Controlling Recurrent Genital Herpes: The Use Of Oral Antivirals In Herpes Management
The following section gives you in-depth information about the use of oral antivirals to treat herpes. Aciclovir has been used for this indication for a number of years now and found to be highly effective in controlling herpes recurrences.
Some people with genital herpes have identified factors which may influence the frequency or severity of recurrences. Factors such as stress, diet and lifestyle may be worth considering when looking at ways of managing herpes in your life. Each case is individual and what works for one may not work for another.
Frequent or severe recurrences of genital herpes infection may interfere with normal work and social activities, and cause disruption to your sex life. However, there are steps which you can take to reduce outbreaks and help bring the herpes virus under control. This section explains what you can do and answers some other questions which you may have about living with genital herpes.
How Do I Take Suppressive Therapy
There are two oral antivirals available for suppressive treatment in New Zealand:
- Aciclovir tablets 400mg taken twice daily, morning and night. If you start suppressive therapy, it is important not to miss any doses and to take it regularly at approximately 12 hourly intervals. If your recurrences are not suppressed by this dose, you should discuss this with your doctor as taking 200mg four times a day may be more effective. Aciclovir is also available in a soluble form if you are unable to swallow tablets.
- Valtrex tablets 500mg taken once a day. People who find aciclovir isnt working in treating problematic recurrent herpes can now access Valtrex by fully subsidised prescription from their doctor through a Special Authority application. This is a new generation antiviral with better absorption.
Put The Diagnosis In Perspective
Couple it with the data they need to put it in perspective. Tell them the herpes statistics, what herpes is, and perhaps relate a little about how it affects you personally.
For example: Are you one of the lucky ones who has never had an outbreak? Or do you now have symptoms only rarely, or even never, after managing or stopping your outbreaks? What if you only have outbreaks somewhere unusual, like your lower back ? Even if you do have frequent outbreaks, do you take care to know the signs one is coming on and take care of your health in general? Then by all means, include this more flattering information!
Not Such a Huge Deal: Heres a way to put it in perspective: You could mention that there are several types of herpes viruses: chicken pox, cold sores, genital herpes, and shingles. They might realize that its stigmatized yet not life-threatening or really even all that scary. Just about everyone gets chicken pox, and the majority contract oral herpes in their lifetime.
It Happens to the Best of Us: You dont need to tell this new person anything about how you came to contract herpes, or defend your past to them. But if you think it helps to let them know some face-saving circumstance, use your discretion and gauge your trust in this person and the intimacy level. Sometimes mentioning that its possible to contract herpes even if you always use condoms is adequate.
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Set The Tone Of The Conversation
You want to be clear and confident, and you also dont want to talk about your infection as if its a huge problem. Dont use overly negative words, and dont open by saying something like, Ive got some terrible news for you, or, promise you wont freak out, as this sets the wrong tone, and telling someone not to freak out is the best way to actually make them freak out. Start the conversation by saying something like, Ive just had the results of a test, and Ive found out I have an infection that causes genital herpes.
What Is Suppressive Therapy
Suppressive therapy involves taking an oral antiviral drug every day for prolonged periods. It interferes with the herpes virus reproductive cycle and so prevents or dramatically reduces the number of recurrences. When recurrences do occur, they are usually less severe and shorter lasting.
If you find the frequency of your outbreaks unacceptable, or if you are finding it difficult to cope emotionally with having recurrences of genital herpes, tell your doctor and discuss the use of suppressive therapy.
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How To Reduce The Risk Of Spreading Herpes
There are ways to lower the risk of spreading HSV-1 to your partner. If you have an active outbreak, avoid letting the affected area touch your partners skin. Concerned about transmitting the virus when no symptoms are present? Using a protective barrier like a condom or dental dam can reduce the risk.
How Can I Prevent Giving Genital Herpes To My Partner
You can reduce the risk of passing the herpes virus to your sexual partners by taking the following steps:
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Tell current sexual partners that you have genital herpes. You also should tell future partners before having sexual contact.
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Be alert to the symptoms that signal an outbreak is coming. Avoid sexual contact from the time you feel symptoms until a few days after the sores have gone away.
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Wash your hands with soap and water after any possible contact with sores.
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Take antiviral medication on a daily basis .
