Genital Herpes

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• 0:04Introduction
• 0:17Symptoms
• 1:08Diagnosis
• 2:17Prevention and transmission
• 3:44Suppressive therapy
• 4:38Blood test screening

Full transcript

1. 0:04Introduction

   Hi, I'm Dr. Taz Varkey. Today I'd like to continue our conversation about sexually transmitted infections, and today in particular I want to cover herpes. This is a tough one to discuss.

2. 0:17Symptoms

   It really upsets patients, but I see it very often. We think that as many as 20% of women in the United States has genital herpes, and most of them don't know it. The reason for that is it doesn't always cause symptoms right away, but if you're going to get symptoms, the most common symptoms are painful sores in the genital area. These sores can also be found in the oral area. Most patients refer to them as oral cold sores, and they can be equally painful in the area of the mouth, but in particular when we find them in the genital area, that's when we call them genital herpes, and that's when it seems to cause the most distress for patients, understandably.

3. 0:43

   The main symptoms, as I said, are painful sores, but you can also get pain with urination.

4. 1:08Diagnosis

   You might get body aches and fevers, feel kind of flu-like. You might get swelling of the lymph nodes in the groin around that area. And the only way to really diagnose it is when you go into your doctor, the doctor has to do a culture of the sore and send it to the lab. And that'll come back telling us whether you have herpes and which strain.

5. 1:24

   Now the reason that's important is there are two strains of herpes, type 1 and type 2. Type 1 can be found in either area, the mouth or the genital area. Type 2 is almost always found in the genital area but not a hundred percent of the time. In other words, we think that there are a very small percentage of cases where type 2 has been isolated in the area of the mouth.

6. 1:49

   So the bottom line is you can find either strain in either area or even in other parts of the body, even though the mouth and the genital area are the most common. So when we get the culture back and it tells us whether it's type 1 or type 2, it doesn't really change the fact that the patient has genital herpes, but if it's type 1, the outbreaks tend to come back less frequently and they don't tend to be as severe.

7. 2:17Prevention and transmission

   With type 2 you can have more recurrences. So what can you do to prevent getting this infection? Well, condom use helps because it reduces the surface area of the skin that's touching the other person's. So if the man is wearing a condom, then there's less skin that's exposed. But if the man's herpes sore is on the scrotum or the surrounding tissue away from the penis, then that area is still touching the woman. It can be transmitted that way.

8. 2:41

   Herpes can also be transmitted through oral sex. If a patient has type 1 cold sores, let's say your boyfriend has cold sores and he performs oral sex on you, you can get genital herpes that way. It's the same strain and it has a much harsher stigma when found in the genital area than in the oral area, but it's actually the same virus.

9. 3:06

   So condoms don't prevent herpes 100% of the time. That's a very common misconception. And the second most common misconception regarding herpes is that it can only be transmitted if a patient has an active outbreak. That's not true. It's most likely to be transmitted from one person to another if, let's say, your boyfriend has an active sore. But even if it's healed up and he doesn't think he's shedding the virus, he might be. So it's still transmittable between two people, even if the person with the infection doesn't have an active sore.

10. 3:44Suppressive therapy

    Perhaps the most frustrating thing about herpes is that there's no cure. The virus lays dormant in the nerve that supplies that patch of skin, and it can reactivate at any time, generally during periods of stress, but there doesn't have to be a particular reason. So even though there's no cure, there is a way to suppress the outbreaks, which is to take an antiviral medication either at the very beginning of the outbreak or preventatively every day.

11. 4:10

    That will reduce the number of outbreaks. Also, if you take Valtrex every day, you can reduce the risk of transmission to an unaffected partner by 50%. There's so much more to teach you about this, but this is the basic information I want to share. I think the last thing I want to mention, a lot of patients come in asking me to do blood tests to screen to see if they have herpes. Maybe they want me to add it in with the rest of their STI screening.

12. 4:38Blood test screening

    And this is not something I do, and it's not something that's recommended by the World Health Organization or the Centers for Disease Control or any other expert organization that gives us guidelines on sexually transmitted infection screening.

13. 5:02

    And the reason for that is if I draw someone's blood and I see that they're positive for type 2, that I will preview. First of all, there can be false positives, and that can be unnecessarily alarming and stressful for patients. But also I don't know for sure that the patient has genital herpes. They may have an oral outbreak or an outbreak elsewhere, even though it is most likely that it is in the genital area that their infection occurred. So the blood tests just can be misleading and can be inaccurate, and nobody recommends doing them because it's very difficult to counsel the patient afterwards and it's just a lot of distress with very little that we can do about it.

14. 5:31

    So that's it. If you have any questions, as usual please talk to your doctor or come in to see me if I'm your doctor. Thanks for tuning in, and don't forget to subscribe. Thanks.