It’s that time of the year again! No, not Christmas, or New Year, or Summer, but yes all three can be factors in a festive season when extra partying can lead to an increase in the risk of getting a herpes infection. Sexual health doctor CATH INSLEY writes …
Herpes is the group of symptoms caused by the herpes simplex virus. It is incredibly variable in its expression with some individuals experiencing extreme symptoms which occur frequently and have physical and psychological morbidity. Many people however have been exposed to the virus and have few or no symptoms , and are oblivious that they even have herpes.
These extremes are in part explained by the type 1 and type 2 viruses. Type 1 traditionally causing cold sores around the mouth and type 2 causing genital cold sores. However with the increase in the practice of oral sex , type 1 and 2 can be found on both genital and mouth areas.
Type 1 tends to be milder, less frequent and ‘burns out’ quickly with potentially no recurrences. Type 2 tends to be more severe with a tendency to recur and manifest in more troublesome symptoms.
Mild symptoms can be an itch or tingling, and more severe symptoms causing flu like symptoms, fatigue, and neurological pain. Painful lesions; lumps, blisters and ulcers in the genital and perioral area have a high level of suspicion for herpes, especially if they are episodic. Primary infection (the first time the virus manifests) is usually the worst episode and in some cases can lead to time off work, hospitalisation (to control pain, secondary infection and urinary retention) and significant illness. Over time the severity tends to decrease with shorter outbreaks and lesser frequency. However these are just general patterns and for an individual their experience is the only experience.
Some people tend to get frequent and severe outbreaks warranting daily medication to avoid the negative effects on daily life. Others are unaware that they carry the virus and are infectious to others ( silent viral shedders). This huge variety in experience leads to problems in tracking and contact tracing.
Those in relationships cannot assume that their partner has been unfaithful as the virus can be latent for long periods of time and have only short periods where the virus can infect others. However primary infection within a long monogamous relationship will often create doubts and questions that cannot be answered.
However at the same time immunity and general health, and other fissures and lesions can greatly affect the chance of an individual being infected by contact with a carrier. Rougher sexual intercourse, co morbidities , other infections , can increase the chance of infection.
Screening and testing for herpes is difficult on those who do not have symptoms as the tests cannot demonstrate infectivity, latency, or prognosis as these vary from person to person. Probably 20% of the sexually active adult population have antibodies to HSV, but many of these do not know as they have no, or very mild symptoms.
Condoms can protect to some extent, but they do not cover the whole of the genital area. Antivirals are very effective but expensive (can be obtained on an authority script with a laboratory diagnosis in Australia), and can be used continuously, episodically (with symptoms or during sexually active times to reduce infectivity), or just with the primary outbreak.
If you have symptoms you should see your local doctor or sexual health physician who will help unravel the clinical picture. However the available medical science may not be adequate to answer questions of who, when, how long, and how infectious am I. Herpes does not shorten your life expectancy or affect fertility or sexual function but diagnosis of herpes can unearth more psychological and emotional morbidity than the physical manifestation.
Cath Insley is a Sydney sexual health doctor and co-director of Gynaecare Health Clinic in Artarmon on Sydney’s lower north shore. For more info check out www.choicessexualhealth.com
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