Of all the sexually transmitted infections (STIs), Herpes simplex virus-2 (HSV2) may be one of the most misunderstood, according to Beth Oller, MD, a family physician who specializes in women’s health and obstetrical care in Stockton, *KS.
She feels it’s important that physicians understand some of the common misperceptions that patients have about herpes in order to help them get the best care.
“One of the biggest [myths] about herpes is that patients had to have gotten it from their current partner. Actually, herpes can activate years after you initially came into contact with it,” Oller says.
This can lead to confusion and frustration between partners that may be unnecessary, Oller says. “I have a patient with a severe primary herpes outbreak who has been married for seven years. I don’t think her husband is cheating on her. She could have brought it into the relationship from a prior boyfriend.”
Herpes can lay dormant for decades, Oller says, though that is less common. Stress and lowered immunity can cause the virus to activate suddenly. More commonly, people get their primary outbreak within two to twelve days after exposure. That first exposure can last quite some time, she warns, from two to four weeks. Later outbreaks tend to be less severe.
Though condoms may protect against lesions directly on the genitals, herpes can still be passed along even with condom use because it can also affect the upper thighs, scrotum and rectum. Herpes is more common in women, where it can show up on the vagina, cervix or urethra. “Women seem to have more intense outbreaks probably because we have more of that muco-cutaneous tissue.”
Oller says that for patients who know they have the virus, they should refrain from sexual intercourse or contact during an outbreak until lesions are completely healed, and to use condoms after that. It’s also important to realize that while HSV2 tends to prefer the genitals and HSV1 tends to prefer the mouth in the form of cold sores, “Both can go both places,” Oller warns. So it’s safest to avoid contact with open lesions of any kind.
Herpes symptoms are not all the same, either. Some people feel a burning or tingling sensation preceding the outbreak, while others experience symptoms like a cold or flu coming on. One of her patients was treated erroneously for a urinary tract infection, experiencing fever and chills and burning when she urinated. When she didn’t improve, Oller saw immediately through a pelvic exam that herpes was the true cause. Still others may carry the virus without any symptoms at all.
Unlike other STIs, the Centers for Disease Control and Prevention do not recommend a regular test for herpes for a number of reasons, Oller says. “Herpes is not life threatening [except to infants] and diagnosing genital herpes has not been shown to change sexual behavior.”
Oller will test patients who are concerned about having been exposed. “If somebody is wondering what they should do, I suggest they talk to their doctor and together they can make the decision on whether they need the test,” Oller says.
The exception with testing is if a patient is pregnant. Pregnant women need to be tested around 36 weeks of pregnancy and if herpes lesions are present, a cesarean section is typically recommended to deliver the baby. To infants, herpes can pose serious risks including blindness and even death, Oller explains.
Once a patient has acquired the herpes virus, there is no way to make the virus go completely away. It is typically treated with short-term antivirals unless a patient is having frequent outbreaks, at which point a longer term suppressive medication may be necessary.
If a patient already has herpes and is concerned about how to reveal this information to new sexual partners, Oller suggests, “You don’t need to tell someone immediately, only if you see yourself having sex with them.”
As with all STIs, the best defense against them is to always use a condom.