You can have herpes and pass it on without knowing it.

Genital herpes is very common and under-diagnosed. A visual examination is simply not adequate. Mistakes can be made when "just looking" because some things look like herpes that are not--and herpes can look like other things. About 90% of people with genital herpes don’t know they have it and can infect their partner, who may not know they have become infected. Getting properly diagnosed is extremely important.

Screening for sexually transmitted diseases does not routinely include herpes simplex virus (HSV) testing, so sexually active adults need to specifically request HSV testing from their healthcare provider. It is even more important now that studies have proven the link to HIV. Genital HSV-2 infections double the risk of acquiring HIV, the virus responsible for AIDS.

Talk to your healthcare provider about the latest laboratory tests used to diagnose and type herpes simplex virus, in the presence or absence of symptoms.

There are two types of herpes virus, HSV-1 and HSV-2. An accurate diagnosis involves either a positive culture that has been typed (1 or 2), or a blood test that accurately distinguishes between types 1 and 2. Cultures frequently give false negative results in patients with recurrent infection or with lesions that have begun to heal. Therefore, type-specific blood tests are often necessary for confirming the diagnosis and treatment decisions of genital herpes. Knowing which type of herpes you have will enable your healthcare provider to suggest what treatment options might be best for you.

Herpes is a manageable disease.

A positive diagnosis of genital herpes is understandably difficult for several reasons: social stigma, fear of getting pregnant and infecting the unborn child, not knowing who caused the infection or how it occurred, not knowing when transmission of the infection is possible, knowing it increases the risk of HIV, and knowing that this is a life long disease.

However, with an accurate diagnosis and the appropriate treatment, men and women with herpes can lead normal lives.

• Herpes is not life threatening
• Herpes is not linked to cervical cancer
• People with herpes can have rewarding sex lives
• Couples with herpes can have healthy babies

As nearly a fourth of the US adult population has genital herpes, newly diagnosed men and women need not feel alone with their disease.

In addition to the counseling available through many healthcare providers, support groups and comprehensive online resources can help individuals effectively deal with the physical and emotional issues associated with this disease.

Meet Your Host
Terri Warren, RN, MS, ANP
Owner, Adult Nurse Practitioner
Westover Heights Clinic
Portland, Oregon

As both nurse practitioner and a person with a masters degree in counseling, Ms. Warren helps patients learn to live with genital herpes. The Westover Heights Clinic in Portland, Oregon, which she owns, specializes in the diagnosis and treatment of sexually transmitted diseases with a focus on genital herpes. She frequently speaks to healthcare providers and patient groups on the challenges associated with the diagnoses and treatment of herpes. In addition to her clinical responsibilities, she is the host and responder at the WebMD herpes message board site. Ms. Warren offers frank advice on how to deal with the emotional and relationship issues associated with genital herpes.

Herpes Facts

The Herpes Virus Family

There are eight herpes viruses currently known to infect humans. The most common is herpes simplex virus type-1 (HSV-1) which is generally associated with cold sores, fever blisters and occasionally genital herpes. The other is herpes simplex virus type-2 (HSV-2), most commonly associated with genital herpes and occasionally oral infection. Herpes simplex viruses are contagious and are transmitted through physical contact. Herpes is not a life-threatening disease, but it is a lifelong disease and symptoms can recur at any time.

Recognizing Signs and Symptoms

Herpes symptoms can be difficult to recognize if you are unaware you have the virus. In fact, some patients do not experience any symptoms at all. Shedding (multiplying of the HSV virus) can occur in the absence of symptoms through genital secretions. One study found that 70% of people get herpes from a partner who is unaware they have active herpes at the time they transmit the disease.⁽⁶⁾

• itching
• burning
• redness
• chaffing
• rash
• vaginal discharge
• bumps

Patients and physicians can also confuse symptoms with different diagnosis:

• Vaginitis
• Yeast infection
• Ingrown hair
• UTI/Bladder infection

• Zipper burn
• Jock itch
• Ingrown hair
• Hemorrhoids

It is important that you share with your healthcare provider the symptoms you have experienced or are experiencing, this will aid in your diagnosis and treatment.

