Why is Herpes So Confusing?

In the last 2 ½ years of my career as an OB/GYN, one thing has become particularly apparent… I diagnose genital herpes far more frequently than I ever thought I would.  Each time I do, there is often the need to explain the dynamics of herpes so that my patients (and/or their partners) don’t start second guessing the sanctity of their relationships.  I thought it would be interesting to blog a little about the basics of herpes to hopefully clear the air for many people. 

Herpes simplex virus, or HSV, or simply “herpes” to most people, is VERY common.  There are two flavors; creatively named Type-1 and Type-2.  Many also refer to these as oral and genital, respectively.  This nomenclature can be a bit confusing because genital herpes, while most often caused by the Type-2 virus, can also be a result of an infection with the Type-1 variety.  I recently read that AT LEAST 50 million Americans have had recognized genital herpes and that there are millions and millions more who have the virus (and can spread it), but have never had symptoms.  It is estimated that about 16% of adults in the United States carry HSV-2.  Studies have also shown that approximately 50% of adults also are positive for the HSV-1, which usually causes the common cold sore or fever blister.  If a person has a history of oral HSV-1 (or cold sores), this HSV infection can be passed to their partner’s genital area during oral sex.  The take home point here is that genital herpes is very, very, very (did I say very?) common.

Let’s break down the different types of genital herpes symptoms.  Herpes can be totally asymptomatic or it can be one of the most painful and worst genital infections out there.  It sometimes depends on whether this is truly your first outbreak, or is this just a recurrence of a previously asymptomatic infection.  Classic genital herpes presents with painful vesicular lesions, or small ulcers, on the genitals.  Sometimes you can get “viral” illness such as fevers, chills, etc.  If it is really severe , women can have very painful burning with urination.  If you think you have herpes, you should come into the office for us to verify the diagnosis (both by exam and cultures) and to initiate treatment.

Ok, so you have been diagnosed with genital herpes, and the questions start coming…

• Who gave me this? 
• How long have I had it?
• Can I pass it on?
• If I get pregnant can I have a vaginal birth or will I give it to my kid?

It is nearly impossible to know who gave someone herpes and when it happened.  And just because you get this for the first time (and let’s assume you are in a monogamous relationship and have been for some time), it DOES NOT mean that either of you were unfaithful.  You could have been asymptomatic for years even, and finally the virus decided to make an appearance.  Your partner could have been a carrier for YEARS and never known it, and may still have never had an outbreak, but could have spread the virus to you.  There is a chance that you passed it to your partner.  There are some blood tests which can determine if your immune system is responding to HSV 1 or 2 for the 1st time, but this still cannot determine exactly when you were exposed to the virus, and these results are often confusing.

Fortunately, if you get an outbreak, it is pretty easy to treat.  So let’s say you’ve been treated and now you and your partner are afraid to have unprotected sex because your partner does not want to risk getting herpes.  As I mentioned above, your partner may already have it and may have been the person who gave it to you.  Your partner may have blood work done, as mentioned above, to see if their immune system shows prior exposure to the same HSV (1 or 2) that has affected you.  If you both test positive for the same type of HSV, then there shouldn’t be any concern of “infecting” the other partner.  If neither of these are true, then there is a chance, that over time, you shed virus and your partner gets an infection.  The frequency of this viral shedding depends on the type of virus you have and also how close you are to an outbreak.  It is difficult to quantify this as a “percentage chance” for you.

If you are pregnant, or plan to become pregnant, and have had genital herpes, you can still have a vaginal birth.  The only situation that would disqualify you from this opportunity is an active outbreak at the time of labor.  An active genital HSV outbreak at the time of labor puts the baby at highest risk for contracting a dangerous systemic HSV infection.   We routinely prescribe HSV prophylaxis (meaning we give you a daily treatment of Valtrex to prevent an outbreak near delivery) beginning at 36 weeks gestation to those with a history of genital herpes.

I hope I cleared this up a little… but it is still super confusing huh?  Here are the take home points:

• Genital herpes can be caused by Type-1 or Type-2 HSV
• If you get painful little ulcers on your vagina, come in and see us to get proper diagnosis and treatment.
• Most likely neither you nor your partner were unfaithful if one of you gets an outbreak, as either of you could have been a carrier for many, many years.
• If you get pregnant and have had herpes, you can have a vaginal birth as long as there is not an ongoing outbreak.

http://www.kmobgyn.com/blog/entryid/246/why-is-herpes-so-confusing