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Use male latex condoms.
Its also important to know that you can pass HSV to someone else even when you do not have sores . The virus can be present on skin that looks normal, including right before and after an outbreak.
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Do The Symptoms Of Genital Herpes Return
The symptoms of genital herpes may reappear from time to time. This is because once the herpes virus is acquired, it stays permanently in the body. Most of the time it remains inactive, but every so often it may reactivate and cause another outbreak.
Each individual is different some people never have a recurrence others may have recurrences several times a year. However, recurrent outbreaks are usually shorter and less severe than the first herpes episode.
Certain events or situations can trigger recurrences, and you may be able to help your partner avoid or reduce the trigger factors, which may include stress at work or home, fatigue, ill health, loss of sleep, friction due to sexual intercourse, and menstruation in women.
If your partner has frequent or severe episodes of genital herpes, or if the recurrent outbreaks are causing a lot of anxiety for your partner, then he or she may benefit from suppressive therapy , which prevents or reduces recurrences.
Do Your Research And Share Your Knowledge
Although we sometimes assume that people are educated about issues such as STIs, many individuals are not aware of the signs, symptoms, transmissibility, and long-term medical consequences of STIs. So, if you have an STI, be prepared to cover the basic points in a direct, honest way. Some people find that having a printout about the STI is helpful in the event a new partner might find additional information reassuring.
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What Is Genital Herpes
Genital herpes is a common infection generally transmitted through sexual contact. It is caused by one of two members of a family of viruses which also include the viruses causing chickenpox and shingles, and glandular fever.
Usually, genital herpes is caused by infection with herpes simplex virus type 2 , and studies suggest that in some countries, one in five people are infected with this virus. Genital herpes can also be caused by HSV-1, the virus which usually causes cold sores on the lips and face, through oral/genital contact.
Genital herpes, for most people, is an occasionally recurrent, sometimes painful condition for which effective treatment is now available. Generally, it is not life-threatening and has no long-term repercussions on ones general physical health.
Anyone who is sexually active is at risk of catching genital herpes, regardless of their gender, race or social class.
When Should You Have The Herpes Talk
Particularly in situations where physical and sexual attractions are high, its important to have a direct conversation about herpes and any other STIs well before sexual contact takes place. That way, if a new partner isnt willing to pursue a relationship due to the presence of an STI, this can be realized early on.
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Is It Safe To Take The Treatment For A Long Time
Aciclovir has been reported to cause no serious side-effects, even after years of use. A few people taking suppressive therapy do experience minor side-effects such as a headache, nausea and diarrhoea. If you have a problem, discuss this with your doctor.
Research to date shows that people with normal immune systems who are on oral antivirals for a long period do not develop virus resistance or clinical breakthrough. Also, there is little interaction with other drugs, e.g. the contraceptive pill is unaffected by Aciclovir.
How Does Herpes Spread
It also helps to know a little about how HSV works when you talk to a partner about the infection. Getting the details from your doctor first may be helpful, says Dr. Baldwin, because theres no doubt that HSV can be confusing. For starters, there are two types of the virus: HSV-1 and HSV-2.
HSV-1 typically causes oral herpes, known for those trademark cold sores, while HSV-2 is usually to blame for genital herpes sores. However, over the past few decades there has been an increase in HSV-1which usually causes oral symptomscausing genital herpes, explains Dr. Baldwin. Genital herpes that come from HSV-1 are typically passed through oral sexa good reason to divulge that you have oral herpes, if you do.
Both types of herpes can be passed on when there are active sores and, less frequently, even when there are no symptoms. Some important information to share would be whether or not you have frequent outbreaks, which is the highest risk time for transmission, says Dr. Baldwin. Lay off the sexual activity during an outbreak, as well as whenever you have the pain or tingling that signal an outbreak is coming, she says.
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Can Genital Herpes Harm Babies Either During Or After Pregnancy
Having genital herpes does not affect your ability to have a baby. Overall, the incidence of neonatal herpes is very rare. However, when it does occur it is potentially very harmful to the baby. It is therefore important to tell your doctor or midwife if you or your partner have had a history of genital herpes. They will then be able to provide information, reassurance and optimal management.
