The heartbreak of Herpes

So let’s start with Herpes type 1. It is estimated that 50-60% of Americans are infected and about 50% are asymptomatic carriers. Usually type 1 is found orally and is usually contracted in childhood from exposure to an infected adult through nonsexual contact. However, if you don’t already have Herpes 1, you can get it genitally from oral sex given by an infected partner. Asking a potential partner if they get cold sores is a good indicator of Herpes type 1 if they say “yes”; however, a “no” answer does not guarantee that s/he doesn’t carry the virus.

If you get cold sores it’s pretty safe to assume you have Herpes type 1. That means that you can’t get it again in another location. It also means that you can give it to a negative partner either orally by kissing or genitally through oral sex. If you do get genital Herpes type 1, there is good news. Firstly, you usually have only one outbreak. It tends to recur only about 14% of the time (much less often than HSV 2 infections). Second, many of your future partners will have Herpes type 1 already (remember that 50-60% statistic?).

Herpes type 2 is much less common, but it’s still out there. It’s estimated that 28% of New Yorkers, and 22% of people nation wide, have Herpes type 2. The real kicker is that same study found that 88% of these individuals had no idea they carried the HSV 2 virus. Herpes type 2 is usually genital, but as with Herpes type 1, it can “move” with various sexual practices to a partners genitals, mouth, or anus. Prior infection with Herpes type 1 also leads to a three-fold increase in asymptomatic Herpes type 2 infection….that is not to say that you are more susceptible to Herpes type 2 if you already have Herpes type 1, but you are more likely to be an asymptomatic carrier of Herpes type 2 in that scenario if you do become infected.

Transmission between adults needs what is termed “intimate” or “sustained” contact. Sharing a glass or a towel with some one who has herpes is not going to get you infected. (No, you can’t get herpes from a toilet seat) Kissing (not a quick peck on the lips), oral sex, anal-penile sex, vaginal- penile sex….These are the activities that can lead to transmission.

On average, symptoms appear about 4 days after exposure (range two to twelve days). Symptoms tend to be more severe in women than in men. Other symptoms in these first time outbreaks include: fever, body aches, headache, local pain and itching, pain on urination, and painful lymph nodes in the groin area.

When some one comes to our office with lesions, we culture them and send blood tests. A positive culture is real and reliable, however a negative culture does not mean you don’t have it . The false negative rate for cultures is high. There are other types of tests available, but they are quite costly and not widely used. We are looking into their availability for our patients. The blood tests let us know if this is a new infection or something you may have carried for a while. We test for both Herpes types by culture and by blood to help figure out which virus is responsible for the outbreak.

Finally, with either type of Herpes, the old teaching that if some one does not have any symptoms they cant pass it is just not true. People with no symptoms still have what is termed “asymptomatic shedding” of the virus that can infect a susceptible partner. You are way more contagious with active lesions, but you are still contagious without them. On average a person with HSV 2 will shed virus 15-30% of the time.

Treatment for Herpes is usually Acyclovir, or Valtrex (Valacyclovir) (almost the same drug, but you don’t have to take it as often). Topical acyclovir has been show to be marginally useful. Treatment does not cure the virus, it just makes the outbreak less severe and shorter. For those who get frequent outbreaks suppression therapy can be used as well. Suppression therapy can decrease the frequency and severity of out breaks; its also important to remember that outbreaks get less severe and less frequent with the passage of time….really!

So, how to prevent getting / giving herpes? The best we have is condoms. Condom use has been associated with an approximately 50 percent reduction in transmission of genital Herpes type 2 infection. However, transmission of genital herpes still remains a possibility even with consistent condom use because the virus may live in areas not shielded by condoms. In couples where only one person is genital herpes positive, suppressive therapy reduces the risk of transmission of the infection to the uninfected partner, but not 100%. Circumcised men tend to have a reduced risk of transmission as well. If the presumed uninfected partner has actually never been tested for Herpes of either type, s/he should be before the infected partner commits to long-term suppression therapy. Regardless of what you use to decrease transmission, it is really important to be honest with your partner. It would be a terrible breach of confidence to have sex with a new partner, not reveal that you have Herpes, and then end up giving it to them.

The CDC does not recommend routine screening, so lots of people have it and don’t know. I must say that in our office we do screen for herpes when our patients as to be “tested for everything”. The problem is the possibility of a false positive test and for that reason, whenever the lab gets a positive blood test, we ask them to run an additional confirmatory test. If results are border-line, we repeat everything in 2-3 months. If we are still completely baffled then we refer to an STD center in the Bronx where yet more testing can be done.

The truly troubling part of Herpes is not the disease itself, but the mental anguish that often comes with it. Even though literally millions of men and women have herpes on their genitals (of either type), the stigma remains HUGE. I have patients who are so ashamed and traumatized that they stop dating for years after being diagnosed. Many of you express a sense of feeling dirty and unfit as a partner as a result of the diagnosis. The conversation that you have to have with partners is also so hard. In warning a potential partner that they may contract herpes from you, you lay yourself open to rejection. All of this is so, so difficult. Yet, it is important to remember that there are so many women who get herpes and still date, form long-term relationships and, yes, even marry.

So, please, try not to let this virus take over your life and destroy your self esteem. Having it does not take away the fact that you are smart, beautiful, funny, and worthy of respect.