Stigma-Free Talk about Genital Herpes

By Sonoa Au, M.D.

One aspect of the challenge of sexually transmitted infections (STIs) is the stigma. But consensual sexual activity, which is a natural part of adult life, involves intimate contact that can spread infection. And millions of people get STIs every year.

Make that about 20 million new cases a year, according to the CDC, including infections such as gonorrhea, syphilis, chlamydia — and genital herpes.

In terms of genital herpes, the American Sexual Health Association states that as many as one out of five people is infected, usually with the “simplex two” form of the virus (HSV-2).

Genital herpes, as well as other STIs such as syphilis and HPV (the human papillomavirus), can be transmitted via skin-to-skin contact. Condoms are effective at blocking transmission of fluid-borne STIs, like chlamydia, HIV, and gonorrhea, but with infections that are transmitted via the skin, while condoms can help, they won’t block infection from an uncovered area.

Increasing openness and awareness is crucial. Most STIs are treatable and catching an infection early can prevent more serious complications. The dermatologist’s office is a valuable resource, as many STIs have skin symptoms.

Organizations such as The STI Project, founded by the Herpes Activist Network’s Executive Director Jenelle Marie Pierce, and the American Sexual Health Association are making important inroads in providing resources and support.

In terms of stigma, genital herpes in particular triggers anxiety because it is what we call a ‘recurrent’ infection. Once a person has it, they have it for life.

In this regard, HSV-2 is similar to its oral relative, the “simplex one” form of the virus (HSV-1), which can cause cold sores and fever blisters. About half of adults have HSV-1, typically the result of non-sexual childhood exposure, for example from a relative’s kiss. Like HSV-1, genital herpes is also usually mild and manageable, so much so that a person may not even know they have it. Some are not symptomatic. And mild outbreaks can easily be attributed to other causes, like an insect bite.

To increase awareness and reduce stigma regarding genital herpes, I offer the following advice:

5 Tips for Understanding Genital Herpes:

1. See your doctor if you’re worried:

   Different tests have distinct parameters. If you notice a skin abnormality – a sore, a blister or a pimple – this can be swabbed and checked. DNA testing of the swabbed sample is the most accurate choice. In the absence of symptoms, a blood test for IgG antibodies can detect long-term infections.

2. Positive results? There are management options:

   For patients with regular outbreaks, there are effective means of limiting frequency. For example, daily anti-viral medications such as valacyclovir pills can reduce outbreaks by at least 75 percent.

3. Be aware of symptomless transmission:

   One challenge with HSV-2 is that at certain times the virus is present on the skin even though there is no visible outbreak. Skin-to-skin contact at such times can transmit the infection. Condoms can limit the extent of skin exposure. And daily anti-viral medications seem to decrease risk.

4. Pregnant? Ensure a safe delivery:

   Pregnant women can be tested for genital herpes because an outbreak is a health risk during delivery. Those who know they have the virus should inform their doctors. In most cases, there is no impact on the delivery, but if there is an outbreak at that time, many doctors will advise for a C-section to protect the baby from serious health problems.

5. Oral sex can cause genital infections:

   With genital herpes, we usually think HSV-2, but oral sex can transmit HSV-1 to the genitals. Awareness can guide people’s choices.

Genital herpes may not have a celebrity spokesperson. But a lot of regular people have it, and they’re leading full and happy lives.

Sonoa Au, MD, is a board-certified physician and a fellow of the American Academy of Dermatology

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies. www.advanceddermatologypc.com.