Sex, Responsibility, & Courage

[joreth]

There's a debate going on in the comments to this article I read and it's really pissing me off.

The article is titled "Is It Necessary To Always Tell Partners About Your STD?"

In this short article, the writer mentions a friend who has herpes who hasn't had an outbreak in 8 years but still tells all potential partners about it, even though her OB-GYN said she wouldn't have to as long as she isn't currently experiencing an outbreak. Then she references an advice columnist who answers a letter from a girl who said she contracted genital warts, called her past partners to notify them, then when she talked to her boyfriend about it, he said "oh, yeah, I was gonna say something about that ... sorry!" The writer takes the position in this example that the advice columnist was right to come down hard on the guy.

But then she points out that scary statistic that says 80% of women will probably catch HPV at some point in their lives, so if it's so common and we can't avoid it, she asks, are there ever any circumstances that justify not disclosing an STD?

Most of the responses are adamantly on the side of Always Disclose, but what is pissing me off is a vocal minority of responses that say "well, yes, you should always disclose, but don't be so hard on the people who don't.  After all, it's scary to disclose".

And this just infuriates me.

"If you disclose, you'll never get laid again"
"If you disclose, no one will ever date you and you'll live alone forever"
"If you disclose, there's a social stigma that makes people not like you and that social pressure is scary"
"If you disclose, you risk rejection"
"If you disclose, you might get your feelings hurt"
"If you disclose, you could destroy a budding relationship"

And I'm supposed to be sympathetic to people in this position, apparently.

FUCK THAT.

Point 1) not all STDs are permanent.  Some are easily treatable with antibiotics and will go away in time, so this is hardly a life-long celibacy punishment.

Point 2) not all STDs result in death.  Some people are willing to trade the risk of exposure to certain STDs in exchange for what they perceive is a life-long or long-term relationship.  Plus, there is that 80% statistic, which means that some people out there have accepted that they will probably get it, so they just don't worry about preventing it.

Point 3)  There are dating websites out there specifically for people with STDs so that they can safely have sex without infecting someone else ... because their partner is already infected.

Point 4) There are things people can do to minimize the chance of infection while still maintaining a romantic relationship, including using condoms and medications for certain STDs, and limiting activity during the most contagious times.

Point 5) Non-disclosure to avoid destroying a budding relationship is hardly likely to yield better results than scaring off potential partners ... when you infect your new girlfriend and have her find out from her doctor that you lied to her and intentionally threatened her life, health, and fertility, all to get laid (as she will probably see it).

Point 6) I don't fucking care if you get your feelings hurt.  This is part of what being a grown up is all about, taking responsibility for your actions.  Some things are scary, sometimes we feel bad.  DEAL WITH IT.  This idea that we're supposed to cushion ourselves from ever feeling bad is completely ridiculous, unrealistic, and childish.  I have a news flash for you all ... YOU WILL SOMETIMES FEEL BAD.  Get used to it.

Now, this is a totally separate issue from needing to remove the stigma from having an STD (which contributes to people feeling scared) or creating better sex education for our society.  This is about someone who has chosen the path of least courage.  This is about someone who is choosing to protect their own ego or hurt feelings AT THE DIRECT EXPENSE OF THE LIFE OF ANOTHER HUMAN BEING through their actions (and by "life", I include the quality of life as well as the life itself - affecting someone's quality of life *is* affecting their life).

This is absolutely reprehensible to me.  The fact that someone might be scared is totally irrelevant.  I've been there, I've had to disclose, I've faced rejection, I've been rejected.  FUCK THAT.  Be a fucking grown up.  There is no excuse whatsoever that deserves my sympathy or compassion.

Having an STD, or any illness of any sort, earns a level of sympathy from me because of the difficulties faced with living with that illness, including public perception of said illness.

But the instant you knowingly infect someone with a potentially life-threatening illness (or even just an "inconvenient" illness) without giving them the information necessary to make an informed decision about their exposure levels, you lose not only whatever sympathy I might have had for you regarding your illness, but you lose all sympathy and compassion I have for any human just for being human.  This falls under the category of "evil", in my book.

Being "scared" does not give you a free pass.

