate odds. Don't look for "standards of safety." Don't go to the doctor.

When you're mildly anxious, sometimes it can be reassuring to confirm to yourself the unlikelihood of the event you're worrying about. But when you're consumed with anxiety, there is no reassurance. Research is just another form of rumination, another way of investing your mental energy in the anxiety. Don't do anything to encourage the spiral.

It sounds like you may have anxiety around your sexuality, not just your health, and it might be helpful to bring that up in therapy.

(Just for the record, herpes is nothing to be ashamed of, nor would it ruin your life.)
posted by praemunire at 10:57 AM on January 21 [2 favorites]


I've had herpes since I was a little kid. I must have gotten the virus from my parents, who both had mouth sores occasionally.

I manage the virus by taking acyclovir when I feel a cold sore coming on, which shortens the active sore phase to a couple days rather than a week. That's the extent of its impact on my life. Would I rather not have it? Sure. Would I give up oral sex to not have it? Nope!

My husband has never had a cold sore and we've been together through many many many outbreaks, including one the week after we started dating which made me feel super self-conscious and he shrugged off by saying "it's just a virus, why would you feel bad about it?".

Avoid sharing eating utensils or drinking glasses with someone who has a cold sore, avoid oral sex or kissing someone who has a cold sore, and you're miles ahead of the like 66% of the population who already has the herpes virus. Stop letting it rule your life like this.
posted by lydhre at 11:20 AM on January 21 [8 favorites]


Have you already tried understanding how NOT a big deal it is to have herpes? Your question is focused on hearing things that would make you feel safer about not contracting it rather than on mitigating your fear of what you see as the worst case scenario. If you're able to, that would probably reduce your anxiety a lot more than obsessively trying not to get it.

I know logic doesn't help with these kinds of anxieties, but is it useful to remind yourself that your anxieties are affecting your enjoyment of sex more than having herpes probably would?
posted by metasarah at 11:36 AM on January 21 [2 favorites]


Your anxiety about getting herpes is having a bigger and worse impact on your life than actually having herpes would. Are you worried people wouldn't want to have sex with you if they knew you had herpes? I bet there are a lot more people who would rule you out as a partner if they know you're afraid to have oral sex. (I would.) If you could somehow convince yourself to stop trying to prevent herpes and as a result you ended up getting herpes, you would actually be better off than you are today.
posted by Redstart at 11:39 AM on January 21 [7 favorites]


You say you're in therapy, but are you taking anti-anxiety meds?

I used to suffer from an extremely similar phobia and engage in behaviors exactly like what you described (and when I say suffer, I mean it, because this level of anxiety can honestly be nonstop suffering). I take anti-anxiety meds now and I don't feel that way anymore and it's a bigger relief than I ever imagined possible.

As the posters above said, herpes is not a huge deal, it's nothing to be ashamed about, and it won't ruin your life. But this really isn't about herpes. The conversation you need to have with your doctor is not about HSV but about a more effective treatment plan for your anxiety.
posted by the turtle's teeth at 12:08 PM on January 21 [4 favorites]


Before becoming intimate with your prospective partner, how about requiring that you both get tested for herpes alongside all the other infections that can be passed? You can then swap results and determine what precautions, if any, need to be taken. For herpes, you would both need blood tests for HSV-1 IgG antibodies, and HSV-2 IgG antibodies. Various online STD testing portals will let you purchase the tests and go to a local lab to be drawn, you don't have to involve a doctor.
posted by txtwinkletoes at 12:28 PM on January 21


Lots and lots of mild or completely benign things cause dots, bumps, and discolorations on genitals when you are sexually active that aren't sexually transmitted diseases. I know that it can be anxiety provoking- been there, got the t-shirt- but after learning about all the things that can happen that aren't necessarily STDs, it really cuts down on the worrying when something happens.

At the top of the benign list are mechanical, "wear and tear" related things. After especially vigorous sexual activity it is not uncommon to have little subcutaneous hematomas, or mini popped blood vessels, which can cause small red blemishes or even small pea sized lumps anywhere on the penis. These go away in a matter of days or a couple weeks and usually aren't accompanied by any particular pain or sensation at all.

