Ask Dr. Nerdlove by Harris O'Malley

My Friend Doesn’t Tell Her Partners She Has Herpes. What Should I Do?

DEAR DR. NERDLOVE: Three years ago, I met a girl that I’m going to call J, and she quickly became the closest friend I’ve ever had. We have the same hobbies, same taste in music, and same sense of humor, and I’ve never had as much fun with anyone as I’ve had with her. To this day I still don’t know what I would do without this girl in my life. 

When we first met, J had recently been cheated on and dumped by her boyfriend of four years. She was going through a lot of heartbreak and self esteem issues at that time, so she was kind of sleeping around. A few months after we met, she was diagnosed with genital herpes. My heart broke for her when she told me, and I was as supportive as I could be. I remember her telling me that when she got the news, her doctor told her she had to disclose this to every partner before having sex with them.

I vividly remember the first time after her diagnosis that she hooked up with another guy. She had texted me saying she was going to his house to hang out. I said something like, “Oh, so if you guys end up having sex, you’re gonna have to have the conversation?” And she said, “I’m not going to have sex with him.”

A few hours later, she texted me saying, “That was the worst sex I’ve ever had.” I asked, “How did the conversation go?” She never texted me back.

Ever since then, I’ve been painfully aware of her sleeping with many other guys without disclosing to them. I’ve tried talking to her about it multiple times over the years, but she doesn’t seem to take it seriously. I think her way of coping with it is pretending she doesn’t have it.  It has always bothered me, but lately it’s been eating me alive.

She just got into a serious relationship for the first time since her ex of four years. His name is D. I don’t know him super well, but I’ve met him a few times, and he seems like a really nice guy with a good head on his shoulders. She’s been sleeping with him without any form of protection for the last 3 months, and he has no idea he could easily get a lifelong infection from her.

A few weeks ago, they somehow got on the topic of STDs. He mentioned that a friend of his has herpes, and then he literally told her that if she had herpes and didn’t tell him, he would dump her as soon as he found out. She was upset when telling me about this and acted like she knew she had to tell him and was going to figure out the best way and time to do so. I told her that sooner is better than later and that she should not have sex with him again until she tells him, because he would be even more upset if she continued having sex with him after that conversation. She agreed and said she would.

A week went by and I hadn’t heard anything. I also knew she had spent the night at his house at least once during that week. I reached out to her again with a long text message listing all of the consequences of not telling him. She said she had thought of all of that and that she would tell him as soon as she was ready.

Another week went by and she texted me saying something about having sex with him in her car. I was super upset and could not believe she was telling me that after everything I had expressed to her.

I can’t do this anymore. I feel like I am an accessory to a crime. What is my obligation in this situation? I feel awful standing by silently while he is in danger of contracting this incurable virus. I also do not want to lose this friendship. Please don’t tell me to end my friendship. If I tell him myself, my friendship will end. If I threaten to tell him myself, my friendship will end. What should I do?

Innocent Bystander

DEAR INNOCENT BYSTANDER: This is the sort of question that I really dislike, because it’s the sort of thing that causes people to get up in arms in ways that aren’t called for by the actual issue. This is in no small part because sexually transmitted infections are incredibly divisive and polarizing… which is the problem.

Before we get to your friend, I want to take a moment to talk about the language you use. You mention that your heart broke for her when she got her diagnosis, talk about being an accessory to a crime and refer to her friend as being “in danger”. All of that is the very definition of “not helping”; it spreads the stigma of having an STI and ends up making people less willing to be up front with the diagnosis. The shame and stigma makes it more likely that people are going to end up being exposed to the virus. When we treat herpes as something horrifying and shameful, then people who are living with the virus are less likely to be upfront about it and less likely to get tested. Not getting tested or being diagnosed means that they’re not going to follow best practices to reduce the risk of exposure to their future sex partners. And just as importantly, it ends up causing greater strife among couples, because that lack of discussion means that a lot of folks remain ignorant about the realities of herpes.