Being a responsible, ethical, courageous person does not mean doing the right thing when it's easy.  It means doing the right thing when it's hard.  It means being afraid of being rejected AND DISCLOSING ANYWAY because it's the right thing to do.  Because if someone else had disclosed to you, then you wouldn't be in this position of potentially being rejected and feeling scared and alone in the first place.

I'm being told that, because it's so scary, that I should have some compassion for people who have to face that scariness and that I should understand why people might want to avoid disclosure.  I'm being told that not everyone is as courageous as me, and that it's not easy to learn to overcome one's fears.

FUCK THAT.  I know EXACTLY how scary it is, how hard it is, how isolating it is.  I was in that position.  And I overcame it.  The fact that some people are not as strong or courageous as I supposedly am is not a reason to allow our society to protect that cowardliness or to reward it by excusing poor behaviour.  When you done bad, you done bad.

And absolutely no reason or excuse justifies non-disclosure.  Ever.

Someone pointed out "misinformation", as in, the person doesn't understand that they are contagious and therefore doesn't disclose based on those grounds.

My rage at that person might be lessened, but not removed.

First of all, how many people do you know keep people at arms-length away before hugging when they have a cold?  They might not know exactly what's wrong with them, but they know a runny nose isn't normal and they tell people about it so that other people can choose to expose themselves to the cold virus, or the flu virus, or strep throat, or even non-contagious allergies, or not as they see fit.  People "disclose" all the time, even amid ignorance of the condition.  Yet, when it comes to STDs, people treat total strangers with more consideration than the people they want to be intimate with, by disclosing a cold but not an STD.

Disclosure and self-educating/self-education is all part of being a responsible and ethical adult.  Engaging in a sexual relationship requires being educated about the process.  Now, I might allow society, or their parents, or the church, or whatever, to share the blame in this case.  But that still doesn't absolve the person from not taking it upon themselves to learn about the activity they are engaging in.

Plus, if you're in the Abstinence-Only camp, then you're not supposed to be having sex at all, so you're a hypocrite on top of it.  But that goes back to what I prefaced this rant with - that education of the ignorant is a different issue and one I also address in other venues (such as the entire STI tag of this journal and the Safe-Sex sections of my poly lectures).

Several years ago, I began dating a guy, and I sat him down to have our Safe Sex, Sex History, & Disclosure talk prior to sharing in below-the-belt sexual activity, as is my custom.  He seemed like a reasonably intelligent person and earnest in his efforts to be responsible.  He had no problems with getting tested, with sharing his history with me, etc.  But then I started to talk about HPV, which, as my Constant Readers will know, is my little Pet Research Project, the STD I spend the most time on.  

He had no idea that HPV is what caused genital warts, or that other strains of HPV caused cervical cancer.  As I continued to talk, he got more and more nervous, until he told me the story of his most recent girlfriend.

He had been out of town for a while, long enough for he and this girl to break up and get back together.  When he came back into town, they started to have sex, and he was using his hands.  He noticed some small, hard bumps along the vaginal walls.  Naturally, he stopped what he was doing and asked her about it.  She said that, while he was gone and they were broken up, she slept with someone else and subsequently developed these little bumps, called genital warts.  But don't worry, she says, they're not contageous.  I'm taking these all-natural, herbal remedies that render them non-contageous and they'll go away soon.  Here's a pamphlet from my natureopath doctor.

Well, being a hippie-anti-Big-Pharma-conspiracy-theorist (which I didn't really understand at the time, or I would have never have dated him in the first place), he just accepted that her treatment was working, that her doctor had the right information, he didn't even read the pamphlet, and they had unprotected sex.

My jaw dropped.

I then had to explain to him (totally unable to keep the incredulousness out of my voice) that she was at her *most* contagious when the warts were present, but that she needed no symptoms at all to still be contagious, and that HPV is a virus that does not "go away" with herbal suppliments.  The only treatment is to have them burned or frozen off, just like regular warts (convenient, since they're the same virus), and, maybe, if she's lucky, the virus will become undetectable to our current testing methods approximately 2 years after her final outbreak (but you won't know it's your "final" outbreak until the next one doesn't come).  He was horrified.  He was mostly pissed at her for not researching it properly, but he was also upset at himself for taking her at her word and not educating himself about something that affects his own genitalia.  He blamed them both equally for his predicament.

Sure enough, about 2 years later, he developed warts.

