One day in my seventh-grade home economics class, the nurses assigned to Jefferson West Middle School by the county health department made a surprise appearance. As my fellow students and I walked into class, they handed out cards of three colors, evenly distributed: red, blue and yellow.
When we had taken our seats and after the grab-ass had died down, one of the nurses spoke up.
“Everyone with a blue card, hold it up,” she said
We – or they – followed the instructions.
“Now, if you’re not holding up a blue card, look around you.”
We looked around us.
“Based on the current rate of infection,” she said, “by 2010, one in three of you will be dead from AIDS.”
“That means that it might be the blue group that’s dead. Or…now, everyone with the red card…”
And so on.
As it turns out, none of my middle school classmates has died from AIDS. In fact, I’m not sure I’ve even met anyone with HIV. I mean, other than the odd motivational speaker who was in my orbit because he had HIV.
I once read (somewhere reliable) that the chances of a male contracting HIV from an HIV-positive female, during unprotected sex, are something like 1 in 500. Not 1 in 2, or whatever those nurses would have told us at the time.
In other words, those school nurses were full of shit.
I understand, of course, what they were trying to do; they were assuming a better-safe-than-sorry approach. Carpet bombs, not sniper rifles. A fire hose instead of a sponge bath. The great wide net of scare tactics over the rod and reel of considered information.
I understand this because one of those nurses was my mother.
Having my mother teach sex ed. was, for the most part, a horrifying set of circumstances (imagine your mother putting a condom on a banana in front of you and your friends) but I’ll save a discussion of the long-term damage it may or may not have done for another piece of writing.
“We just didn’t know back then,” she said one day, when I made fun of her statistics from a decade before. She was right, my mother. In 1991, no one knew what HIV might do. At the time, it probably seemed to those in public health that they were the only thing standing between humanity and viral Armageddon.
But we must know more now, right? After all, our American society is a sexually aware one. We start sex education in elementary school. We seem to talk about homosexuality more than we talk about literature, history and economics combined. Our movies and TV shows are sometimes little more than soft porn interspersed with the occasional bit of dialog.
We know that we’re supposed to use condoms because we don’t want to have babies and we definitely don’t want to get AIDS. But beyond that? Guesswork. Supposition. Personal hypotheses with no more intellectual weight than a fraternity brother’s drunken stab at the year the Normans invaded Britain. (They did, right?)
This bothers me. Especially because now I have a dog in the proverbial fight; I’m not the seventh-grader I once was. Now, I occasionally find girls who want to kiss me. Sometimes – and this is not a development I anticipated back then – they even want to have sex with me.
When that happens, I use condoms, because I’m not a fucking imbecile. (The upshot of having your mother teach sex ed. at your school is that these things stay with you.)
But sometimes, something goes wrong.
And when it does, what I worry about is the STD (or STI, if you like) that probably shouldn’t have the stigma it does.
I’m talking about herpes, of course. Why do I worry about herpes? Because, while none of my friends has AIDS (that I know of), some of them must have herpes, at least if we believe those statistics floating around – that one in four or five of us has it.
If I give you a few minutes to think about that, you’ll come to the same conclusion I always do:
Wait, I’ve had sex with more than four or five people. How is it that I don’t have herpes?
I could continue to flail through the world in the state I’m in (ignorant and scared), but that seems dumb, especially because the answer is right at my fingertips, in the form of a doctor I know pretty well.
He’s a fellow in infectious disease at Cornell’s New York Presbyterian Hospital in New York City. He’s worked with tuberculosis, HIV/AIDS…and with that dreaded disease I worry so much about: herpes.
He’s also my brother, Dan.
(In my family, you’re either trying to prevent STD infection, or you’re worrying about STD infection.)
And so, because I’m tired of living in fear, and because my brother is only an email away, I sent him a note, in the hopes of some real information.
This is that note. What follows is his response.
How’s it going over there? Cured the high-five yet?
No? Okay, keep on keeping on.
I have a question.
Let’s say, hypothetically, that I’m in a city I don’t know. I go to a bar, and this girl who I thought was with her boyfriend but it turns out was not comes over and starts talking to me. She has tattoos and likes good books and we talk for a while until it gets late and she comes back to my hotel room and, whoopsydaisy, we have sex.
In this hypothetical situation, I use a condom, because what would Mom say if I didn’t…wait, I’m bringing Mom into this, gross…but the goddamned thing breaks. I don’t know when it breaks, exactly. What I do know is that morning-after pills cost $50. Did you know that? I thought they would hypothetically set me back, like, $15 at the most.
