Genital Herpes: Intimate Conversations

Sex, STDs, Safety and Your Teen

2008-03-13T16:38:00.007-04:00

A recent study by the CDC suggests that 1 in 4 teenage girls have a sexually transmitted disease. This may include the genital wart virus, chlamydia, or trichomoniasis, among others. This doesn't surprise me at all. Sex in teenagers in incredibly common - by age 15, about half of teen girls have had intercourse, and probably more have given or received oral sex. And it often isn't with committed partners; it may be quite casual or fit into the category "buddies with benefits", friends having sex without a romantic attachment at all.

But where are the parents in all of this? Are we doing a decent job of talking with our kids about sex? I don't think so. If you have a teenager, let me ask you this: how often have you talked to your child about giving and receiving oral sex? Its the big thing now, kids have lots of oral sex so they can preserve their virginity and feel like they really haven't had sex. And anal sex is the same - if you've had anal sex, they will tell you, you are still a virgin. Interesting thinking, wouldn't you agree? I have 16-year-old female patients who have had lots of anal sex so they can still be virgins and 45 year old men who would give their right arm to have anal sex once in their lifetime. Its boggles my mind sometimes.

But teens are vulnerable and desperately need frank and honest information. Yes, abstinence would be my preference too, at least for a while, but this really isn't our choice. It is their choice, it is their body, and no matter how much we talk and lecture and pray and hope, they will do what they do, and often that's have sex. They are curious and want pleasure and sometimes drugs and alcohol impair their judgment. Does this sound familiar to you?

How old were you when you first had sex? I made the dubious decision to tell my youngest daughter when that was for me, and at that age, she told me that she first had sex then, too, so it must have been OK. That's a decision I might revisit with my granddaughters someday! But she and I talked a lot about sex - about the risk of getting herpes from a cold sore and oral sex, about the damage that chlamydia can do to fallopian tubes, what HPV can do to the cervix. We talked about all the behaviors that could put her at risk, and we made the discussion a casual, regular thing we talked about because I knew it was on her mind. Her friends sought me out for birth control and STD testing and free condoms and information. I felt mixed, but mostly incredibly glad that they did, that they trusted me and knew they could count on me for straight answers. These teens are very dear, just beginning to explore their worlds, and they need their parents to be the ones who they can turn to for these discussions.

But the truth is not all parents can do it, so it would be good to have a back up person in mind to talk the talk. Teens who are having sex need STD screens, and they need reminders about condom use and they need to hear that mutual masturbation holds no risk and oral sex and anal sex ARE sex and do present some risks of their own. And they need to know their parents love them, even if they are sexually active. Because no matter how uncomfortable we are, their safety and their future fertility and sexual health is what's important, right?

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Technorati Tags: teen sex, oral sex, anal sex, STDs, sexually transmitted disease, chlamydia, herpes, HPV, genital warts, trichomoniasis, sexual health

STD Testing - Who is at Fault?

2008-01-17T18:25:00.000-05:00

I wonder how many times I've heard someone say to me as I'm diagnosing them with an STD, "But I asked my partner before we had sex and they said they were clean!"

On one hand, its good that the topic of sexual health came up at all. But on the other, how do people really know if they are "clean" anyway? And do you think that we could use some other term for not being infected with an STD? Because the opposite of "clean" is "dirty" and I would really love to see THAT concept go away somewhere and never return. Is it any wonder STDs are stigmatized in our society when that's how we define someone who is infected?

STDs spread largely because people don't know they have them. If someone knew, for example, that they had chlamydia, a bacterial STD, they would get it treated and it would not be spread to anyone else. But about 2/3 of women who have chlamydia don't know they have it, and perhaps a third of men, so it just keeps moving from person to person, not because anyone is "dirty" but because the bacteria stays inside people, unrecognized, even for years, until someone diagnoses it and treats it.

The same is true with genital herpes. Ninety percent of those infected with herpes have no clue. They infect someone else who notices, and then all hell breaks loose - who gave what to whom and how dare you! But its nowhere near that malicious.

Perhaps the irresponsible part relates more to not getting tested before having sex with a new partner. If people did get tested for STDs more often, there would likely be less of them. So whose fault is that? I think the blame falls on both clinicians and sexually active people. Spur of the moment sex with a new partner is hot and interesting and fun, but it really doesn't allow for the time it takes to sort out STDs, does it? Is there a middle ground somewhere in there?