As for me, I chose to maintain HPV Boundaries in place for the duration of our relationship and have since had only 1 abnormal pap smear in the intervening years (for which they followed up with an HPV DNA test, that turned out negative).

So, my point is that ignorance is not a valid excuse, because *I* am not ignorant and I asked him the kinds of questions that, even with his lack of knowledge, I was able to get his status that only a baldface lie could have hid.  I felt sympathy and compassion for him in his ignorance, but his willingness to discuss sexual safety, and my own self-education on the subject, prevented this from spreading any further.  

His ex-girlfriend, however, allowed him to have sex with her without disclosing up front that she had an STD, all mis-information aside.  If she had told him prior to their sexual encounter, perhaps with his blood flowing properly to all his organs instead of just one, he might have been clear-headed enough to do some independent research before allowing himself to be exposed to something he didn't really understand.  She intentionally engaged him in sexual activity and only disclosed after she couldn't hide it.  She might have been ignorant about the STD's contagion, but she was not ignorant about having it, and I believe she willingly hid this information out of a fear that he would reject her because of it, since they both claimed to be each other's "best friend" and they told each other "everything" (I knew both of them while they were dating).

And now *he* suffers through the fear of rejection and a limit to his dating pool because *she* didn't disclose to him.  Yet, even with his own ignorance on the subject, *I* do not suffer this same punishment because I questioned him, and I did so in a manner designed to bring us both to the same level of education on the subject, so only a lie on his part would have put me in his position.  Yet, he took the path of greater courage and disclosed the information when I removed his ignorance from him, thereby saving me from suffering the same fate.  For all his other flaws, I give him that.  He didn't, however, think to disclose his exposure in the first place - I had to ask the right questions, share the right information, for him to be aware that this was something he needed to disclose, which is part of the education problem that is a different subject, as I've repeatedly said.

Ironically, she once condemed me for having vengeful thoughts about someone who was harassing me, and for wishing harm to another human being, yet I never took any action against that other person, although I almost did.  

When I open myself up to another person, figuratively and literally, I take my responsibility for how my actions affect them very seriously.  I allow them the dignity to choose how their own life should look and what risks they should take, even if it means I risk losing the type of relationship I might want from that person.  My care and consideration is for the other person above my own desires, because what I desire above that is the happiness and safety of people I care about.  

I can't even fathom the idea of liking someone enough to want their bits and pieces inside of my own yet willfully endangering them without their input on the subject.  Part of the concept of "caring" about someone, or loving them, or even just liking them as a person is the idea that I care about their happiness and well-being too.  How can anyone rationalize "love" (or even like) co-existing with actively harming someone else?  And for the casual-sex crowd, I can't fathom allowing someone inside of me that I dislike enough to want to harm them by infecting them with an STD yet liking them enough to want those bits inside me in the first place.  Either they are a human being, deserving of being treated with dignity or respect, or they are not.  And if they are not, then why do they have access to my vulnerable parts in the first place?


And atheists & polyamorists are the immoral ones.  I've got your "immorality" right here, you fucking weak, cowardly hypocrites.

Comments

[leora.livejournal.com]

On a mostly unrelated side note... nobody told me that you're not supposed to have sex the night before a pap smear for ages (although I hear now they have better testing methods and can tell the difference). It is a tad awkward to be told you have an abnormal pap smear, but they think it's because of sexual activity. If they had just told me in advance. I'm used to being told all the things I need to do or not do in advance of an exam (like don't eat or whatever might be required).

But yes, I'm all for disclosure. I even disclose, although it's fairly obvious, that I'm mysteriously ill. We have no reason to think my disability issues are contagious. We have no evidence of contagion. We have some reason to think it's a mix of genetic predisposition and environmental triggers (like multiple sclerosis and other such diseases are). But I'm mysteriously ill, which I generally think is worth pointing out. I don't donate blood, just to be on the safe side. It seems vastly unlikely that casual or even sexual contact will harm anyone, but I figure that if there's a way to harm someone blood donation is more likely to work. I am potentially an organ donor though, mainly because I'd like someone else to make that decision and since I don't think I have any organs they can use that aren't vital for life, I do think my organs and any risk attached to them is a lot better than death.

[joreth]

This is what I'm talking about responsible people.

