Dr. Jacqueline Gerhart: Many With Herpes Show No Symptoms
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: I heard that more than 20 percent of the population has genital herpes. Is it possible to test positive without having symptoms? How can I prevent symptoms?
Dear Reader: Unfortunately, herpes is a sexually transmitted disease that is on the rise. One in four women and one in eight men in the U.S. has genital herpes. And unfortunately there is no cure. Once you are infected with the herpes simplex virus (HSV), it stays dormant in your body, even if you don't have any signs of it on your skin.
Many people who are infected with the herpes virus do not have symptoms. When a person does develop skin lesions, it is called an "outbreak." Most people will get their first outbreak about two weeks after contact with a person with herpes, and the symptoms will last for about two to three weeks. Symptoms include itching, burning or pain in the genital area, sometimes preceded by fever or flu-like symptoms. About two to three days after these symptoms, small red sores appear on the genital region. These often evolve into small blisters, which may become painful open sores. Usually they come in "crops" and eventually "crust over" at about the same time.
Since herpes is spread by skin-to-skin contact, and because the virus is never completely cleared from your body once you are infected, it is possible that you can spread it on at any time - although it is much more likely to spread when there is a lesion. For this reason, when a woman who has a history of herpes becomes pregnant, we give her anti-viral medications near the end of pregnancy, so there is less risk of her passing the virus on to her baby during birth.
Here are a few other questions I have had from patients regarding herpes:
Q: I had a herpes outbreak two years ago, and now have a new partner. Should I tell her?
A: Being open and honest is always the best policy - even if you do not have symptoms. Wearing a condom reduces but doesn't eliminate the risk of transmission.
Q: I came to the clinic to be tested for STDs, and I wasn't tested for herpes. Why is that?
A: The best test we have for herpes is performed when you have skin lesions. We touch the lesions with a cotton swab and test for the herpes virus. If you don't have skin sores, you can get a blood test. However, the blood test only detects HSV antibodies - which take up to three months to form after the initial infection. Therefore, if you are coming in soon after your "exposure," it is possible your blood will not test positive, even if you were infected.
Q: What can I do to decrease outbreaks?
A: Most people will have outbreaks a few times per year. Outbreaks decrease as you get older. While there isn't a cure, there are antiviral medications that can reduce your symptoms and shorten their duration. In fact, those with frequent outbreaks (more than four times per year) should consider being on daily antiviral medications as prophylaxis. Taking these medications can help reduce your symptoms and your likelihood of spreading herpes.
If you are concerned you may have herpes, you should also be tested for other sexually transmitted diseases, so make sure you see your health care provider.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 04/03/2012