And clinicians - how receptive are they to patients requesting full STD screening? And how good are they at including all the possible STDs that someone might reasonably have? They are notoriously not great about including herpes testing in an STD screen, and that's the most prevalent STD in the US!

I think the burden must fall on the sexually active person who holds off on penetrative sex until testing has been done or least uses condoms for everything until testing can be done.

Or maybe its me. Maybe if I could figure out how to make testing hot and interesting and fun, people would do it more! But that's a whole different blog.

~Terri

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Technorati Tags: STD, testing, herpes, chlamydia, sexual health

Herpes Stigma

2007-09-07T10:50:00.000-04:00

So there's good news and bad news about the social stigma associated with herpes. In a recent phone survey of about 2,000 people in the US, 3/4 without herpes and 1/4 with herpes, a slight majority of both groups felt that the topic of genital herpes was not taboo. But when ranking the social stigma associated with any STD, herpes ranked only behind HIV - but hey, let's face it, there is stigma associated with any STD - it does involve genitals, after all, and we, as a society just aren't comfortable about our genitals.

Another piece of good news was that for people who had herpes, the biggest issue was bothersome symptoms of herpes outbreaks. That was listed way ahead of being bothered by stigma. Outbreaks can be treated or mostly prevented with medicine but there's no prescription for feeling stigmatized by your herpes.

The bad news is that a majority of people who didn't have herpes said they would avoid having a relationship with someone with herpes or break up with a partner who had herpes. Now that is truly stunning to me. This is 2007, folks! Of all of the things that can go wrong in a relationship, herpes is so far down the list, its almost not detectable. I'll bet if you surveyed discordant married couples - that is, couples where one person has herpes and the other doesn't, they would tell you that sex, money, in-laws, household chores and inability to talk to each other cause way more problems than herpes ever could.

It makes my heart very sad to think of the wonderful, quality people that I know, and know really well, who have been turned down for relationships because they have herpes. I used to think that people who did that were scumbags, that they didn't have a good sense of ethics or of what's important in life or that they would be unreliable in future hard situations. But I think a bit differently about that now. Now, I think that often they are just unreasonably afraid, that they know too little about the real experience of herpes, that they are just afraid of the reputation, not the actual disease and that they will never be able to know the "real" herpes.

I also think that people who count a lot on their sexuality for their identity are less likely to take any risk of getting herpes. It's like if you are a pianist, you take extra care with your hands or if your job is to model toenail polish, you take extra care with your feet. If much of your identity is tied up in your ability to be sexual, then you will be less willing to take risks with that part of you. And lest you are thinking, "yea, see, they are scumbags, they are oversexed weirdos", I would say that isn't necessarily true. They just may feel good about the way they look or the things they can do sexually and may not have built up their confidence about themselves in other areas at the same rate as the sexual confidence. We all feel strong in some areas, but not in others, right?

Another group of people who just can't seem to deal with herpes in a partner is people with obsessive compulsive disorder, and this is more common than you night think. And it comes in mild, moderate and severe cases. The severe case is the person who comes into my office and won't touch the doorknobs - they wait for someone else to walk into our suite to let them in, then we have to open and close the exam room and bathroom doors for them because they cannot touch the knobs.

The moderate is the person who is unreasonably fearful about transmitting or getting STDs - like "if my daughter digs through my laundry basket for her pink socks can she get herpes on her hands if I had a pair of jeans in there that she touches" (undies would always be kept separate, of course, and never within reach of the daughter). The moderate might also do lots of hand washing, far more than necessary.

The milder is the person who asks lots and lots of questions about germs and presents several scenarios about getting an STD - like "so if I touch a guy's penis through his jeans, but there is a little wetness from pre-cum on his jeans and I do it without gloves on, can I get herpes under my fingernails?" True, lots of people ask questions about transmission, but if someone leans toward OCD tendencies, the questions have a different feel, are more "out there", are more troubling for the asker.