You have a pretty small chance of your problems being contagious, but that's not the point. People deserve to know what they're getting into and to make an informed decision about how to proceed.

In general, at least in my own social circles, poly people show much more care and compassion for other people than the population at large. We check our health status, both sexual and general, we talk to our partners, and we care what happens to them. Yet we're the "downfall" of society, immoral people who don't have family values?

It takes strength, courage, and compassion to be an ethical person, and my polyamorous, atheist, pagan, "alternative" friends have that in abundance.

Meanwhile, mainstream people mistake my compassion and outrage for "hysterics" and "intolerance" and encourage us to feel sympathetic towards people who knowingly infect others with diseases.

[summer-jackel.livejournal.com]

This.

Because I'm poly and extra vigilant, I test at least twice a year and prior to any new fluid bond, and I pretty much expect the same from my partners. I've got a hard time imagining the mindset that would not disclose an STD. Yikes.

[joreth]

Yeah, I test once a year, just prior to any new partners, and 3 months after exposure to any new partners (which, of course, can be more than once a year in total, but I think you understand that I mean annually even in the absence of the other factors). I, also, expect the same of my partners, and so far the only partner I've had who took any partners after me (while I was still with him) follows this, not because I told him to, but because he came to the conclusion that this was a good policy before he even met me :-)

Hell, my metamours call me up directly to tell me when there's anything unusual in *their* medical procedures!

And, like you, because of this, I have a hard time imagining the mindset that would not disclose, hence the opposition's position that I be more "compassionate" towards those who are scared of rejection. I just can't imagine *ever* even considering not disclosing something to a partner. Being afraid of their reaction, sure, but that doesn't necessarily lead towards non-disclosure, and I just can't make that leap to understand why it would.

I'm currently being called "intolerant" and "hateful", and even "hysterical" because I condemn anyone who knows he has an STD and doesn't disclose because I don't believe that fear of rejection as an excuse deserves my sympathy. Apparently, I'm supposed to allow gradations of non-disclosure the way we allow gradations of murder.

Yes, that's what she said.

[joreth]

The sad part is how some people are in such awe of me for maintaining these practices because they themselves cannot attain this level of personal health.

People, this should be basic health 101 here, I am not superwoman and never pretended to be. It's not that difficult to keep my pants on until the test results come in.

And when I did have casual sex prior to exchanging test results (in my younger and stupider days), it still wasn't all that difficult to keep the pants on just long enough to say "hey, just so you know, I've got this STD, you OK with that?" One-night-stands don't usually wait for the results to come in, but I still had enough time to disclose what I already knew I had.

[summer-jackel.livejournal.com]

WTF?! That attitude is...just incredibly scary. But underscores why a lot of communication about health prior to sex is so important. Dog forbid that I should ever end up sleeping with or metamours with anything that thinks like this. *shudder*

[kauainightdrive.livejournal.com]

I recently was sexually active with someone I didn't know very well--the first time I've ever done that in my life. We (as is my custom) discussed our sexual-health history before we had sex. He disclosed that a previous partner of his had genital warts, but that he had never had any symptoms. He also mentioned that after 2 years without a flareup the virus leaves your system. We used protection when we had sex.

In later conversations with him I found out some things I didn't know before which definitely would have affected the decisions I made. 1) The fact that he and this previous partner had slip up less than 1 month ago. I had assumed that he and her were an old thing--the way he tacked on the 2 year marker made it seem as if he had passed that 2 year marker without any flare ups. He meant to just tell me that after 2 years a human would be free of the disease, not that he or she was. 2) He made it sound like you WOULD be free of the disease, not you might be free of the disease, which is what I found out. 3)They never used protection in their sexual relationship. I also did not know this. More than either of the other two things, this definitely would have affected some of my sexual activity with him.

Of course I'm not exactly thrilled at all this. I'm definitely mad at myself and at him as well. He wasn't a stranger or anything like that, he is a friend of a friend, someone known and liked by many people I know. Just not anyone I knew well, and I also knew we weren't actually going to be in a relationship due to our circumstances--we live across country from each other. But now, I feel hurt and betrayed, and I fear this is going to affect my life. If it DOES, of course I'll deal with the consequences of this action, but I'd rather not have to.