Almost 90% of patients that have HSV-2 will experience an outbreak in the first year. On average HSV-2 positive persons may have 4 outbreaks annually.⁽¹¹⁾ Once infected, the virus will remain dormant until it is triggered again. It isn't clearly understood what may trigger the virus but it may be attributed to stress, menstruation, vigorous sex, or a worn down immune system. Once the virus begins shedding, the outbreak may occur at the same site as the initial infection or spread to neighboring areas. Lesions or sores will last for 7 to 10 days, however each individual may be different.

The rate of frequency of symptoms can be uncomfortable, annoying and create anxiety. To reduce the frequency of outbreaks, suppression therapy options may be available.

Getting Tested - Should you?

Visiting a physician or STD clinic for an STD screening can be a difficult and overwhelming experience. It is important to openly speak with the physician about your sexual history and the tests that will be performed. Some physicians and STD clinics DO NOT offer herpes testing as part of the routine STD screening.

CDC states that at least 45 million Americans have HSV-2, and there are up to a million new infections each year⁽²⁾. Of the 1 in 5 infected with HSV-2, 90% are unaware they have the virus⁽⁵⁾.

African American women have about three times higher risk of acquiring HSV-2 than Caucasians⁽⁸⁾.

Anyone who is sexually active, no matter how many partners, may be at risk for acquiring a STD. There is no clear formula for who is the most at risk, however if you are sexually active, then it is important to know your and your partner's HSV status.

In recent years, studies have associated a synergy between HSV-2 infections and an increased rate of becoming infected with HIV. The herpes virus can act as a portal for HIV and increases individuals chances of acquiring HIV by two to three times. Additionally, HIV positive patients have a worn down immune system and have a harder time fighting off infection so a HSV-2 infection will increase the progression of HIV.

Pregnant women also need to know their HSV status so they can reduce the risk of passing the virus to their baby during delivery. Neonatal herpes is very serious and can lead to infant mortality. Women who have tested negative for HSV-2 and have had no symptoms should also know their partners status. Should pregnant women become infected near labor, there is increased risk of neonatal herpes. Often a physician will recommend a cesarean section to HSV-2 positive pregnant women to avoid passing the virus to the infant.

Diagnosis Guidelines

Any person who has been sexually active may have contracted genital herpes. You should see your healthcare provider about being tested for genital herpes if any of the following apply:

• More than five lifetime sexual partners
• A partner with known genital herpes
• Pregnant and you or your partner have had more than five lifetime sexual partners
• Any recurrent lesions or symptoms in the area of the genitalia
• A history of STD or HIV infection

CDC Sexually Transmitted Diseases Treatment Guidelines
(as printed in the Morbidity and Mortality Weekly Report)

CDC Guidelines excerpts**:

"...the clinical diagnosis of genital herpes should be confirmed by laboratory testing. Both virologic tests and type-specific serologic tests for HSV should be available in clinical settings..."

"Because false-negative HSV cultures are common, especially in patients with recurrent infection or with healing lesions, type-specific serologic tests are useful..."

"...older assays that do not accurately distinguish HSV-1 from HSV-2 antibody, despite claims to the contrary remain on the market."

"...serologic type-specific gG-based assays should be specifically requested when serology is performed."

The MMWR series of publications is published by the Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), US Department of Health and Human Services, Atlanta GA 3033.

**Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006. MMWR 2006;55(No. RR-11):[page 16].

To view the complete report, please go to:
> http://www.cdc.gov/STD/treatment/2006/rr5511.pdf

Laboratory Tests

Ask to be Tested?

Diagnosing genital herpes by physical examination alone is difficult for your healthcare provider. For this reason, laboratory tests can be useful for helping to diagnosis and will help you and your healthcare provider determine what actions need to be taken to manage your symptoms and help you prevent transmission to a sexual partner or unborn child.

Laboratory testing is required for an accurate diagnosis.

The following information will help you take an active role in your diagnosis and treatment. When visiting your healthcare provider it is important to disclose how long you have had the sore or lesion and if you have experienced symptoms previously.

• If you have genital lesions or sores at the time of your physical exam, a swab of the lesion may be taken and sent to the laboratory for viral culture.


• If your lesions are healing, your symptoms are unclear, or you are sexually active but do not have symptoms, a blood test may be performed to confirm infection.

Some healthcare providers can test in their office with the HerpeSelect Express rapid HSV-2, this provides results in about 15 minutes from a finger stick.

HerpeSelect® Tests

Ask for it by name

HerpeSelect is the brand name of HSV diagnostic test kits manufactured by Focus Diagnostics. Make certain that your healthcare provider orders an FDA-cleared type-specific test (glycoprotein-G based assay) for your herpes test.