Another reason someone might not take the risk of getting herpes is simply that they don't know the person who has herpes well enough to take that risk, and that is completely understandable. That's why, when you have herpes, and you meet someone at a party, you don't say, "Hi, I'm Terri, and I have genital herpes." You wait until they know you better, have more invested in you, have more reason to be willing to take some risk. But this discussion must happen before having sex, of course, so they have an opportunity to make the decision about risk for themselves.

The survey also deals with the fact that many people with herpes admit to NOT disclosing their herpes status to sexual partners. But that's another blog.

I'm sure you can think of more reasons why people are reluctant to take the risk of getting herpes, but think of this: do you think it is in one's best interest to chose or not chose a life partner based on whether they have a virus on their genitals that can be well controlled with medicine and causes infrequent symptoms that can also be successfully and easily treated? Are there not more important qualities for a partner to have or not have that will sustain a relationship over time? I think the answer is quite clear. The trick is having people think it through carefully and being brave and sensing what is truly important in a partner.

Terri

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Technorati Tags: herpes, stigma, STDs, genitals, sexual health

Itches, Rashes and Discharge Have More Than One Cause

2007-07-06T15:30:00.000-04:00

Let's see - a patient presents with itching, burning, cracking and irritation of the genitals. Is it herpes? Is it yeast? It is a bacterial infection? It could be any of those things, but the herpes option strikes the most fear into patients. That's probably because of the stigma and the lack of knowlege about the subject. But indeed, many things can mimic herpes symptoms in the genital.

Herpes itches but so do lots of things, primarily yeast. Herpes can cause blisters in the genitals, but so can staph infections. Herpes can cause a discharge, but so can gonorrhea and chlamydia and bacterial vaginosis and trich. My point is, if genital symptoms are present, they aren't always herpes, and that's true even with the person who has a diagnosis of herpes. That's why is is important for people who have herpes who have symptoms that are constant, are unresponsive to antivirals or that are outside of the "normal" pattern of herpes to have those symptoms evaluated by a clinician rather than assuming that they are herpes.

Of course, the reverse is also true, and probably happens more often. A person has symptoms like pain with urination. They present to the clinician's office where urine is dipped for white cells (pus). White cells are found, so the person is put on antibiotics. But when the urine sample is sent to the lab to grow bacteria, none is found. That's because what the person really had was herpetic urethritis, herpes lesions in or at the urethra. These lesions cause pain with urination because urine, which is acidic, is passing over open sores, which hurts. And there are pus cells in the urine because the lesions have pus in them. But the symptoms get better, so the patient and the clinician believe it was a bacterial UTI. Really, time just passed and the lesions resolved.

There are a few problems with that, as you might imagine. The first is that people are taking medicine for things they don't have. That's an issue because they might have allergies to those medicines or the medicines might cause side effects, like antibiotics cause yeast infections. As if having first episode herpes wasn't bad enough, now that same person has a yeast infection or more serious complications from the antibiotics. It's a vicious circle, for sure.

Here's the bottom line: Symptoms need careful evaluation by a clinician who knows genital herpes and takes a good history and does good lab work. Nothing should be assumed.

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Technorati Tags: genital herpes, itches, rashes, bumps, sexual health

Can Pap Smears Test for Herpes?

2007-02-26T16:24:00.000-05:00

For all you women out there getting annual exams with pap smears: you need to be very careful. There is a bad thing happening out there - a pap with a herpes PCR test built in. This is sometimes called a "silver pap". It often includes tests for chlamydia, gonorrhea, and herpes.

Here's the problem: If you get a pap and the PCR HSV test portion is negative for herpes, does that mean you don't have herpes? Of course not. It means that there was no herpes virus present at the moment the pap was taken, but that certainly does not mean that you don't have herpes!

The bacterial infections gonorrhea and chlamydia are always present until they are treated. They aren't there intermittently, and so the "silver pap" that includes only gonorrhea and chlamydia is legitimate. But in order to test for herpes, an antibody test needs to be done, not a swab test (PCR or culture) and certainly not a pap.

Herpes virus is present only intermittently and so looking at one point in time for VIRUS is not accurate, not legitimate, and a total waste of money in the asymptomatic individual. It gives false reassurance about lack of infection to patients who have no idea how to interpret these results. Clinicians are confused enough about testing that they don't seem to get it either.

Testing for herpes with a pap test is like someone did a pap looking for sperm and found none and saying, therefore, this person never has sex. It just isn't valid!