It just goes to show: just because they disclosed doesn't mean they disclosed all of it. I'd never had a partner tell me they had been exposed to an STD before. I asked a TON of questions and felt satisfied with the answers. However, as our later conversation showed, a lot of the answers he gave me were actually kind of ambiguous. But for example, I asked him if he took "precautions" with this partner and he said yes. "precautions" meant "condom" to me. I don't know what the hell they meant to him, but apparently not condoms.

The whole thing is a goddamn bummer.

[joreth]

Wow, I'm really sorry to hear about that.

But that is exactly the sort of thing I'm talking about. I have a really hard time feeling sympathy for him, knowing what you have to go through because of his stupidity, malice, or ignorance (I can't say which one it was, not knowing him, but frankly, I don't care - when he contracted it, he should have done his own homework even if he was a victim of an ignorant partner like you were).

This is also why I insist on actually getting copies of their test results. Of course, there isn't a test for HPV for men, but the conversation gets *really* specific when you start involving doctors, spreadsheets, and links to the CDC and Planned Parenthood. Especially if you can get your new partner to go *with* you to get tested.

I hope very much that your body manages to fight off the exposure (which is fairly common), and now you know better about what kinds of questions to ask the next time.

If people were more responsible in general, people wouldn't have to get their education post-exposure when it's too late.

No, my sympathy lies with people like you, not people like him.

[kauainightdrive.livejournal.com]

Actually, he's a Nurse. He's pretty damn educated about this shit, as later conversations proved. Its tough not to feel like things were said in ambiguous manner with the intent to coax me into bed, though I don't actually think that's the case. I don't think this was out of maliciousness, but stupidity. I don't think he thinks of it as a big deal. First, he and his partner were together for quite a number of years and split on good terms. He told me that he felt like the risk/benefits of having unprotected sex with her were worth it to him. To HIM. He loved HER. WE didn't love each other. Maybe for HIM the risk of having unprotected sex with a person that he loved was worth it, but it's not worth it to ME to expose myself to someone who doesn't matter to me emotionally. Second I feel like he doesn't actually believe he has it. Kinda like an immortality complex. He hasn't had any symptoms, so he can't possibly have it, though it hasn't been 2 years since the last time they had sex, so there is still a possibility he has it. What I consider to be a LARGE possibility. Third, I genuinely feel like he thought he had disclosed everything to me. When we had our later conversation and I started to find out this information I sorta shrieked and said "WHHHAAAT???" and began to sorta aggressively challenge some of the things he had said before. He got a very very stricken look on his face and actually looked like he was going to cry and began apologizing for not making things clear enough, asking me if I regretted what we had done, if this was going to change things, etc etc. He also totally volunteered all this information to me, initiating the sexual-history conversation on his own. It IS a practice of mine to have it anyway, but he brought it up on his own.

Again, I don't think it was maliciousness, but stupidity. On BOTH our parts.

[joreth]

Being as educated as he is, I am doubly sorry for the emotional pain you have to go through on top of the discovery that you've been exposed. He, of all people, should know better. Lots of people feel invincible, until it happens to them. It's also quite possible, even likely, that he *will* pass the virus through his system with no symptoms, but that still leaves him as a carrier, again, something he should know better about. Since HPV has long been called a "woman's disease", that should be an indication that women tend to contract it easier than men, and he should be taking more responsibility for how his behaviour affects other people, and that includes full disclosure.

People don't seem to understand that lies of omissions are still "lies" and are just as reprehensible as other forms of lies - going back to the path of greater courage, etc.

So, even moreso, my sympathy is with you and less and less with him as I hear more details. I am truly sorry to hear about your situation and I wish more than anything I could help. I'm afraid all I can do is provide a sympathetic ear.

[kauainightdrive.livejournal.com]

Thanks. I appreciate that.

I'm trying not to obsess about it or freak out about it. First, I of course won't know if I actually have it till I get tested, which will be very, very soon. It's so annoying 'cause I just got my pap smear done, about April and now I have to have it again. Blah. Second, I'm trying to be positive and be relieved that, of possible STD's this isn't as bad as some. It's not life threatening, there is a possibility it will spontaneously heal itself, even if I suffered with it for years, and it's not painful. Third, WE did use condoms, making my exposure less, though of course it's still possible and Fourth, the community that I associate with is not one that stigmatizes STD's. While I'm certainly hoping I DON'T have one, I don't feel ashamed that I might, and I don't feel that it will affect my selection of possible partners in any significant way. Obviously, if I do end up with this, it will affect some sexual activity that I have with my potential partners in the future, but I feel hopeful that the those affects won't drastically impair my sex life. Perhaps I'm being to optimistic about the whole thing, but I'm just trying not to freak out.

