Wow. This is a hot button topic for me. Let me share what I know and feel the best way I can.
The fact that many doctors don't like to test for HSV because it is so common gets my hackles up. If more people knew their status, less people would be concerned about it. Seems like an easy way to lessen the stigma on those few people who do get symptoms, and therefore know their status.
When someone who doesn't know their own status gets all uppity about disclosure requirements for other people who do have HSV-1 or HSV-2 I get snarky.
I do NOT like how this issue makes people who have HSV-1 or HSV-2 feel. It pisses me off.
One of the ways I've delt with this is having a rule at some of my parties that states "If you want to know a partner's STI status, you need to ask them." I'd love feedback on this.
I know my status for HSV-1 and HSV-2 based upon HerpesSelect tests. Want to mash genitals with me? We will be discussing both of our testings results.
I said it in the confessional, and I'll say it again:
I encourage testing for HSV1+HSV2, IGM(new infection) IGG(old infection)
I am a midwife, not a doctor. I also frame any positive results in a way that minimizes stigma and with words that give hope, not judgement. I make a point of discussing healthy sexuality, and the fact that although this adds a conversation (that should have been a part of their conversations with their partners, anyway) that they will still be able to enjoy their partners and enjoy sex in light of the results. We discuss how to approach outbreaks, and how to navigate difficult conversations, social stigma, and the prevalence of HSV in society. ALWAYS in a respectful, open manner that tries to mitigate the despair (and shame) that I often see reflected on their faces when I share positive results. And ALWAYS with words that let them know that they can, and hopefully WILL enjoy a healthy sex life in the future. thanks for listening.
I'm curious. For those pregnant clients who are negative for HSV-2 and are poly or have a HSV-2 positive primary partner, do you discuss the risks or acquiring HSV-2 during pregnancy, especially the third trimester?
yes, I do. I actually discuss this as part of my initial counseling with diagnosis. I try to realistically address in a NON-fear based, NON judgement based, factual manner what impact the diagnosis will have on her life (my patients are all women) so I discuss safer sex, communication with present and future partners, and the ramification for childbirth. (I usually discuss this BOTH with those intending and not intending to have children because there are times when women who have previously decided not to have children change their minds, in my [professional] experience.)
The issue of primary outbreaks in pregnancy has come up several times recently in the last 6 months because the practice has had a few women who were known HSV negative (through serum testing) whose partners were positive. Because of the risks associated with neonatal HSV, they were counseled that it probably was a good idea to either abstain from sex or use a barrier method and be veryvery careful, AND to have their partners be on supression therapy for the remainder of the pregnancy. Part of that counseling is CERTAINLY because of how devastating neonatal herpes is, but in OB these days there is a huge dose of (?over)caution because of the concern for litigation.
probably more information than you were looking for, but sexuality, safer sex and women's health are topics near and dear to me!
i had to force my HMO to include HSV testing, even when told "if you never had an outbreak, why bother?" and "you might come back positive anyway, and it would freak you out". AND it costs money ;) they were paying.
as far as disclosure goes, there are many people i would love to kiss, often but their status is sometimes tricky and inconvenient.
oral cold sores, esp bad ones that are easily visible just seem so troublesome for many people, that i'd like to not get them, by practicing some care. seems reasonable. outbreaks elsewhere from what i've heard range from "meh" to "please kill me now".
some people have VERY bad outbreaks, and they suffer terribly for it. not all of them can afford anti-virals to control it. some over the counter stuff can help, but apparently is not completely effective.
getting herpes in certain body parts can be VERY bad. fingers/fingernails/nail beds? nose? eyes? yow! while rare, i'm told there have been deaths.
so to answer other people's questions above and elsewhere "why do you care about a puny non-lethal disease?" well... if a little care prevents suffering and $$$$ spent? you better well believe i'll take some care... i already have enough body pain and joint issues, why add to the life experiences?
and i really do expect disclosure, at least as much as "i have a cold today" to quite a bit more, depending on the person/case. big fan of barriers too :)
i find it fascinating that in our particular culture/crowd, where go out of our way to respect others and their choices, write ingredients down on cards for parties, and are big on communication with many partners, could knowingly impinge upon someone's health choices even if it's a low probability.
in talking to my friend earlier too, she found cites on HSV decline, unlike the tone of that scare article someone posted earlier/elsewhere. quote:
2006 JAMA article: These data show declines in HSV-2 seroprevalence, suggesting that the trajectory of increasing HSV-2 seroprevalence in the United States has been reversed. Seroprevalence of HSV-1 decreased
I am sorry you encountered resistance and ignorance in your health care professional. I hope you were in a position to express your disagreement either through diaglogue (if it was a care provider you wished to continue care with) or through seeking care elsewhere (if it wasn't).
