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Women's Health

Widespread Concern Living with genital herpes. By Dr. Lisa KaramardianPublished: July, 2003

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If the above title caught your eye, you are not alone. Up to 60 million Americans have the virus that causes genital herpes, accounting for one of every five adults. In fact, the spread of genital herpes is not under control these days. Genital herpes is reaching epidemic proportions with up to 1 million new patients becoming infected every year. Read on to learn more about genital herpes and how you can take steps to manage it. What is genital herpes and how is it spread? Genital herpes is a lifelong sexually transmitted disease, with recurrent outbreaks that are caused by a virus know as herpes simplex virus. Herpes simplex virus can only be transmitted by direct physical contact, so forget the myths about toilet seats or moist towels. Another common myth is that genital herpes virus is spread by patients only during active outbreaks (when they are having physical symptoms). The truth is that 70 percent of transmission may result from sexual contact during periods when the virus if reproducing even when you aren't experiencing symptoms (asymptomatic viral shedding). That only makes sense, because as I explain to patients, no one would knowingly be with someone who has active lesions. Obviously the virus is being shed at times that we are unaware of, and that is why there are so many new cases of the disease. It is important to remember that herpes is a very common disease and if you have sexual relations, then you are at risk for contracting it. Interestingly, up to 90 percent of those infected are unaware they have the virus that causes genital herpes, and therefore most genital herpes infections are acquired from a person with no history of infection. Avoiding sexual contact during outbreaks and using latex (not natural membrane) condoms between outbreaks can help reduce the risk of transmission. In some people, a first-time infection causes no or only mild symptoms. That is why there are so many people who are infected and unaware that they carry the virus. In others, the first infection is severe and symptoms can last for several weeks. When symptoms are noticeable, patients often appear at the gynecologist's office. The symptoms usually include swelling, pain, itching, and burning. The symptoms are preceded by a "prodrome", which can include fever, chills, muscle aches, fatigue and headaches. Next, tiny blisters, may appear which burst and become open sores. These eventually crust over and heal. Unfortunately, this doesn't mean the virus has left the body. The virus hides inside of your nerve cells and can reactivate itself at a later date. The average person has three to four recurrences of herpes per year. No one knows what causes the virus to reactivate itself. Different people have different triggers. For some it is physical or emotional stress, lack of rest or even sunburn. How is genital herpes treated? The first episode is usually treated with an antiherpetic medication, of which there are three - Acyclovir, Valtrex and Famvir. The first episode is often the most severe and requires medication for 10 days. Once this stage has passed, you can discuss with your health-care provider how you want to manage the treatment of recurrent episodes. You have two choices. Some patients opt for episodic treatment where they will take medication at the earliest signs of an outbreak. In this case, I usually prefer to prescribe Valtrex because it is dosed only twice a day for three days. Another option is to take what is called "suppressive therapy." With this regimen, you take medication every day to reduce the chances of having an outbreak. This may actually reduce the number of outbreaks you have and help to decrease the times of asymptomatic viral shedding. If you have genital herpes, do not be embarrassed or scared. Go to your doctor for information and advice. Remember that if you have a healthy immune system, your health should not be significantly impacted. Although there is no cure, there are medications to treat the symptoms and even reduce the number of recurrences you will have. With the right help, you can take back control of your life.

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