[joreth]

Well, if it makes you feel better, genital warts is the only STD that I've had too. I had an outbreak when I was 17, had the warts frozen off, and never had another outbreak again. Every pap smear came back normal for the last 15 years until my most recent pap, which was "slightly abnormal", prompting an HPV DNA test that came back negative.

So, yeah, for all the STDs that it could have been, this is a pretty minor one. It's not one of the strains that will turn into cancer, it's fairly easily treated even for recurring outbreaks, and, being so common, it's not likely to condemn you to celibacy (contrary to that one asshole's comments on that article).

I don't think you're being too optimistic, I think you're being realistically hopeful. Reactions to warts are varied - I found them to be intensely itchy and slightly burning like a really bad yeast infection, but then they never came back after the first treatment. I have an ex who has a single wart that never grew to multiple warts, but that lasted pretty much indefinitely. It never went away, but it also never caused him any discomfort, not even mild itching. Plenty of women were willing to have sex with him as long as he used a condom, since it was on the tip.

So the physical complications of warts is pretty mild, comparatively speaking, and if you've got the whole social pressure thing handled, then yeah, things could be much worse. I know some of my posts about STDs emphasize the danger of STDs to encourage education and safe-sex practices, but really, things could be much worse in your case.

[aclaro.livejournal.com]

My only addition is that I think people who get cold sores should disclose that.. and people who have never had a herpes test should probably assume they have it. It continues to drive me nuts that people think genital herpes is OMG the end of the world and don't even consider oral herpes even though often it's the same strain of the virus (and most people who use a condom aren't using a dental dam which means they are much more at risk for the oral kind).

[joreth]

I completely concur. That's why I finally saved up the money to get the Herpes test even though I've never had any known exposure. I admit that the Herpes test will only be part of the annual exam, not the pre/post exams unless I suspect being exposed, partly because of money, partly because the doctors continue to make it difficult to get tested without a sore present, and partly because I *do* ask the questions about cold sores and stuff. But, I also notify my partners during the disclosure talk what role the Herpes test takes in my procedures and allow them to decide if that's sufficient for them or not.

There was a bit of debate about that in the comments of that article too, about how "oral" herpes wasn't as bad as "genital herpes" vs. "you idiot, there isn't 'oral' vs. 'genital', there are 2 different strains which happen to be more common in one area than the other but can still affect both".

I was too riled up about the "but have sympathy for those poor people who don't disclose because it's so scary for them!" to launch into that debate too.

[aclaro.livejournal.com]

I can probably concur, anecdotally that if you get the oral strain genitally it's mild, goes away, and doesn't seem to ever come back. However if you get the oral kind orally, well it can kind of suck, with multiple flare ups a year on your face. What bugs me is A) people don't care about that at all and B) people don't even think about getting it through oral/genital contact. Most people who have it will be asymptomatic their entire lives, and many people will pass it through asymptomatic shedding.
So actually this doesn't make me feel like everyone should be freaking out about cold sores - but rather that they should stop freaking out quite so damn much about the genital strain, so at least to be consistent. ie. don't have a rule that you will never have intercourse with someone who has herpes - and then have an open rule about kissing and oral sex with anyone, regardless of status.

[dorklord07.livejournal.com]

My own personal problem has always been with HPV.

A partner of mine was tested for it, and came back positive for a cancer causing strain, one of the ones that isn't immunized against. So I erred on the side of caution and told all possible sexual partners what was up.

Until a while ago, I didn't think about changing this. Then I started thinking logically: chances are good that I have HPV, most likely oral and genital, of a kind that will, most likely, never effect me. Currently, and for the foreseeable future, I cannot be tested to learn if I actually do have HPV or not. So, HPV generally decreases to below-measurable levels after 2 years; but what if it doesn't? I don't know, I can't tell. Therefore, to be cautious, I would have to inform every sexual partner for the rest of my life.