Then from oral sex particularly, it is not uncommon to get fungal infections from someone else's mouth. It turns out that mouths are pretty fungus-ey places. Women experience this as a yeast infection often; men get a condition called balantitis which is basically a fungal infection of the tip of the penis- think of it kind of like athlete's foot of the shmeckle. Everyone's skin is different and it can take the form of a diffuse, spread out rash, or evidence as dots or patches of rash. The itchy and burning sensations associated with something like this make many people think it could be Herpes or another STD, but it is easily cleared up with over the counter anti-fungal creams or stronger prescription creams.

Then, more uncommon for genital infections, but possible, are benign warts called molluscum contagiosum. Unless you come into direct contact with someone with them, you won't get them. There are treatable as well because the virus lives on the skin and not in the nervous system as Herpes does, so they usually clear up on their own or can be removed by a doctor.

Finally, as everyone has mentioned, Herpes is very common and many people have the virus and many more have been exposed to it and not necessarily contracted the virus. The blood tests that screen for Herpes I and II are antibody based tests- not a test which detects the virus itself. Therefor, there are a range of antibody levels that people who are considered not to have the virus can exhibit in the blood tests. Because many people are getting results back showing some antibody levels in negative or neutral ranges that don't have an infection of the virus, the CDC is now providing guidance that doctors not order Herpes I and II screens as part of standard STD panels because the anxiety and psychological problems being caused by these results is causing more suffering on balance than the non-existent infection. It is recommended that only if a person has symptoms or reason to believe a transmission occurred, that testing is appropriate.

My own feeling about Herpes from oral sex: If someone had an active, noticeable outbreak on the mouth, I would request that we hold off on oral sex. With that said, it can get transmitted even when nothing is outwardly visible. My own perception of the risk is very low in this case. If this is a data point the allay your fears: when I was in college, I was young, reckless, and generally didn't think about risk, and my girlfriend at the time one day had a very noticeable lip outbreak. She performed oral sex on me a few times and nothing ever became of it. I have never had symptoms nor have any blood tests to screen for it have come back positive for Herpes. Would I do it again? No, but I don't think Herpes is like Ebola that the most minute exposure of it and the next minute you'll start sweating with god awful diarrhea.
posted by incolorinred at 1:07 PM on January 21 [2 favorites]


Much of the stigma against herpes was created by drug manufacturers after they developed drugs that would treat it.

I would make a decision about the level of caution you want to take and then not read anymore and not get tested again or examine yourself for signs or symptoms unless you are in clear pain or have some lesion that's obvious without you looking for it. Like, if your body has a problem that's causing you distress because it's painful, investigate. Otherwise, leave it all alone.

Many years ago after a possible exposure, I developed an almost paralyzing obsession like this with the possibility that I might have and spread bedbugs, and giving in to it by repeatedly examining my bedding with bright lights, etc only fed it more. I eventually settled on the idea "don't borrow trouble" - I try to use reasonable caution to prevent myself from being exposed but my policy is that I will only start worrying or investigating more if I'm persistently itchy or if there are easily visible blood stains on my white sheets.
posted by needs more cowbell at 1:26 PM on January 21 [2 favorites]


[This is a response from an anonymous answerer.]
Just to give you some anecdata that might help: I’m a het woman who’s had a fairly large amount of sexual partners and right offhand, I can think of four of them who disclosed to me that they had the HSV-2 virus; one of them is a regular sexual partner right now. I’m sure at least another half dozen have had it and didn’t tell me, either because they didn’t want me to know or they didn’t know themselves. None of them ever passsed the virus to me (I always use condoms). And as others have noted, it’s not a huge deal even if someone did pass the virus to you; basically, you just make sure you don’t have sex if and when you have an active outbreak, and some people who are HSV positive literally never have an outbreak.

