HSV Testing in Pregnancy: Just DO it!

After speaking a lot with OB/GYN providers in the past few weeks, I would like to vent about HSV testing in pregnancy. There are so many reasons given for not testing in pregnancy, but to me NONE of them hold a candle to the value of testing.

If the statistics are true that about 1 in three women in their 30's have HSV 2, and 90% of them don't know, ASKING pregnant women if they have genital herpes is almost worthless. Yes, you will catch a few, but miss 90% of those infected!

If you believe the research that shows that people who test positive for HSV 2, but have no outbreaks shed asymptomatically at the same rate as those having 1-12 outbreaks, then wouldn't it be useful to know who is infected, rather than basically playing Russian roulette with the pregnancy?

If you believe that viral suppression treatment for women with herpes at the end of pregnancy is the right and valuable thing to do, would you not then want to know who all the infected women are? If you believe that the woman who gets new herpes in the third trimester has a 30-50% chance of infecting her baby, would you not want to know which women are vulnerable and which of their partners is infected?

Pregnant women are routinely tested for syphilis, gonorrhea, chlamydia, rubella, HIV (in many states), and their pap smears hopefully look for HPV. Why, then, we would not test for herpes?

In my next blog, I will share with you the reasons I am given for not testing. Some of you will be amazed, others of you will not be surprised. Suffice to say, in preview, we are letting social stigma and emotional upset guide testing decisions. This is not true for all clinicians, but many. Perhaps testing for HSV in pregnancy will need to come from patients, driving clinicians to test. But it should be the other way around, I think.

Terri

Related Topics: Are You Sex-Smart?, Vaginal Gel Blocks HIV, Herpes

Technorati Tags: HSV, genital herpes, STD in pregnancy

Separating Emotional and Physical Reactions

Commenters had much to say about my "Positive Attitude" post! Here's one that sums up most of them:

I contracted genital herpes as a result of my husband's affair with my son's girlfriend's mother. I suffer severe symptoms with each breakout, while he (yes, we are still married) doesn't seem to have any symptoms or either doesn't mention any. I wonder if anyone can tell me why? I agree that a positive attitude is helpful when dealing with any stressful situation or illness but I'm having a really hard time due to the fact that my son will probably soon marry his girlfriend and I will be forced to face this woman. Any suggestions to help me with any or all of this sordid information? Thanks (An RN who learned the hard way)

Sometimes one person who has herpes has very frequent symptoms and a person that they infect have none. We really aren't sure why that happens, but it is likely due to individual immune responses, rather than something to do with the virus.

In addition, people perceive symptoms differently. One person might describe a sore as "debilitating" while someone else might describe the exact same sore as "irritating". The difference probably relate to people's pain tolerance and reactions to discomfort, but I'm convinced that a lot of the perception is due to people's emotional reaction to having herpes.

The emotional component of herpes cannot be separated from the physical. I've had patients tell me that they are having weekly outbreaks that are devastating to their lives, that they are unable to function normally. When I exam them, I see nothing or minimal redness, and when I have them do daily home swabbing, there is no virus recovered. So what I think is going on is that people are reacting emotionally to the infection, overinterpretting their symptoms, and that is driving the devastation in their lives.

I see the same thing in people who say that their suppressive therapy is "not doing anything". Often, these symptoms are some other medical condition, but sometimes they are the emotional fallout misperception of symptoms. This is a painful emotional issue for people, but if they are able to understand that this isn't all about the physical manifestations of genital herpes, and actually believe it, then they can feel better.

Related Topics: Drug Shortens Genital Herpes Outbreaks, Vaginal Gel Blocks Herpes, HIV

Technorati Tags: genital herpes, depression, STD