GENITAL HERPES:
Dear Sumner:
How would you handle Peter, a 38 year old man, with periodic flare-ups of herpes? He is not married, but he tells me that he has been in a monogamous relationship for the past year. I have checked him out for the “standard” sexually transmitted diseases (gonorrhea, syphilis, non-specific urethritis and HIV) all of which were negative. His fiancée, Melissa, thus far, has shown no signs of herpetic lesions. However, she is quite concerned that it is only a matter of time before she becomes infected. First of all, how can we be sure she is currently free of the disease, and what is the best way available currently to protect her? How can she tell if/when she gets the disease? Are there tests available to monitor her status? Can Peter take some medication which will prevent his being infectious?
Dear Mark:
I had quite a discussion with Peter and Melissa re the various aspects of genital herpes. I tried to address their many questions. Herein is a brief summary of our discussion:
First of all, the incidence of genital herpes is quite high; 25% of women and 20% of men are infected with the virus. Unfortunately once the genital herpes virus (HSV type 2) gets into the body, it remains in certain nerve cells for life and may be reactivated at any time. However, after the first episode, subsequent outbreaks are almost always of shorter duration, less severe, and occur less frequently. I commented that it is not known what factors cause the virus to become active, although flare-ups seem more common during times of either emotional or physical stress, , possibly resulting from an added strain on the immune system. They were quite aware that the infection is most commonly spread during the time when there is a lesion/sore, which can shed viruses, but were taken aback when I mentioned that Peter could be infectious without any obvious sores being apparent. We discussed how, with the first episode of infection, there may be associated flu-like symptoms of fever, muscle aches and malaise and that the initial small red bumps evolve into blisters and subsequently become painful open sores which become crusty. These lesions usually heal without leaving a scar. . Since they engage in oral as well as vaginal sex, I mentioned that HSV type 1, the virus causing blisters on the lips (commonly referred to as “fever blisters”) can also be spread to the genital area with oral sex.
Melissa was concerned about her current status. Although she has not seen any herpetic lesions on herself, she inquired about tests which could tell if the virus had gotten into her body, as yet in an undetected state. We will be obtaining a blood test a blood test which, by checking the antibody titer, will indicate if Melissa has ever been infected with either HSV 1 and/or 2. Unfortunately, this test is unable to determine if that person is currently infectious. Indeed, a person could have genital herpes with a “negative” titer for HSV. The only sure way of confirming the diagnosis is by culturing out the virus from a herpetic lesion. Should she become pregnant while infected with the virus, she asked about the chances of infecting her fetus. I replied that this would be likely to occur only if she had an active vaginal lesion at the time of the birth and if so, the delivery would be done via caesarian section.