I always encourage people, including current clients/patients of mine not only to communicate directly with their care providers if they have a concern about their care, but ALSO to write a letter or contact the practice manager with feedback. (?Sometimes? ?Often?) Care providers pay attention to positive and negative feedback, especially if it comes from a practice manager. IMO, it is important to let them know if you are leaving the practice, because medical groups are a BUSINESS and they do pay attention to the bottom line. Sometimes too much, unfortunatly.
I have had patients affected with Whitlow (hand infection) and one with very severe recurrant face infections that were difficult to control/treat, as well as recurrant genital or oral outbreaks. It's difficult to see patients I care for (and care about!) have to navigate the waters of this virus: from the physical discomfort/pain, the psychological/phyche ramifications (not the least of which is the self-judgement which can be more harsh than what society doles out)as well as social fallout. It's gratifying to see them over time and see how they (usually/hopefully) adjust to the diagnosis and continue to have meaningful, satisfying, engaging, EXCITING sex lives!
Prevalance rates are tricky. I usually quote a 60-80% figure but discuss the difficulty in acurately pin-pointing it. Suffice to say, research indicates that greater than half of sexually active adults have some sort of HSV.
Thanks for your thoughts! As I said above,
"probably more information than you were looking for, but sexuality, safer sex and women's health are topics near and dear to me!" :)
i think mostly my HMO deals with people who are in the car care mode of "fix it", they don't want to know why or how...
now with my car, i want to see the parts and hear the complete details, including if there's rust, and preventive and pro-active things. applies to my body. sometimes it takes the doctor a little bit to "wake up" as they coast too often without having to talk. the guy i have is/was a teaching doctor, so he actually seems delighted to converse with someone, even the lay person, who is making SOME effort :) i've learned more than a few things... and sometimes challenge them :> which hopefully makes their day better too.
when i explained to them at the time i was planning on entering a long term r-ship with someone, and we wanted ALL the tests just for peace of mind, he explained that some of the tests might NOT give us peace (like HSV), because of prevalence rates, lack of clarity on what results MEAN, etc, etc. after all that, he took multiple-samples, send them off, and i got a detailed letter sometime later with lots of negatives, plus the usual eat better, sleep, drink water, ... :)
and information is good! i have an perhaps more than selfish interest in those near and dear to me as well. myself included :>
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branchandroot
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Date: 2011-02-16 11:37 pm (UTC)The fact that many doctors don't like to test for HSV because it is so common gets my hackles up. If more people knew their status, less people would be concerned about it. Seems like an easy way to lessen the stigma on those few people who do get symptoms, and therefore know their status.
When someone who doesn't know their own status gets all uppity about disclosure requirements for other people who do have HSV-1 or HSV-2 I get snarky.
I do NOT like how this issue makes people who have HSV-1 or HSV-2 feel. It pisses me off.
One of the ways I've delt with this is having a rule at some of my parties that states "If you want to know a partner's STI status, you need to ask them." I'd love feedback on this.
I know my status for HSV-1 and HSV-2 based upon HerpesSelect tests. Want to mash genitals with me? We will be discussing both of our testings results.
my $0.02
Date: 2011-02-17 12:50 am (UTC)I encourage testing for HSV1+HSV2, IGM(new infection) IGG(old infection)
I am a midwife, not a doctor.
I also frame any positive results in a way that minimizes stigma and with words that give hope, not judgement. I make a point of discussing healthy sexuality, and the fact that although this adds a conversation (that should have been a part of their conversations with their partners, anyway) that they will still be able to enjoy their partners and enjoy sex in light of the results.
We discuss how to approach outbreaks, and how to navigate difficult conversations, social stigma, and the prevalence of HSV in society.
ALWAYS in a respectful, open manner that tries to mitigate the despair (and shame) that I often see reflected on their faces when I share positive results.
And ALWAYS with words that let them know that they can, and hopefully WILL enjoy a healthy sex life in the future.
thanks for listening.
Re: my $0.02
Date: 2011-02-17 01:02 am (UTC)I'm curious. For those pregnant clients who are negative for HSV-2 and are poly or have a HSV-2 positive primary partner, do you discuss the risks or acquiring HSV-2 during pregnancy, especially the third trimester?
Re: my $0.02
Date: 2011-02-17 05:07 am (UTC)I actually discuss this as part of my initial counseling with diagnosis. I try to realistically address in a NON-fear based, NON judgement based, factual manner what impact the diagnosis will have on her life (my patients are all women) so I discuss safer sex, communication with present and future partners, and the ramification for childbirth. (I usually discuss this BOTH with those intending and not intending to have children because there are times when women who have previously decided not to have children change their minds, in my [professional] experience.)
