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- Complications and Severity of Herpesvirus Infection - It Is Not Always Benign!
- Genital Herpes
- Could It Be Herpes? How Do I Know? Am I Contagious?
- How Is Herpes Diagnosed?
- Okay, It's Herpes - Now What Happens?
- Well, What About a Cure?
- Herpes Really Is a Problem. But Just How Big a Problem Is It?
- Websites For Patients
Introduction and Goals
One of the goals of the American Herpes Foundation (AHF) is to assist healthcare providers in the process of increasing patient awareness of the risk of herpesvirus infections, and to disseminate information on its diagnosis, available treatments, and prevention. This patient information page is designed to give an overview of ways to discuss and explain herpesvirus infections to your patients in order to dispel some of the myths surrounding herpes.
Through your patient education efforts, you can help patients better understand the many forms and modes of transmission of herpesviruses, so more patients will become aware of their risk of infection. By recognizing its prevalence and potentially severe outcomes, patients may be less embarrassed and more inclined to approach healthcare providers for help in diagnosis, treatment, and protection against transmission of this prolific virus.
What follows is information that may be useful to share with your patients because it puts some basic principles about the virus into layman's terms. The text addresses the patient as "you" for easy adaptation to your patient education repertoire.
If you are a layperson, use the information to stimulate a conversation with your healthcare provider. Please note that this site is designed primarily as an information service for healthcare professionals and researchers on herpesvirus infections and AHF activities. The AHF regrets that we cannot give medical advice or referrals, nor are we able to offer a medical question-and-answer service. If you are seeking additional resources, click here to visit our "Herpes Resources" page. There, you will find listings of web sites, centers, organizations, and hotlines that may be of further interest to you. Any views expressed by these organizations are those of the organizations themselves and are not necessarily endorsed by the AHF.
Even Chickenpox?
Some common conditions caused by herpesviruses include cold sores or "fever blisters," genital herpes, chickenpox and shingles, CMV (cytomegalovirus), infectious mononucleosis, childhood roseola, and Kaposi's sarcoma. At least eight different herpesviruses are currently known to infect humans. Each has its own specifically associated disease, but all have one thing in common—they all involve a latent (inactive) infection that can be reactivated. Many people don't realize that these seemingly benign conditions are the result of a chronic (lifelong) infection by a herpesvirus, and can lead to complications.
Complications and Severity of Herpesvirus Infection—It Is Not Always Benign!
In some individuals, especially pregnant women, newborn babies, and immunocompromised patients (eg, AIDS patients, organ transplant recipients, and patients undergoing chemotherapy), herpesvirus infections can be serious, even life-threatening. Complications for such individuals can include infections in the newborn, sight-threatening eye disease, encephalitis, or even a form of Kaposi's sarcoma, all resulting in severe illness or possibly death. Acquisition of the genital herpes virus is particularly dangerous to pregnant women, as primary genital herpes (initial infection with the virus) during any stage of pregnancy can result in spontaneous abortion, low birth weight infants, and premature delivery. If a pregnant woman contracts herpes during the third trimester of
pregnancy, her baby can also develop the disease if delivered through an infected birth canal. Fortunately, most herpesvirus infections in otherwise healthy individuals are self-limited and treatable.
Genital Herpes
Genital herpes, commonly referred to as herpes (predominantly caused by herpes simplex virus type 2 [HSV-2]), is a growing problem in the United States. It is the most common ulcer-causing sexually transmitted disease in North America. HSV-2 antibodies (produced after exposure to HSV-2 virus) can be found in approximately 22% of Americans 12 years of age and older—about 45 million people—with an estimated 1 million new infections occurring each year. The vast majority (up to 90%) of people who test positive for HSV-2 do not have a history of genital herpes, showing that most cases of the disease are misdiagnosed or unrecognized. Many individuals who are aware of their infection have no understanding of the risks associated with genital herpes, the times when they are
contagious, or how and when the virus is transmitted, and thus they continue to have unprotected sex, transmitting the disease to their equally unaware partners. In fact, most newly identified infections occurred when sexual partners did not realize they were shedding the virus and, therefore, contagious. Transmission concerns are compounded when you consider that 90% of the people with this infections are unaware they are carriers. These individuals unwittingly transmit disease to their partners, thus, adding to the epidemic.
Could It Be Herpes? How Do I Know? Am I Contagious?
Part of the problem clinicians have in diagnosing genital herpes is that the symptoms, if any, are varied and widespread. If symptoms do occur during the primary episode, it is usually within 2 weeks after exposure to the virus. The extensive range of symptoms can include severe to little or no pain; genital itching, burning, or soreness; small size or number of sores to clusters of small, painful blisters, which may ulcerate, crust, and heal; and the presence or absence of fever, headache, muscle pain, meningitis, swelling of the lymph nodes in the groin area, painful urination, or discharge from the vagina or penis. Most patients who have symptoms during their first episode of genital herpes will have several more symptomatic outbreaks each year. One of the misconceptions
about this disease is that most people are asymptomatic. Studies have found that most people who are infected with HSV are symptomatic. When people are taught to recognize the disease, most will be able to recognize recurrences. All patients frequently shed virus and are, therefore, contagious. Viral shedding can occur when symptoms are present or absent. In fact, you are infectious as much as 8% of the time. Again, this statistic includes both asymptomatic shedding (with no signs or symptoms) and symptomatic shedding (with signs or symptoms). So, it is very important to realize that you can be contagious with or without symptoms.
