Herpes is not new, the Roman Emperor Tiberius (yes, the one Captain James T. Kirk got his middle name from) outlawed kissing in public in an effort to stop the spread of oral herpes. About 150 million Americans have had at lease one bout with this virus.

Herpes simplex virus (HSV) is the causative agent of this disease. There are two types of herpes virus: Type I and Type II. Type I causes fever blisters. Type II is the cause of genital herpes and is considered a sexually transmitted disease. Type I can infect the genital area from oral contact, but even if an infection is caused, HSV I recurs less and causes less shedding (see below).

I generally do not diagnose anyone unless I get a positive culture test of the lesion. There are other things that look like herpes, and before I give someone this diagnosis, I want to be sure. Assuming you have the problem, you are very likely still infected. There is also a blood test now that can see if it is in your system, but it can predict your exact response to the disease.

Genital herpes is like having a fever blister in the private area and like fever blisters genital herpes is more active in some people than it others. It is also more active when one is under a physical stress (i.e. fever, fatigue, during pregnancy or a menstrual cycle). The virus actually infects nerve cells, and recurrent outbreaks are caused by the virus traveling down the nerve to the skin and re-infecting that area. The virus can lie dormant for years in the nerve root before something triggers it into action.

Can I be treated and cured?

There is treatment, but not a cure. There are three medicines, acyclovir, valacyclovir and famciclovir. They can be taken to shorten the period of out-break on a problem by problem basis. It can also be taken on a daily basis, two or three times a day, to suppress the virus, it doesn't cure the infection, it just increases the period of time that the virus is dormant. You would not be a candidate for this medicine if you so rarely have an outbreak, it is about a dollar a pill.

Can I give my herpes to my partner?

Yes. I was thought this only occurs when there is an active lesion, but recently it has been found that even asymptomatic carrier can shed the virus on a regular basis. Your partner can be tested with a blood test to see if he is already infected. If he is then there is no need for further concern, if he is not then daily suppression reduces viral shedding an may protect your partner. Still clearly then no sexual activity should be undertaken if there are active lesions until they are gone.

Can herpes prevent me from having children?

No, herpes does not affect fertility, but there are some risks. If a woman has an active lesion when the baby is delivered there is about a one in 20 chance the baby will be infected passing through the birth canal. Acyclovir is currently used for suppression in pregnancy and is started at around 34 weeks to prevent such an outbreak. If I suspect an outbreak is present around the time of delivery, I perform a cesarean section to protect the child. Routine cesarean section is generally not performed for a distant history of herpes, but you and your Ob-Gyn will need to watch closely for the problem near term.


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