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Technorati Tags: health and wellness, genital herpes, pap smear, HSV PCR

Who should be tested for herpes?

2006-12-05T12:36:00.000-05:00

This is a question I am often asked, and my opinion may not match everyone's on this topic, but here it is anyway.

If you've had a partner in the past who has had herpes, you might want to find out if you got infected and didn't know it.

If your current partner has herpes, and you are wondering how to reduce the risk of transmission, the first step is to determine that you are indeed, not infected! Why go to all the trouble to reduce transmission risk when you may already have the virus, and would need to make no changes in your sexual practices to accommodate your partner's herpes?

If you have had lesions or sores or breaks in the skin in the past, and they have been swabbed for herpes and you've had negative swabs, you need a blood test to confirm that you are actually not infected. Swab tests often have false negative results, and you can take the extra step to find out that you actually are or are not infected.

If you have new symptoms, and you want to know if this is actually your first infection or reactivation of an old one, you can use a combination of swab test and blood test to sort that out. If you have a positive swab test for HSV 2, let's say, and a negative antibody blood test for HSV 2, that tells you this is your first infection. You've got virus present on the skin, but have not yet had a chance to develop antibody to the virus - it is too soon, because this is your very first infection.

If you've had a clinician look at your genitals and tell you by physical exam that you have genital herpes, you may wish to get an antibody test to confirm that diagnosis and/or determine whether you have HSV 1 or HSV 2 - you can't tell from a look.

If you are pregnant, you may wish to know if you have herpes or not. This test is not usually included in pregnant screening - this is a topic to raise with your OB provider, if you wish. If you are starting a new relationship or coming out of an old one and would like to know which, if any STDs you bring to the table, so to speak, antibody testing for HSV is important to be comprehensive, and often isn't included in routine STD screens.

So there are a few ideas for you about who may benefit from antibody testing for herpes. Be certain you get IgG testing, not IgM testing, and that it is truly type specific - there are good and not good blood tests for herpes. Feel free to post on the message board if you have questions about antibody testing.

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It's not always herpes

2006-11-27T13:00:00.000-05:00

Sometimes when a person gets diagnosed with genital herpes, they start recognizing symptoms in the genital area. That's a good thing, because most herpes is unrecognized but not asymptomatic.

However, don't assume that all symptoms in the genital area are herpes symptoms. People with herpes get yeast infections, they get bacterial infections, they get genital warts, they get molluscum, they get scabies, they get urinary tracts infection and they get other STDs like Chlamydia and gonorrhea.

It's important that herpes not become a dumping ground for all symptoms. On my WebMD message board, I get lots of questions from people who are having continuous symptoms -- non-stop itching or irritation and they report that their antiviral medicines "aren't doing anything".

Antiviral medicines, acyclovir, Valtrex and Famvir, are all very effective and reduce outbreak frequency by about 70%. In healthy adults who have fully functioning immune systems, these medicines always improve symptoms. But they improve symptoms that are related to herpes. So if no improvement is seen in symptoms, then they are likely caused by something else. It worries me that some people get so stuck on their herpes diagnosis that they miss getting appropriate diagnoses and treatment for other infections.

If you have herpes, and antiviral medicines "aren't doing anything" to improve your symptoms, think other types of things going on and get that sorted out.

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Technorati Tags: herpes, STD

HSV Testing in Pregnancy: Just DO it!

2006-04-27T13:44:00.000-04:00

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

Separating Emotional and Physical Reactions

2006-04-14T16:10:00.000-04:00

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

Latex Condom Allergy Solution

2006-03-22T05:29:00.000-05:00

A question from a commenter on my previous post about positive attitudes:

"My partner is allergic to latex. is there anything that I can do with my new partner to prevent transmission or atleast reduce it as much as possible."

Condoms reduce transmission of HSV by about half (as does the taking of daily antiviral therapy). These two methods, combined, can provide a lot of protection from infection, and make susceptible partners feel quite reassured about the low risk of transmission.

However, every now and then I hear from patients whose partners are allergic to latex. Latex allergies can be life threatening, so nothing to fool around with. Fortunately, there are condoms now made out of polypropylene. These are good choices for those with latex allergies, and are better for reducing the risk of viral STIs than natural animal skin condoms.