As a general rule, I’m of the opinion that herpes isn’t that big of a deal; medically speaking, it’s a skin condition. An incredibly inconvenient and painful skin condition, but a skin condition none the less. However the stigma surrounding herpes is far higher than the actual medical consequences. Chlamydia, syphilis and gonorrhea have far larger consequences, yet those infections don’t have the stigma that comes with a diagnosis of HSV-2. And yet, for all the stigma, herpes is incredibly common; it’s estimated that 1 in 6 people in the US between the ages of 14 and 49 have herpes. Most people who are infected have no idea that they even have it. The vast majority of people who carry the virus have one outbreak, and then never have a second.

Even then, they may not notice the outbreak, or not realize that it’s herpes. People who discover they’ve been exposed to HSV-2 often assume that it’s their current partner who exposed them. In reality, it is just as likely that they’re the ones who did the exposing… and that they caught the virus from previous partners and had no idea. As a result we get caught up in a cycle of shame and anger, with people being shamed for catching a common virus… and who may not even realize they have it in the first place. After all, most STI screenings don’t include tests for HSV-2, and the most common tests are wildly inaccurate, with a false positive rate as high as 50%.

But because the stigma is so outsized versus the actual impact, we end up with people who’s reactions are disproportionate to the impact of the actual infection. Folks, for example, like your friend. And unfortunately, her behavior — which, make no mistake, is incredibly irresponsible — is only going to serve to increase and spread the stigma of having herpes. To start with, it sounds like she may not be doing the best practices needed for reducing the potential to spread the virus. A combination of antiviral medication like Valtrex and careful use of condoms keeps the likelihood of spreading the disease to a minimum. But if your friend is having unplanned hook-ups, she may be playing a little fast and loose with protection or dating guys who will try their damnedest to not use condoms. That’s a great way to end up infecting someone and running the risk of having a pissed off ex-hook-up rolling back into the picture with an axe to grind.

And that’s without getting into potential legal ramifications. While most states don’t have laws surrounding disclosure of herpes, it’s entirely possible that she could end up being sued for pain, suffering and humiliation. The virus itself may not be a big deal, but it wouldn’t take much for a lawyer to make her life a living hell, even if they didn’t ultimately prevail in court.

But then there’s the situation with his current partner. His attitude is the product of the stigma surrounding herpes infections, which is bad enough, but her behavior justifies his feelings on the subject. By lying by omission, she runs the risk of his contracting the virus if they decide to forgo condoms and be fluid-bonded, which is going to be a much bigger issue than if she’d been up front with him. If she’d been straight with him from the beginning, then maybe he would have ended things… or maybe he would’ve been understanding and they could decide how they wanted to make this relationship work. Hell, it may have prompted him to go and get tested himself, where he very well might find that he’d had the virus all this time and had no idea.

But her not telling him is fundamentally unfair. While herpes isn’t a big deal and is incredibly common, that doesn’t mean that folks who don’t have it are wrong for wanting to avoid it. People have the right to decide to make an informed decision as to whether they want to risk exposure or not. Her keeping her diagnosis a secret robs him of the opportunity for him to decide whether or not he was willing to accept the risks.

That having been said: you’re not helping things either. Your treating this as an unspeakable crime is only going to make your friend less likely to want to talk about it with her partners. Freaking out at someone is a great way to make them decide that they’d be better off keeping their diagnosis as a deep, dark and horrific secret instead of learning to accept it as a simple fact about who they are. After all, if YOU are getting this worked up about it, imagine how her boyfriend might feel.

And then there’s the fact that, at the end of the day, this is ultimately between your friend and her partner; you aren’t part of this equation. They’re both adults and — the state of sex-ed in this country aside — that means accepting the risks that come with having a sexual relationship. If he decides to not use condoms, then he’s tacitly accepting the possibilities of an undesirable result, whether that’s an STI or pregnancy.

So if you want to help your friend, then the best thing you can do is for both of you to get educated on the realities of living and dating with herpes. There’re a number of resources out there that can be incredibly helpful; I’d suggest starting with Ella Dawson’s TED Talk about living with herpes and then moving to resources like Planned Parenthood. The more that you learn, the less you’ll be letting ignorance drive your fears. Knowledge is what can help drive away the stigma of having herpes and help your friend conduct her life with honesty and integrity.

Good luck.

Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, doc@doctornerdlove.com