Answer:

This puzzler poses a common but interesting moral dilemma, not only for people like Marty, but for health practitioners as well. From Marty's point of view, his first concern might be to get well and to be somehow relieved of the burden of dealing with genital herpes. Then he has his friends and their health, his reputation, and his doctor to contend with. Whereas the doctor's first concern is Marty's health, and plenty of time should be spent sharing information about herpes and discussing how to carry on in sexual relationships without transmitting the disease to others, he or she is also concerned about the health of the public.

Both the doctor and Marty know that herpes is casually transmitted all the time, and that prevention is the only hope of controlling spread of the disease. But if Marty is unwilling to talk to his friends, what is the doctor to do about his or her obligation to society? Do we value the privacy of the individual over the health of others? How does Marty, who was victimized (hopefully unwittingly) by one of his friends, balance his desire for privacy with a moral obligation to disclose to his lovers that they may have been exposed to herpes?

Now plug HIV into the equation. What was a problem of painful sores that come and go becomes an issue of life and death. Does the risk of AIDS shift our thinking to demand that others know who has HIV, who doesn't, and who is being exposed? The HIV Act of 1996 is currently before the US Congress. It has provoked controversy in that it would allow rape victims to request that their accused rapist be tested for HIV; it would allow doctors to test patients before doing surgery without their consent; and it would require states to track down and notify every sexual contact of an HIV positive individual to notify them that they had been exposed.

Regardless of how you feel about these proposals, it is clear that a lot of issues are raised. If partner notification is required, would people be less likely to get tested and miss an opportunity for early diagnosis? Would the doctor be violating his or her vow to non-judgmentally care for the patient in confidence? If we protect the babies of HIV-positive mothers by requiring testing of them (effective treatment is available to prevent neonatal transmission of HIV), why not do the same with sexual partners?

Having pondered some of these questions, there remains the practical need to decide what to do in this case. Perhaps the best that can be done is for the doctor to make himself an ally of Marty, to provide answers to his questions, to try and reduce the fear and stigma often associated with herpes, and to suggest that there is a moral obligation to inform any sexual contacts since the onset of his earliest symptoms. One of our respondents said, "Neither the doctor nor society should pressure him. His conscience should, and I wouldn't feel any differently no matter WHAT disease it was. All STDs are the same to me. It's called lack of respect for your fellow man, not to mention yourself, to keep anything like that a secret from friends and especially potential lovers. Do not misunderstand that I avoid those with STDs, I don't. What I despise is secrecy."

The doctor shouldn't push anything; the doctor's primary task is the well-being of his patient and not to moralize. The doctor should, however, present the entire picture: how the infection spreads, and what the consequences really are (for women, untreated herpes may include the risk of infecting a newborn).

The important thing is to warn his friends -- life is hard and he has just learned the lesson. He has to tell his friends, as herpes is contagious and could increase the risk of other STDs (open sores permit easier transmission of disease -- including the AIDS virus). If it helps, it is not only his fault -- the infected partner he caught it from should have told him.