I've tried them with my partner, and they feel fine - they do make a bit of noise and generate a fair amount of heat (which might be a good thing!). Other than that, they are the same as latex condoms. Give 'em a try and let us know what you think!

Related Links: Are You at Risk for Genital Herpes?, Coping With Your Partner's Diagnosis

Technorati Tags: HSV, Herpes, antiviral therapy, condoms

South Dakota Abortion Ban

2006-03-15T00:26:00.000-05:00

I have grave concerns about the decision made by the South Dakota governor and legislature to effectively ban abortion in that state. There were no provisions left for abortion in the case of rape or incest, which is in itself, reason to be livid about this decision.

But to take away the choice to carry or terminate a pregnancy from a woman and her clinician and hand it over to the government is fundamentally frightening. As a nurse practitioner, I want the right to offer my patients options that fit with their choices.

This is not an area for governmental interference, and this decision does not fit with the wishes of the majority of Americans! Are we not a country of democracy, where the citizens make choices anymore?

I hope the citizens of South Dakota get an opportunity to vote on this issue, and let their legislators know how they really feel. Then we will see if democracy reigns - or not.

Related Topics: Reasons Women Choose Abortion, Unwanted Pregnancy

Technorati Tags: Abortion, Unwanted Pregnancy, South Dakota, Women's Rights, Rape, Incest

Herpes: A Positive Attitude Matters

2006-02-27T17:21:00.000-05:00

People are absolutely miserable about having herpes and others have a bit of an upset and move on without thinking too much about it.

Why do different people react so differently? I think that the major difference is what people believe about having herpes. If someone believes that herpes is a moral judgment, is a punishment for bad behavior, is going to end the sex life that you had before, is going to interfere with having a family, and will make you suffer forever, than the feelings that you have about herpes will be sad indeed. Perhaps even desperate. So the belief leads to the feelings.

Let's now change the beliefs - let's say you believe that herpes is simply a virus that found a cell in which to live, has nothing to do with shame, is manageable when it comes to a sexual relationship with suppression and condoms, can successfully be managed during a pregnancy by a qualified OB, that there is sadness at this news, but that having herpes does not change the core of who you are, then the outlook will be much brighter.

So it isn't the infection "herpes" that causes the feelings, again, it is the beliefs about herpes that either causes you to adjust nicely or to fall into a depression. Changing your beliefs is not easy, it takes repetition and reminding yourself every day to think differently. But it is possible and necessary for a rich and rewarding life in spite of herpes.

Related Topics: Sex Ed for the Suddenly Single, Genital Herpes Support Group

Female to Female Herpes Transmission

2006-02-16T12:57:00.000-05:00

Sometimes I am asked about female to female transmission of HSV. Many women who have women as their sexual partners have also had men as their sexual partners at some time in the past or currently. These women may well have HSV 2 due to penetrative intercourse in the past with a man.

However, if a woman only has sex with other women, it is probably true that she is more likely to have genital HSV 1 than 2, most commonly transmitted by receiving oral sex from someone else. HSV 1 genitally recurs less often and sheds less often, but does not protect a person from getting HSV 2. If any protection is offered, it is minimal. HSV 2, however, does appear to almost completely protect a person from getting HSV 1 subsequently.

Related Topics: Oral Sex Raises Women's Genital Herpes Risk, Sexually Transmitted Diseases

Technorati Tags: HSV, herpes, GLBT,

Type I Herpes Transmission

2006-02-06T03:31:00.000-05:00

Here is a question from a commenter on my earlier post about Herpes Myths:

i was diagnosed with Type 1 HSV in the genital area. I have recently begun a new
relationship and I don't know how to broach the subject. Any help?

Type 1 is increasingly a cause of new genital herpes infections. This is probably due to an increase in the practice of oral genital sex.

People who have cold sore virus, without or with symptoms, can transfer this virus from their mouth to the genitals of their partner by giving them oral sex. HSV 1 sheds from the mouth on about 18% of days that we look.

However, when that virus gets transferred to the genital area, it prefers this location less. In fact, HSV 1 genitally sheds on about 3-5% of days measured, vs. 15-20% of days measured for HSV 2 genital infection. And the recurrence rate is a lot less also.