Well, let's continue to follow this train of thought: the statistic is that 75-90% of all people have or will become infected by HPV, and men cannot be tested for it. So, chances are pretty damn good that 8 out of 10 people that you've slept with have HPV, of one form or another, whether they know it or not. Therefore, the same reasoning that brings me to inform others of my possible status should bring you to the same conclusion that you should assume that the majority of the people you have sex with have HPV.

Now, chances are better that I have HPV than random Joe on the street, but not by much. A study was released recently that HPV and rough kissing appear to be linked, meaning that the HPV barriers of 'no fluids, no genital skin' may not even matter, given that you biting your boyfriends lip means maybe you just gave it to him, but either way, HE'LL NEVER FUCKING KNOW.

There was something I read somewhere (I know, awesome sourcing Josh) about a group of people at the CDC looking to get the 'STI' tag removed from HPV, due to the amount of research coming out that makes it barely harder to transfer than Mono.

So, I, Joshua Simpkins, MAY have a symptom-less disease that we still don't know all the ways it can transfer. It could be as easy as regular old common warts, and I've been giving it to everyone I've kissed or shaken hands with after I've rubbed my balls (and chances are pretty good, that's most of you). And, once again, chances are pretty good that you'll never know if I've given it to you. I don't know, you don't know, and chances are pretty good, we never will.

I still disclose my 'STI status', if you can even call it that (Hey! I know you like me, but I may have a symptom-less disease that isn't even considered a threat to people under 30 and I may have given to you by shaking your hand!). I'm planning on waiting until Jessa turns up negative to stop, as that's something that I find morally right to do.

But I still don't know, and will never know, when and where I am HPV positive, or who I've given it to. Hell, I don't even know if I can give it to people, or if I give to everyone I cough on. But HPV is one STI I can understand people not disclosing. Not of the warts kind, mind you: but of the symptom-less kind in males, with that wonderful 'who the fuck knows?' property about it.

It gets to be really rather FUCKING ridiculous at times.

[joreth]

It is ridiculous, and I'm in favor of removing it from the STI list. If mono isn't on the list, HPV shouldn't be either. I caught mono when I was 11/12-ish, and I was teased mercilessly because the boy next door had it before me, even though he and I hated each other at the time and most certainly were not doing any kissing for me to catch the "kissing disease", but I probably did catch it from him since I didn't know anyone else who came down with it. Or maybe we both caught it from the same carrier who wasn't exhibiting any symptoms.

However, I'm still in favor of disclosing that you have a known exposure to it, which is significant compared to other men whose partners have regular normal pap smears. Although it's true they could have it and just don't know it, the fact that their partners are currently testing negative for it is significant. Because it's not *really* a symptomless strain, it's still a cancer-causing strain, that you, in particular, are not currently showing symptoms. You *may* get cancer from it yourself in the future (it's just that the number of men who actually develop cancer is proportionally lower than the number of women who develop cancer, which is also a fairly low number all on its own), but in the meantime, yes, you wouldn't know if you have it at all unless Jessa tests positive for it. Then you could assume you have it for roughly 2 years after your last contact with her (or 2 years after her first clean pap smear/DNA test if the contact is ongoing).

Even moreso once the HPV DNA test becomes more routine. At the moment, private physicians are supposed to be testing for it automatically after age 30, and anyone who has an abnormal pap gets it too, so regular male partners of women in these categories *can* safely assume they don't have it (or have it to undetectable levels, which in a practical sense, amounts to the same thing - especially when these qualifications are also addressed during the disclosure discussion).

Hell, I disclose when I have a cold or strep throat before hugging or kissing people, so why should a known HPV infection/exposure be any different? And as I said elsewhere, my metamours and I (for those partners who are all fluid-bonded) discuss all our health stats, including when we have a yeast infection, because that can be contagious too. It's not going to kill us, and we tend to get them fairly regularly, but we still disclose illnesses that can be passed on.

Plus, it brings up the conversation of STDs and safe sex practices and your knowledge of the subject and all its quirky details allow you to make sure you ask all those annoying detailed questions that have slipped by so many people and gotten them in trouble, like my reader above.

[dorklord07.livejournal.com]

The problem would be with men with no other female partners, of course. Or with female partners who have HPV, but don't know it, due to not having significant levels of the virus at the time of testing.

