Q: My doctor just told me that I have herpes. I don’t know if I got it from my last boyfriend or the one-night stand I had after we broke up. I'm so upset, I feel like I never want to have sex again. What should I do?
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A: I understand how upset you are. The diagnosis of herpes has a major psychosocial impact on many people. A 1999 telephone survey by the American Social Health Association found that adults age 18 to 39 considered receiving a herpes diagnosis to be more traumatic than being fired from a job, breaking up with a significant other, or failing a course in school. The knowledge that once this virus is in your system it can persist and cause recurrent lesions and/or infect a sexual partner becomes overwhelming.
But let me try to reassure you. The diagnosis of genital herpes should not “single you out” or impugn your self respect. This sexually transmitted virus is present in a very large group of individuals over every social and economic strata. One in five Americans has been infected with the herpes simplex-2 virus (or HSV-2), the most common cause of genital herpes; moreover, 90 percent of them are unaware that they have it! HSV-2 can be shed and passed to a sexual partner in the absence of a lesion. It's this ignorance of past or present infection that has made it so prevalent; most individuals don’t go around having unprotected sex while they have an open sore. They pass on the virus in total ignorance that they have ever had herpes or are “at the moment” secreting it.
HSV-2 can infect many areas in the body, not just the genitals. Lesions can appear on the thighs and buttocks, as well as the cervix and the vulva. They can even appear on the plantar surface of the foot. If they occur on the cervix, and/or if the lesions are very small, many women won't know they have it. Ten percent to 15 percent of people with herpes also experience symptoms such as a bladder infection, urinary retention (inability to pee) and flu-like symptoms.
Like many of those who actually receive a herpes diagnosis, you probably saw your doctor with a painful sore or recurrent and “always in the same place” irritation in the genital area. She or he may have thought that it looked like herpes, but for confirmation swabbed the base of the sore for a viral culture. And a positive result definitely confirms the diagnosis. However (and this is a big however) false negatives are very common when this test is employed. By the time the culture is run, the lesion may have started to heal and is no longer shedding the virus. Up to 75 percent of recurrent HSV-2 cases are not detected by viral cultures. If the culture is negative, a blood test can be performed to detect specific antibodies (called IgG) to the herpes simplex-2 virus. This is far more reliable than a viral culture and is positive more than 95 percent of the time in individuals who harbor the virus.
My experience over the years in treating women who were newly diagnosed with herpes is that they have six major concerns: Did my partner cheat on me? How did he get it? Could I have had it before I met him? Does this mean that in the future I will give it to another partner? Can I have children? Will I need a C-section? Many of these questions can not be definitively answered. It's often impossible to know if the virus was harbored in your system for months, or even years; if you're newly infected or if your partner recently contracted the virus and transmitted it to you; or if he too harbored it from the past. A positive culture or blood test may tell you that you have herpes, but it doesn't tell you when you become infected (or who to blame).
Herpes-related lesions can develop within two weeks of exposure, but you may have had the initial lesion months or years ago and not have been aware of it. Studies show that those who harbor the infection can shed the virus over 10 percent of the time, often without any symptoms or lesions. Your long-term partner, unbeknownst to him, may have had herpes for a while and for some reason only secreted and infected you now. It's important to be aware of all these possibilities before you accuse him of infidelity.
A major concern for most young women regarding herpes infection is transmission to a newborn during delivery. A neonatal herpes simplex-2 virus infection can be serious and even fatal. This, however, is more likely to occur when the mother has a first, not recurrent infection. (If the mother has already had herpes, she has developed antibodies which she passes on to the fetus, and these protect the newborn baby.) Many obstetricians also treat pregnant women with a history of herpes with antiviral medications in the last few weeks of gestation in order to prevent lesions at the time of delivery.
Most clinicians will prescribe anti-herpes medication for a first or painful recurrent herpes infection. This will shorten its duration and intensity. Medications include:
Acyclovir (Zovirax): For the first known infection, 400 mg three times a day for 7 to 10 days or 200 mg five times a day. For a recurrence, the dose is 400 mg two times a day for 5 days.
Famciclovir (Famvir): 250 mg three times a day for 7 to 10 days for the first clinical episode. For a recurrence, the dose is 120 mg twice a day for 5 days.
Valacyclovir (Valtrex). This has twice the bioavailability of acyclovir and the dosing is simple. One 1 gram tablet twice a day for 7 to 10 days is recommended for the initial infection. For a recurrence, the dose is a 500 mg tablet (or single 1 gram tablet) twice a day for 3 to 5 days.
Although there is no permanent cure, there are ways to significantly decrease viral shedding (by 50 percent to 80 percent) and alleviate some of your fears of transmission to your present or future partner. The dosing for suppressive therapy varies depending on which medication you're taking: Zovirax 400mg twice a day; Famvir 250 mg twice a day; or Valtrex 500 mg once a day.
These medications do not increase resistance in the virus. Studies show that infected patients who take suppressive therapy shed HSV-2 73 percent fewer days than those taking a placebo.
Dr. Reichman’s Bottom Line: In many ways you are fortunate that a herpes diagnosis was made, since it's not made in 90 percent of those who shed the virus. This allows you to take medication to prevent viral shedding and infection and it decreases the risk of transmitting herpes to others. You can still bear children, usually with a vaginal delivery, and you can and should continue to be a sexual person. Contracting herpes doesn't necessarily mean your partner was with someone else. Talk to your doctor and get the right care — herpes need not define your gynecologic or sexual future.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.
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