The person who has HSV 1 genital infection may still want to disclose
this information to a partner, as the infection can be transmitted, though it is
not common for this to happen, through intercourse.

If the new partner is also HSV 1 positive, but has the infection orally (that is, they have a known history of cold sores), then they are unlikely to get the infection genitally, through sexual contact, as they have antibody that will likely (though not perfectly) protect them from getting the HSV 1 at a new location. The same is true for the person with the HSV 1 genital infection. They are unlikely to now get cold
sores from their partner who has oral infection. It should be noted, however,
that the person who has HSV 1 genital infection can still get a type 2 infection.

Related Topics: Vaginal Gel Blocks Herpes, HIV, Cranberry May Help Fight Herpes Virus

Natural Remedies?

2006-01-30T09:58:00.000-05:00

I am often asked if there are any natural remedies that are worth trying to deal with herpes outbreaks. I must tell you that I don't think there are any natural remedies worth trying.

For some people, Lysine seems to help, but good studies have not shown Lysine to be of any significant value in treating herpes outbreaks, and very minimal (but not statistically significant) benefit from taking daily Lysine. It may be useful to get adequate sleep, to keep the genitals out of the sun (dah) and keep long term stress to a minimum if possible.

Before I feel something is worth trying, I believe clinical trials that are well designed should be done, even on "natural substances". That's just me, I'm a scientist at heart, and believe that money shouldn't be spent on things that have not been shown to be effective in trials. Others may feel differently, and that's fine.

However, I think it should be stated that "natural" things can be dangerous, just like prescription medication. Remember that digitalis, for example, comes from a plant, and given in inappropriate quantities, can kill you. Just because something doesn't require a prescription or is sold in a natural food store, that it is necessarily safe, especially when taken in combination with other things. There are references for non-prescription medications on the net, describing side effects and potential drug interactions.

Mythbusting Genital Herpes

2006-01-25T12:56:00.000-05:00

One of the most common myths that I correct is that herpes can be transmitted via inanimate objects, like toilet seats. If you think about how genitals do or do not come into contact with the toilet seat when it is used, one could process that transmission via this method is really so unlikely. I would say virtually impossible.

Let's even say that someone has a buttocks lesion and sits down on a toilet and leaves virus on the seat. In order for transmission to happen, the next person that comes into the bathroom has to come in very quickly, since virus probably wouldn't live long on a cold, dry surface. But in addition to that, the next person would need a break in the buttocks skin at exactly the same location where the virus was on the toilet seat, and exact match. Virus does not penetrate intact buttocks skin, nor it is shed from intact buttocks or thigh skin. The skin is too thick to shed; shedding occurs from genital skin or mucus membrane type skin. So that covers toilet seats, the most common suspected culprit for non-human to human transmission.

Swimming pools and hot tubs are also not a concern as they have large quantities of water to dilute small quantities of virus, and also have chemicals that will kill virus. I do suggest that people use their own towels as towels stay moist and warm and virus could conceivably live there, though I think it is not likely at all. Herpes could live a short time on sex toys, and if used during a sexual encounter, could pass virus between partners. But other than that, there is nothing to worry about in terms of inanimate objects and transmission.

Related Topics: Answers About Sexual Issues, What Can You Catch In Restrooms?

Technorati Tags: genitalherpes, transmission

Treating Herpes Outbreaks

2006-01-02T05:15:00.000-05:00

New research has shown that treating outbreaks with one day of Famvir (1 gram twice a day) is effective. This shortened course of treatment makes things much more convenient for those who chose to treat outbreaks only vs. daily therapy. I think it is important to remember that treating outbreaks, however, does nothing to impact viral shedding between outbreaks, so this new dosing schedule needs to be viewed with an awareness of that concept.

Patients who are not in relationships with uninfected people, whose partner is already infected with the same type, or who are not concerned about the frequency of recurrences will find this new option convenient and easy.

Related Topics: Living With Genital Herpes, Dating With Herpes

Anonymous STD Contact Notification

2005-12-27T05:16:00.000-05:00

A new website in LA will allow people to anonymously notify partners that they may have been exposed to an STD. The internet has given us many new opportunities, but this may be one of the most interesting, and controversial. Traditional methods of STD tracking and notification are in place everywhere in the US, but many people infected with an STD are unwilling to comply with these laws, or in the case of herpes, may not be reportable by law.