It looks like the reason why the ACS, the AMA, the CAP, and the CDC all recommend against getting the HPV DNA test under 30 is to fight that stigma of HPV, not so much by attacking the cultural values, but more by not stigmatizing 90% of the population. Especially since there's still much uncertainty about where the virus comes from and how it spreads. From all the material I'm reading, the conclusion seems to be that HPV infections in women under are common and generally harmless. Of course, this information will probably change, too, right after we all find out that green vegetables naturally contain lead.

It comes down to this, with me: at what point does statistics overcome morals? My partner from Tennessee is coming to visit this weekend. There is a chance she could die in a car crash while doing so. Am I morally at fault for asking her to come visit? Chances are good she won't, but chances are also good she won't develop cervical cancer from catching HPV at this point in her life. At what percentage point do we place our morals?

[dorklord07.livejournal.com]

On a side note, Brittany and I maintain HPV barriers. However, since it looks like HPV is related to rough kissing, maybe we didn't.

[joreth]

of course you're not morally at fault for asking her to visit, but you would be if you knew someone had tampered with her car first & didn't tell her.

Your position is fairly simple. You tell future partners that you were exposed on X date and let them decide for themselves. It's not your place to decide for someone else how "risky" those statistics are. You are different from other men in that you know for a fact that you were exposed. Some other men don't.

[joreth]

Also, it's not 8 out of 10 people that you've slept with have HPV, it's 8 out of 10 people that will catch HPV at some point in their lives. It's entirely possible that all 10 of those people are HPV-free at the time of your contact with them.

[dorklord07.livejournal.com]

It is entirely possible, but as the number of people you have sex with approaches infinity, the percentage of them that have HPV will approach 75-90%. Obviously, nobody's had sex with an infinite number of people, no matter what Wilt Chamberlain claims, but the statistic is still rather high.

Add in that I'm working with a different age group than yourself and a few others (the young 20's set) where HPV is much more prevalent and much more undetected, and then throw in the precautionary principle applied above...

[aclaro.livejournal.com]

I don't find the disclosure to be too difficult. "I had an abnormal pap in 1997 and 2008" - or, "my girlfriend at the time had an abnormal pap in 2004, and my current girlfriend has had abnormal paps for the last year and a half." That kind of thing.. the fact is, while it is pretty ubiquitous, it's pretty much a guarantee that if someone in your sexual network had an abnormal pap, that you're going to get one too. That not being the case, it's kind of amazing how often you can avoid it. It's good to get a heads up before you make your decisions. I will say that there shouldn't be any stigma attached to it. I personally, would never let HPV stand in the way of forming a fully sexual relationship with a *regular* partner. I would probably say no thank you to a one night stand or highly sporadic sexual relationship if I knew it was going to result in HPV transmission.
It's not so much that OMG HPV is going to kill you, it's that it can be a massive hassle, and very expensive to treat - especially if you don't have insurance. One night of sex would probably not be worth it to me, and I'd be pissed if someone witheld that kind of information.

[violet-flames.livejournal.com]

I have far too many thoughts about this to organize coherently, but yes I'm all for full disclosure. I'm also all for assuming there's a good chance that full disclosure won't occur through some combination of omission (intentional or not), miscommunication, deceit, or simply not having a complete and/or accurate sexual history of former partners.

The real interesting thing to me is the HPV DNA test stuff, which I didn't know a lot about since I don't believe it was used as frequently when I was doing HIV education.

My first thought upon reading the guidelines that women over 30 be tested for HPV with a DNA test, were that the guidelines were based on some assumptions that don't necessarily apply to poly women. I pondered that for a bit, and then figured out that I should see if there was a good positive predictive value for the test and there appears to be. http://jnci.oxfordjournals.org/cgi/content/abstract/djn444 This article actually suggests it would be better to do the DNA test first and then follow up with a pap if necessary.

All that to say, I learned something new today. :)

[joreth]

You are correct, they're just having a hard time convincing doctors to do it in that order, since they spent several generations pushing the pap smear. I've been trying to convince my doctors to just skip the pap and go straight to the DNA test, but since I use clinics and Planned Parenthood, not private physicians (no insurance), they just flatly refuse - clinic policy that is set at the government level and there's no arguing against that.