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Friday, May 26, 2017

Questions About Herpes

Written by  Dr. Eva Hersh, MD

Dear Dr. Eva,

I am a woman in my 30s. I have been in what I thought was a monogamous relationship for the past five years. I recently developed a group of pinheads sized, painful/itchy blisters on my left labia. My partner swears that she has not had sex with anyone else, but this sure looks to me like evidence to the contrary. She says that her doctor told her that a person can be silently carrying herpes for years and then have it show up by infecting another person. Could that possibly be true?

Hurt

Dear Hurt,

Weird as I know it seems, yes this is true. It has long been known that some people can have silent herpes, in which they carry the virus and can transmit it to others but never have any symptoms themselves.

The riskiest time for catching herpes is having sex with a person who is currently having an outbreak: that is, a person who has open sores. However, most people with herpes avoid having sex when they have open sores. The majority of new cases of herpes are transmitted by people who have no herpes symptoms at the time. This is an excellent argument for consistent condom use.


Dear Dr. Eva,

How common is herpes?

Wondering

Dear Wondering,

Genital herpes is very common. It is the most common of all sexually-transmitted diseases. Herpes antibody blood tests, which show that a person has been exposed to herpes and is a carrier of herpes, are reactive in one in five adult members of the population overall and one in three adult African-Americans.


Dear Dr. Eva,

Can herpes make it difficult for a person to pass urine? I have been having to sit in the bathtub to go.

Awkward

Dear Awkward,

Yes, that can happen, usually to women, when the soft tissues of the genitals swell up enough to interfere with urination. It does not mean you have a urinary tract infection. Usually, this only happens with the first attack. Sitting in the bath can help a person in the situation you’re in. If you are unable to urinate in a warm bath, please go to an emergency room.


Dr. Eva,

How often does herpes come back, and does it matter if it’s herpes type 1 or type 2?

Type Two

Dear Type Two,

Herpes type 1 and type 2 are the two viruses that cause mouth and genital herpes infections. Originally, herpes type 1 was thought to cause only cold sores on the lip, which are much less severe than the sores of genital infections can be. Herpes type 2 was thought in the past to cause all genital herpes infections. It is now known that about 20% of genital herpes infections are caused by herpes type 1, and some lip infections are caused by type 2. When people become infected with herpes type 1 on the genitals, they usually have an initial outbreak without recurrence. Herpes type 2 is the virus found in most cases of genital herpes, and it does recur. Recurrences can be as frequent as every month and as infrequent as once a year. Recurrences become milder over time and are not usually a problem after the first few years.


Dr. Eva,

Does acyclovir ointment work as well to prevent recurrences as the pills do?

Don’t like to take pills

Dear don’t like pills,

Unfortunately, studies of acyclovir cream show that it works no better than a non-medicated cream (placebo.) The only medicines that have been shown effective to prevent herpes recurrence are anti-herpes medicines taken by mouth: acyclovir, famciclovir, and valacyclovir.

There are two approaches to preventing recurrent bouts of herpes. The most effective is to take an anti-herpes medicine by mouth every day. This will make outbreaks happen less often and make them milder when they do occur. The other approach is episodic, meaning that as soon as a person notices the early signs of herpes outbreak (usually itching, burning) they start taking their anti-herpes medicine and take it for a week. This will make outbreaks briefer and milder, but this technique is not as good for preventing transmission to other people as taking the medicine continuously. Some things, for some people, can trigger recurrences. These triggers include sunlight, stress, illness and menstrual periods.


Dear Dr. Eva,

Can you get herpes from using a towel someone else used, or from a doorknob or toilet seat?

Anxious

Dear Anxious,

No. Herpes can only be passed on by skin-to-skin contact with a person who has it.

Eva Hersh is a Baltimore family physician. Send your comments and questions to her by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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