Perhaps this method is better than none at all. My concern is that this method could be used as a joke or worse, a mean way, of getting back at a previous partner. Already, in our clinic, we have people calling who have been told they were exposed to an STD. Some even get fake letters! That's the downside. The upside is that more people will get tested for STDs, even if the notification is fake.

I suppose on balance, there are more upsides than down, but it can still be pretty frightening or alarming. What do you think?

- Terri

Related Topics: Sex Ed for Guys, Confidential Sexual Healthcare for Teens

Herpes Transmission Facts

2005-12-15T05:45:00.000-05:00

Lots of people ask me how likely it is that they will either contract or transmit a genital herpes (HSV 2) infection to a sexual partner, so I thought I would address that in today's blog.

The first tool in reducing transmission rates is knowing whether herpes is even in a relationship! If two people have no idea that one of them is infected, they can't begin to reduce the risk of transmitting the infection because they don't know there is anything to be concerned about! So testing for genital herpes is the first step - finding out who is infected and who is not.

Let's say you have an infected male and an uninfected female. If they avoid sex during outbreaks, don't use condoms regularly, and don't take antiviral therapy every day, the risk of tranmission is about 10% per year. But if you add condoms, it reduces transmission about about 50%, if he takes Valtrex 500 mg once a day, he can reduce transmission also by about 50%. So you can see that the numbers get very low!

If it is a woman infected with HSV 2 having sex with an uninfected male, given the circumstances listed above again, then the transmission rate is about 4% prior to the interventions of condoms and Valtrex.

Which interventions are appropriate and desirable are decisions that individual couples makes, based on concerns about infection.

I hope this is helpful for those of you wondering about how likely it is that you might infect someone else or get infected yourself.

Terri

Related Topics: Dating and Herpes, Understanding STDs

Seattle Planned Parenthood Genital Herpes Lecture

2005-12-08T19:02:00.000-05:00

This week I was in Seattle, lecturing to the Planned Parenthood providers. There were probably 50 clinicians attending, and it was so great to see how much they already knew, and also, how excited they were to learn all the latest details about genital herpes tests, treatment and counseling.

One of the most frequent questions to come up is "What do we do about people who test positive by blood test, but have no symptoms?" As I have said many times, people who have positive blood tests but no symptoms are both infectious and infected. Anna Wald and I have a study in the New England Journal of Medicine in 2000 describing this research. If someone has a positive blood test, they can also become more aware of subtle symptoms that they previous did not notice or thought were due to something else.

They were also so happy to have access to the patient counseling video as talking about the "softer" issues of self esteem, sexuality and how to tell partners can be both difficult and time consuming.

Stay warm out, our winds in Portland today are taking the perceived temps down to 14 degrees!

Related Topics: Could I Have Caught Herpes From Him?, Shattering the Genital Herpes Myth

Progress on Herpes Testing during Pregnancy

2005-12-01T15:45:00.000-05:00

Hello from snowy Michigan. As many of you know, I travel around the country, lecturing on genital herpes infection for about 10 days a month. This week I am in Michigan for the entire week, driving across the state from Kalamazoo to Jackson to Monroe to Detroit to Saginaw. I've had several lunches, breakfasts and dinners with physicians and nurse practitioners and nurse midwives and physician assistants, and here, have focused mostly on OB/GYN providers.

It has been gratifying to find many of these clinicians open to testing for herpes during pregnancy. You see, herpes testing is not a part of routine OB care in many parts of the country. The usual practice is to ASK patients, as they begin their OB care, "do you have herpes or does your partner have herpes?" But as those of you who read my posts know, 25% of the US population is infected with HSV 2 and 90% of those infected don't know. So ASKING misses 90% of those infected!

If we don't know who is infected with HSV 2, we cannot put them on suppressive therapy at 36 weeks, we cannot avoid the use of fetal scalp electrodes for monitoring fetal health (which disturbs intake skin and may allow virus to enter the baby's body), we might prematurely rupture membranes to speed labor (which also puts babies more at risk of HSV acquisition). All of these things could be avoided if we only knew the woman was infected!

