Monique Rainford

I often have the responsibility of informing a woman that she has genital herpes. Her response is often the same - sadness. Sometimes she is tearful and wonders how the infection was acquired. She often also worries about her partner and future pregnancies.

If she is single, she worries about future relationships and grapples with the difficulty of sharing the diagnosis with a future partner. She feels marked and stained. I try to encourage her as best I can. I share the success stories of patients who have informed their partners and were supported even when the partner is not infected. I reassure her that it is not a life-threatening infection and counsel her about protection against infections that are, in fact, life threatening. I counsel her on methods to reduce the risk of transmission.

Yes, it is true that not all women have partners who are supportive and, in some cases, relationships even end. However, even in some of those cases I am able to witness the woman's resilience, and I have often been told that she is happier outside of that particular relationship.

Common infection

Genital herpes is a sexually transmitted disease caused by the herpes simplex virus (HSV). Although two types of the virus exist, it is usually caused by type two (HSV 2). Herpes is a recurrent infection which, like all viruses, cannot be cured, but outbreaks can be effectively treated.

Genital herpes is a very common infection, but about 60 per cent of people who are infected with herpes for the first time will have no symptoms or are asymptomatic. As a result, many persons with genital herpes are unaware of their condition. It is highly contagious and transmission can occur whether or not the person has an outbreak. In most cases, transmission is from asymptomatic spread. Therefore it is easy to understand how a woman might have acquired the virus without knowing.

More than two thirds of women who have a positive blood test (HSV-2 antibodies) for herpes type 2 never had an outbreak. If a woman has been exposed to the other type of herpes (HSV-1), which is usually transmitted in a non-sexual manner, it appears to protect against HSV-2. Her risk of HSV-2 infection from a positive partner decreases from 32 per cent to 10 per cent in one year.

Although herpes lesions are usually described as ulcers (small shallow open wounds), women may sometimes only have itching, abrasions (scratches) or fissures (cracks in the skin). If she has any of these symptoms, especially if no other cause has been identified, she may consider getting herself tested for the infection.

Partner should be tested

If a woman gets diagnosed with herpes she should get her partner tested, since, if both partners are positive, transmission is no longer an issue. If she is positive and her partner is negative, consistent condom use, avoiding intercourse when lesions are present and taking the medication. Valacyclovir (sold locally as valtrex) can significantly reduce the risk of her partner being infected.

Oral medications including acyclovir (zovirax) also reduce the risk of recurrent outbreaks, shorten the duration of an outbreak and reduces the spreading of the virus. Topical medications such as creams and ointments are ineffective against outbreaks. Women with a diagnosis of herpes who are considering pregnancy in the future can be comforted in knowing that the risk of transmission to the baby is low and can be reduced even further with the use of medications. Most infected babies are born to women without a known history of herpes.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.