Basically, I think Redstate really hits the nail in the head here. Your fear of herpes is having a far greater negative effect on your sex life than actually getting herpes would.
posted by cortex (staff) at 1:27 PM on January 21


For me, low dose Prozac, (10mg), totally turned this anxiety off like a light. And gave me a perspective on how brain-misfiring it was, so that even years after stopping the med, the anxiety has never come back the same.
posted by mercredi at 1:49 PM on January 21 [1 favorite]


I don't think there is anything wrong with wanting to avoid herpes and choosing partners without it. I don't have it either, not even the antibodies and I want to keep it that way. I don't judge others who have it. I just don't want to get it myself. It manifests differently in different people and for all I know, I could end up having constant outbreaks. I am very careful with partners. I flat out won't date someone with HSV2. I will date someone who has HSV1 antibodies, but has not had an outbreak. I don't really care for oral sex, so it's not a problem for me to give that up.

There are women out there that don't have either type of herpes and who will be willing to show you their test results. I don't have sex with strangers though and don't have a desire to have sex with strangers. If you want to have sex with strangers and don't want to get herpes, that's going to be very difficult, so I think you'll have to make a choice.
posted by parakeetdog at 1:50 PM on January 21


The over-the-top, life-disrupting nature of this anxiety obviously calls for some reframing about the likelihood and severity, etc, and you got good advice upthread. But once you get things feeling more manageable, you should know that your choices aren't unprotected oral (and the accompanying anxieties) or no oral (and the accompanying social awkwardness/frustration for everyone). Condoms and dental dams for receiving and giving oral, respectively, will do a lot to reduce (not eliminate) the risk of transmission of all sorts of STIs. The use of protection for oral sex is a habit more of us should get into.
posted by hollyholly at 3:14 PM on January 21


You should not ruminate on this. However, if you are going to continue to research, I highly suggest you read The Good News About the Bad News: Herpes Everything You Need to Know by Terri Warren RN. This book is written by a highly regarded expert who has also run a sexually transmitted infection clinic.

That being said, most people who have responsibly been tested before having sex with a new partner will not be tested by their doctor for herpes by default. Unfortunately, the IgG blood test can provide both false positives and false negatives. The culture test during an outbreak has been the most accurate in confirming herpes.

This book goes over what the transmission rates are for oral and genital HSV-1 and HSV-2 transmission and will put your mind at ease if you are taking appropriate precautions. Additionally, if your partner does have HSV-1 or 2, the suppression treatments are highly effective.

I found out this year that I have culture-confirmed genital HSV-1. All of my prior partners have tested clean, and no one had a history of outbreaks. Even my IgG antibody blood test comes back negative. I had a very negative view of herpes before I read the book and fully understood the effects of it. It does not affect my day to day life at all, and I don't have constant outbreaks.
posted by msladygrey at 4:12 PM on January 21 [3 favorites]


Count me in as another person who's had oral herpes since childhood (no idea whether its HSV1 or HSV2, and the Canadian government has zero interest in paying for testing to find out which). It's mildly annoying when I have an outbreak, but Valaciclovir has been great for preventing cold sores from developing or shortening the typical healing time. It's had no significant impact on my life. No one has ever dumped me because of it - I always disclose and encourage my partners to do their own research on the subject.

I'm about to say some things that might freak you out at first: A recent Canadian study found that about 14% of the adult population has HSV2, and more than 90% of them don't know they're infected. The vast majority of adults have HSV1, and again they usually don't know it. This happens because most people don't have symptoms and transmission can occur without symptoms or blisters being present through a process known as "viral shedding".

The key point I hope you take away from this is that herpes has so little impact on most people's lives that they literally don't realize they have it.

Standard precaution would mean avoiding direct contact with infected areas when someone has an outbreak, and to be extra safe avoid sharing utensils & glassware during that time (for oral herpes). Viral shedding is highest just before, during and after an outbreak so avoiding contact for several days after the outbreak has healed is also reasonable. Condoms and dental dams for oral sex are a good idea at any time. For intercourse the female condom covers more area than a regular condom and so offers more protection. As a cis guy you have a lower risk of genital infection from unprotected intercourse than someone who has a vagina (not terribly relevant for you since you always use condoms, but I thought I'd mention it).

Best of luck treating your anxiety. I hope what I've said helps you be less anxious rather than more so.
posted by Secret Sparrow at 5:37 PM on January 21 [1 favorite]


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