How Is Herpes Diagnosed?
Given the wide range of symptoms, and the fact that symptoms often go unnoticed, diagnosis of genital herpes must begin with an assessment of sexual history as well as physical symptoms. The key tool for diagnosis is laboratory testing. Clinicians take a sample from the sores, if present, and test it for the presence of herpesvirus. This is called a viral culture. If positive, it indicates you have herpes. If negative, it can still mean you have herpes. Virus is present in the sore for a short time. Therefore, if your sores are several days old, the virus is often gone.
Another way your healthcare provider detects if you are infected is by taking a blood sample to test for antibodies to the virus. This is called a serology test. New type-specific tests are available that can detect if you have HSV-2, the most common cause of genital herpes, or HSV-1, the most common cause of cold sores or fever blisters. Be sure that your healthcare provider asks for a type-specific test that measures the glycoprotein G. Glycoprotein G is specific for HSV-1 or HSV-2. Previous testing methods could not distinguish between HSV-1 and HSV-2. Therefore, if your serology was positive you would not know if the test was picking up antibodies formed from a fever blister infection or a genital herpes infection. The new tests can tell the difference. It is important to know whether or not you have HSV-1 or HSV-2. As mentioned earlier, HSV-1 is most commonly associated with cold sores. However, HSV-1 can also cause genital herpes. About 30% of the cases in the United States are actually caused by type 1. It is important to know the difference because the long-term prognosis of genital herpes due to type 1 versus type 2 is different. Genital long-term HSV-1 usually recurs less frequently and there is less asymptomatic shedding.
Okay, It's Herpes—Now What Happens?
Once diagnosed, the patient must understand that the disease is chronic, and does not "go away" when symptoms are not present. The occurrence of asymptomatic viral shedding is very real, and can result in transmission of the virus to sexual partners and even unborn fetuses. Whenever symptoms are present, infected individuals should completely abstain from any sexual contact. Even using condoms at this time may not offer enough protection, since the sores may not be completely covered by the condom. At all other times, even when it seems safe, latex (not natural membrane) condoms should be used.
Well, What About a Cure?
A number of antiviral medications have been proven effective in shortening and even preventing genital herpes outbreaks. These same treatments have been shown to significantly reduce the frequency of asymptomatic virus shedding, but because it is not totally eliminated, the transmission of genital herpes may still be possible. Studies are currently underway to determine if taking an antiviral medication every day can prevent outbreaks. There is also much research being performed on developing a vaccine against HSV, however a vaccine probably won't be available for several more years. At this time, herpesvirus infection is still a chronic condition, and while treatment is available, the cure is still a long way off.
The good news is that there are three effective therapies currently available—acyclovir, valacyclovir, and famciclovir. All are effective in treating outbreaks and preventing recurrences. Talk with your doctor about these and other treatment methods to determine what is best for you.
Herpes Really Is a Problem. But Just How Big a Problem Is It?
It's normal to feel depressed, embarrassed, worried, or even angry about having herpes. However, the very fact that at least 45 million Americans with known genital herpes, and millions of others with various other forms of herpesvirus infections, share the problem demonstrates that no herpes sufferer is alone. Just being aware of the magnitude of herpesvirus infections in the United States and that therapies are available to treat or prevent outbreaks should help sufferers feel less stigmatized by the condition, and allow them to seek the help available from their healthcare providers. Recognition, diagnosis, treatment, and protection go hand in hand in the fight against the spread of herpesvirus, and we hope this section has helped you to build awareness and decrease the
stigma of herpesvirus infection as you educate your patients.
Again, please note that this site is designed primarily as an information service for healthcare professionals and researchers on herpesvirus infections and AHF activities. The AHF regrets that we cannot give medical advice or referrals, nor are we able to offer a medical question-and-answer service. If you are seeking additional resources, please visit our "Web Sites for Patients" or "Herpes Resources" page. There, you will find listings of web sites, centers, organizations, and hotlines that may be of further interest to you. Any views expressed by these organizations are those of the organizations themselves and are not necessarily endorsed by the AHF.
For the layperson, bear in mind that it is not possible to diagnose diseases over the internet (or to diagnose them yourself). If you suspect you might have a herpes infection or you have any related health or prevention concerns, the best thing to do is seek medical attention and/or advice from your physician right away. If you receive a diagnosis, he or she will tell you what steps (if any) you should take.
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American Herpes Foundation - Hackensack, New Jersey
Telephone (201) 342-4441 | Fax (201) 342-7555