Anyway, the first thing I think of, because I am me, is:
Oh shit, I’ve got herpes now for sure.
What are the chances I would have been right? You know, if this had ever happened to me.
A girl I don’t know that much about, a one-night stand, a broken condom. Was there a bullet to be dodged, or am I only scared because I think too much?
Interesting question. Even though I’m a fan of scare tactics in the world of STDs, I will relent in this case and try to break this down as accurately as I can.
First of all, let’s go over a few background statistics.
Herpes is transmitted through skin-to-skin contact, and not through contact with fluids or blood. An exposed person can be infected with the herpes virus, triggering the immune system to make an antibody. This person will then test positive in a blood test. The number of people who test positive is called seroprevalence. This is the number that gets quoted in all those news stories you see.
These people don’t necessarily have blisters on their unmentionables – many infected people have no symptoms.
There are two important types of Herpes Simplex Viruses (HSV) – 1 and 2. Classically, HSV-1 causes those irritating cold sores everyone hears about, and about 60 percent of people are infected. HSV-2 is really what we are concerned about here, as it is the more frequent cause of genital herpes.
In the U.S. population aged 14-49 (I’m assuming this encounter was in the U.S. and the person was not a grandmother), as of 2008, 16.2 percent of all people were positive for HSV-2, according to the Centers for Disease Control (CDC). For females, the number is 21 percent and for males it’s 11.5 percent.
To answer your question about transmission, though, we should look at a study observing 1,484 couples in which one partner was positive and one was negative. Over the eight-month study, the chance that non-infected male “Paul,” in a monogamous relationship with infected girl “Rando,” became infected (blood test positive) was 1.8 percent.
If the genders were reversed – if the infected person was a male and the non-infected person was a female, the rate was 7.4 percent.
About half of those infected had blisters or burning in their nether regions and half were asymptomatic. Always using a condom decreased the chance of transmission by about half compared to never using a condom. The average number of sexual encounters during the eight-month period was 46.
In another study in which condoms were used about one-third of the time, it was found that the average number of sex acts before transmission from infected to un-infected partner was 40.
So, to answer your question in an objective way, we need to take the 1.8 percent chance of becoming infected as a male if the female is infected, divide that by five since one in five females is infected, and divide that by 40 since we are talking about a singular sex act.
The result is 0.009 percent.
In other words, about one in 10,000.
This is decreased more by the fact that an observant sex actor would see blisters and bail out, and even a broken condom might protect against some skin-to-skin contact.
As you can see, this is not a big risk. Remember, though, that the risk increases if condoms are not used, if the partner is of the especially “experienced” or “willing to accept money for sex” variety, or if you are in a higher-prevalence area such as certain inner cities/other countries.
So, even though the odds were against you coming out of this hypothetical encounter with herpes, and as I tell the teens who come into clinic after a weekend of fun, or my other brothers:
Herpes is forever.
When I first read my brother’s note, I breathed a sigh of relief. Not because of the encounter in question because THAT WAS HYPOTHETICAL, I PROMISE, but because, well, 1 in 10,000? That’s not so bad.
But then I started thinking about that number. Would I play the lottery if the chances of winning were 1 in 10,000? Probably. Would I sleep well if the chances that my house was going to burn down were 1 in 10,000? Probably not.
What I’m saying is that 1 in 10,000 isn’t much if you’re Wooderson from Dazed And Confused and anxiety is as foreign to you as Myanmar. But if you’re me, and your entire existence is steeped in unnecessary worry, well, it doesn’t sound great.
I guess what I mean is this:
I’m glad I have the information now. I’m glad that, if I had sex with a girl with herpes, the odds that I’d soon need to check my parts for blisters would be 1 in 56, and that I’d have to have sex with her 40 times before I reached even that level of probability. I’m glad that, if I did catch herpes, it wouldn’t be life threatening or all that tragic.
But I am my mother’s son, and I am my brother’s brother.
And that means that I probably won’t stop worrying until my hypotheticals become impossibles.
Probability is a strange beast. It’s great for the masses, but not so great for the individual.
So be safe out there, kids. Use a condom. Get checked. Consider monogamy.
You’re probably not going to die from HIV (especially now, what with recent advances in treatment) and you probably won’t get herpes.
But that doesn’t mean you should be stupid.
Like Dr. Dan says, it may only be one in 10,000.
But that one is forever.
For more from Paul…
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