In addition, if we did herpes testing on all pregnant women, we would know who was NOT infected and still vulnerable to infection. If we knew that, then we could advise an HSV negative woman to proceed in one of two ways: 1) she could have her sexual partner tested. If they are also negative for HSV, then sex could proceed normally. If her partner was positive for HSV 2 or had HSV 1 orally, then we could advise the couple, prior to the third trimester, about sexual behavior that is safe or not safe. or 2) she could simply avoid sexual contact during the third trimester, thus protecting her baby in that way. The WAY COOL thing is that I identified one OB doc who already tests all of his patients, another who is offering testing to all patients (I personally think it should not be optional but mandatory, as is gonorrhea and chlamydia testing), and another group of OB providers who was eager to hear about the testing protocol and was eager to implement it. Very exciting week in terms of openness to pregnancy testing!

Perhaps I will write you blogs from the backroads of America, taking the "herpes temperature" of US providers.

Stay warm, everybody, it's cold out there!
Terri

Related Topics: Herpes and Pregnancy, STD's and Pregnancy

Questions and Answers About Herpes Diagnosis

2005-11-29T19:45:00.000-05:00

This was an exchange I had recently on my Genital Herpes message board that is an excellent overview of relevant questions about herpes diagnosis:

Q: Are the results of a Herpeselect bloodtest definitive for the diagnosis of HSV provided enough time has passed (e.g. 6 months) from onset of symptoms?

A: I think it is a very good diagnostic tool, and will be made even better during the month of September. I think 6 months is long enough to seroconvert. The number of people who will seroconvert after that is very very small. I prefer to live life with the likelihoods, not the statistics that are way out on the edge somewhere. Otherwise, I would never leave my house.

Q: Have you seen any cases where the blood tests are negative despite positive clinical diagnosis or culture results?

A: Yes, and I have seen cases where the western blot does not become positive either.

Q: I've been diagnosed with genital HSV by physical examination but still have not had a definitive test result after 12 weeks and no recurrences so far.

A: You need a laboratory confirmation. I would wait a month or so longer and retest.

Q: What are the main difference between the Immunoblot and ELISA test from Focus?

A: The differences are simply in the way that the test is run - one for large lab formats and one for small labs. The cell lines used to develop the test are the same.

Q: If after 12 weeks of apparent onset of symptoms, the Immunoblot is negative and the ELISA is 0.90 (equivocal range), then which set of results should I go by? Do you recommend testing again after another 6-8 weeks or use a different test?

A: The ELISA is also negative at .90. I would recommend retesting in another month. if you are HSV 1 positive you can take slightly longer to serconvert.

Q: In your clinic, how many Oral HSV 2 cases have you seen?

A: Three

Q: If no sex is involved, how easy is it to transmit HSV2 to someone if lets say you share the same house and bathroom and has a lot of day to day physical contact, but no sexual contact?

A: You need skin to skin contact to transmit. It is not transmitted through household contact.

Related Topics: Diagnosed with Herpes, Living with Herpes

Herpes: What's the big deal?

2005-11-26T21:53:00.000-05:00

We often talk about physical herpes outbreaks being fairly minor for most people, but emphasize the psychological aspects as being the most troubling. I don't like this spin because of the medical risks and because having genital herpes really isn't the same as having a cold sore. Like it or not, there are social stigmas. To minimize them sends the message that we are saying, in essence, quit whining and buck up. Since it is a big deal for many people, that's not a message I want to drive home.

Most people DO have serious symptoms; 90% just don't recognize them. That's a big difference, because identifying those infected would then allow them to begin accurately observing for subtle symptoms or symptoms not presenting in the genital area.

We can talk about transmission (rather than "spreading" - sounds too much mayonnaise in my book) -- people always want numbers. How does talking about transmission lead to thinking it would be horrible if infected? There is an underlying negative feeling about herpes in this country. If we tell people it's no big deal, don't worry about it, we risk losing them, and losing them can have serious implications.

For example, neonatal herpes is very serious. Many babies die. The risk of transmission from mother to baby is very low if the mother is infected prior to the third trimester. But if she gets infected IN the third trimester, her baby has a 30-50% chance of getting infected. So it's good to know, going in to the pregnancy, who is infected and who is not, so vulnerable women with infected partners can reduce the chances of getting infected.

Related Topics: Herpes: Breaking the Silence, STDs and Pregnancy