Some healthcare providers can test in their office with the HerpeSelect Express rapid HSV-2. Should this test be available the physician will obtain a sample from a finger stick and apply it to the HerpeSelect Express device and results can be provided in about 15 minutes.

HerpeSelect assays are designed to aid in the diagnosis of:

• Sexually active adults, with or without symptoms, who could transmit the virus to a sexual partner.
• Expectant mothers, to reduce the risk acquiring an infection near labor and transmitting the infection during labor.

Treatment

While there is no cure for genital herpes, there are treatment options available. Talk to your healthcare provider about the treatment option that is best for you.

Treatment with antiviral medication can help control the infection in one of three ways:

First episode: a 7 to 10 day course of oral antiviral medication, such as acyclovir, can dramatically shorten the duration of the first episode and lessen the severity of symptoms.

Episodic therapy: when taken at the first sign of a recurrence, oral antiviral medication can help reduce the duration of the symptoms and discomfort of an outbreak.

Suppressive therapy: continuous daily treatment with smaller doses of oral antiviral medication can suppress the virus’ activity and reduce the number of recurrences.

Medications: acyclovir [ZOVIRAX®] and valiciclovir [VALTREX®] made by GlaxoSmithKline; and famiciclovir [FAMVIR®] made by Novartis.

Frequently Asked Questions

I think I have genital herpes. Is it necessary to get tested?

Yes. It is important that you seek testing from your health professional so that you can be properly diagnosed. If you are diagnosed with genital herpes, you and your physician can discuss ways to manage this disease and reduce the risk of transmission to your partner or baby, if you are pregnant.

How is herpes diagnosed?

Health professionals diagnose herpes by taking your medical/sexual history, performing a clinical examination, and ordering laboratory tests. The presence of herpes virus can sometimes be determined from a swab of an active lesion (sore). A blood test (serology) can determine if you have herpes, even if you don’t have symptoms. Newer serology methods utilize highly specific technology that can determine if you have herpes type-1 or type-2 (genital herpes).

Can you spread genital herpes when you are not having an outbreak?

Yes. Genital herpes can be spread even when there are no visible signs of outbreak. This is called asymptomatic viral shedding. Most people contract genital herpes from an infected partner who has no symptoms.

If I become pregnant and have genital herpes, can I transmit it to the baby?

It is possible to transmit infection to your baby if you become infected during pregnancy or if you have an outbreak at the time of delivery. Your healthcare provider can discuss ways to reduce the possibility of transmission to your baby and carefully monitor you for symptoms during your pregnancy. Women with genital herpes can have healthy babies.

Is there any connection between AIDS and herpes?

Genital herpes, and other genital diseases that produce sores, increase a person’s risk of getting HIV if they are sexually active with an infected (HIV) individual. People who have both infections have more frequent symptoms and shed virus at a much higher rate, thus increasing the likelihood of transmitting infection. 

Who gave this to me?

If you have been sexually involved with more than one partner, it will be difficult to determine the source of infection, as genital herpes infection can be spread even when there are no visible signs of outbreak. As genital herpes infections are often asymptomatic or symptoms go unrecognized, it will also be difficult to determine when you were first infected. Over 50% of people contracting herpes get it from a partner who is unaware they have it.

What do I tell my partner?

It is important to share this information with your partner before you become sexually active. If this has already happened, there is a very good chance your partner has already been infected and needs to visit a healthcare professional for diagnosis and treatment. The best approach is to be direct and honest. Carefully think of the words you will use and deliver them in a frank, open manner that will lead the way to further discussion about your sexual relationship. Since herpes is just one of many sexually transmitted diseases, and the consequences of some are more grim than herpes, this dialog is necessary to built the trust and commitment needed for a relationship.

Where can I get more information about herpes?

The American Social Health Association has a Herpes Resource Center to assist people with herpes. There is a quarterly newsletter, called The Helper, a telephone hotline, and information about local HELP groups.

For more information, send a self-addressed, stamped envelope to:

National Herpes Resource Center
American Social Health Association
P.O. Box 1327
Research Triangle Park, NC 27709

Herpes Hotline
1 (919) 361-8488

> http://www.ashastd.org/hrc

Or

> Call the CDC Sexually Transmitted Disease National Hotline
at (800) 227-8922