The issue of primary outbreaks in pregnancy has come up several times recently in the last 6 months because the practice has had a few women who were known HSV negative (through serum testing) whose partners were positive. Because of the risks associated with neonatal HSV, they were counseled that it probably was a good idea to either abstain from sex or use a barrier method and be veryvery careful, AND to have their partners be on supression therapy for the remainder of the pregnancy. Part of that counseling is CERTAINLY because of how devastating neonatal herpes is, but in OB these days there is a huge dose of (?over)caution because of the concern for litigation.
probably more information than you were looking for,
but sexuality, safer sex and women's health are topics near and dear to me!
Re: my $0.02
Date: 2011-02-17 03:40 am (UTC)as far as disclosure goes, there are many people i would love to kiss, often but their status is sometimes tricky and inconvenient.
oral cold sores, esp bad ones that are easily visible just seem so troublesome for many people, that i'd like to not get them, by practicing some care. seems reasonable. outbreaks elsewhere from what i've heard range from "meh" to "please kill me now".
some people have VERY bad outbreaks, and they suffer terribly for it. not all of them can afford anti-virals to control it. some over the counter stuff can help, but apparently is not completely effective.
getting herpes in certain body parts can be VERY bad. fingers/fingernails/nail beds? nose? eyes? yow! while rare, i'm told there have been deaths.
so to answer other people's questions above and elsewhere "why do you care about a puny non-lethal disease?" well... if a little care prevents suffering and $$$$ spent? you better well believe i'll take some care... i already have enough body pain and joint issues, why add to the life experiences?
and i really do expect disclosure, at least as much as "i have a cold today" to quite a bit more, depending on the person/case. big fan of barriers too :)
i find it fascinating that in our particular culture/crowd, where go out of our way to respect others and their choices, write ingredients down on cards for parties, and are big on communication with many partners, could knowingly impinge upon someone's health choices even if it's a low probability.
in talking to my friend earlier too, she found cites on HSV decline, unlike the tone of that scare article someone posted earlier/elsewhere. quote:
2006 JAMA article:
These data show declines in HSV-2 seroprevalence, suggesting that the trajectory of increasing HSV-2 seroprevalence in the United States has been reversed. Seroprevalence of HSV-1 decreased
#
Re: my $0.02
Date: 2011-02-17 05:48 am (UTC)I always encourage people, including current clients/patients of mine not only to communicate directly with their care providers if they have a concern about their care, but ALSO to write a letter or contact the practice manager with feedback. (?Sometimes? ?Often?) Care providers pay attention to positive and negative feedback, especially if it comes from a practice manager. IMO, it is important to let them know if you are leaving the practice, because medical groups are a BUSINESS and they do pay attention to the bottom line. Sometimes too much, unfortunatly.
I have had patients affected with Whitlow (hand infection) and one with very severe recurrant face infections that were difficult to control/treat, as well as recurrant genital or oral outbreaks. It's difficult to see patients I care for (and care about!) have to navigate the waters of this virus: from the physical discomfort/pain, the psychological/phyche ramifications (not the least of which is the self-judgement which can be more harsh than what society doles out)as well as social fallout. It's gratifying to see them over time and see how they (usually/hopefully) adjust to the diagnosis and continue to have meaningful, satisfying, engaging, EXCITING sex lives!
Prevalance rates are tricky. I usually quote a 60-80% figure but discuss the difficulty in acurately pin-pointing it. Suffice to say, research indicates that greater than half of sexually active adults have some sort of HSV.
Thanks for your thoughts!
As I said above,
"probably more information than you were looking for,
but sexuality, safer sex and women's health are topics near and dear to me!"
:)
Re: my $0.02
Date: 2011-02-17 05:51 am (UTC)Re: my $0.02
Date: 2011-02-17 03:03 pm (UTC)now with my car, i want to see the parts and hear the complete details, including if there's rust, and preventive and pro-active things. applies to my body. sometimes it takes the doctor a little bit to "wake up" as they coast too often without having to talk. the guy i have is/was a teaching doctor, so he actually seems delighted to converse with someone, even the lay person, who is making SOME effort :) i've learned more than a few things... and sometimes challenge them :> which hopefully makes their day better too.
when i explained to them at the time i was planning on entering a long term r-ship with someone, and we wanted ALL the tests just for peace of mind, he explained that some of the tests might NOT give us peace (like HSV), because of prevalence rates, lack of clarity on what results MEAN, etc, etc. after all that, he took multiple-samples, send them off, and i got a detailed letter sometime later with lots of negatives, plus the usual eat better, sleep, drink water, ... :)
and information is good! i have an perhaps more than selfish interest in those near and dear to me as well. myself included :>
#