Recurrent episodes of genital herpes during pregnancy are not harmful to the foetus. If you have genital herpes at the time when your baby is due, there is a small risk that the baby could become infected at delivery as it passes down the birth canal. This risk is most substantial for mothers who are having their first ever episode of genital herpes near to or during delivery. However, if you are simply having a recurrence of genital herpes, then the chances of your baby becoming infected with herpes at delivery are low as the baby is protected by antibodies circulating in the mothers blood.
Do You Need To Tell Them
Before you tell anyone that you have genital herpes, its worth asking yourself whether or not they need to know. Your friends, colleagues and family probably dont need to know about it, as theres minimal risk of them catching the virus from you through sexual contact.
If you have close friends and the subject of herpes comes up in discussion, feel free to tell them about your HSV-1 or HSV-2 status if you feel comfortable. Just remember that you dont owe an explanation or confession to anyone youre not putting at risk of catching the virus from you.
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Tell Your Partner About Your Herpes Without Delay But Not Too Early
It is important thing for you and your partner, he or she has the right to know it. Whether you choose a long walk or a dinner is not important, but the absence of sexual contact is. The discussion should take place where sexual contact is unlikely to follow the discussion. Do not delay. Tell your partner in the right time. educate your partner on an equal basis make it a shared experience.
Try your best to stay in control of the situation. You have some medical facts to discuss and some plans for avoiding transmission. You will want to tell your partner that this is something he or she is being entrusted with because you feel that the relationship is worthy of it and you sense that sexual involvement may soon develop.
How Long Will I Need To Take The Treatment
Many people who use suppressive therapy say that they get so used to taking the tablets or capsules they are happy to continue with the treatment.
If you choose suppressive therapy, you do not have to stay on it permanently. If you prefer, you can take it until you feel in control of the herpes infection, but this is usually a period of 6-12 months initially. Your doctor may suggest you stop the suppressive therapy for several months after you have taken suppressive therapy for some time, in order to assess how active your genital herpes remains. If you are still having problems with herpes recurrences, you and your doctor may then decide that you should start suppressive therapy again.
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Is It Safe To Take Drug Treatment For Genital Herpes During Pregnancy
As with any drug therapies, oral antiviral tablets are not routinely recommended for use during pregnancy. Aciclovir has been used for treating genital herpes for over 15 years and as with any drug, a register has been kept to report any adverse side effects for women who have taken it during pregnancy. To date, there have been no adverse side effects reported for either the baby or the mother.
Due to the potential seriousness of a primary episode of genital herpes for the baby and the relative safety of Aciclovir, it is now recommended that Aciclovir is used for treating the first episode of genital herpes or severe recurrent herpes in the last trimester of pregnancy. It is believed that the benefit of using Aciclovir, by reducing the risk of transmission of herpes to the baby, outweighs the risk of not using it.
Pick The Right Time And Place
You should have the conversation when you both have time to talk it through, without any time pressures or other distractions. Dont try and tell them while youre rushing to leave for work in the morning or as theyre drifting off to sleep at night.
Pick somewhere where youre both comfortable and can talk freely. Talking at home over a coffee on a weekend afternoon is probably going to be better than in a public place.
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How Effective Is Suppressive Therapy
Studies have proven that continuous suppressive antiviral therapy for herpes can dramatically reduce the frequency of herpes outbreaks or prevent them all together and reduces the risk of transmission by 50%.
For example, a very large study found that people who had an average of over 12 herpes occurrences a year, could reduce the frequency of their herpes outbreaks to less than two a year after one year of continuous suppressive therapy.
The study also showed that if recurrences do occur during suppressive therapy, they are usually less severe and shorter lasting.
I didnt want to take any drugs, so I tried natural therapies. These didnt work. I now take aciclovir 400mg twice a day and have not had any outbreaks since. If your outbreaks are frequent, I really recommend it. MK
Case #1 A Person Who Didnt Know They Had It Passed It To Their Partner
A 25-year-old woman named Julia came to the office with a genital skin rash that she had never had before. A herpes swab test came back positive for herpes .
She confronted her boyfriend, Tony, whom sheâd been dating for nine months.
Tony is a young professional who denied having sex outside of his current relationship with Julia. He also said the following:
- Heâs been fully tested for STDs after each relationship ended .
- He hasnât ever had herpes symptoms.
We gave Tony the HSV-2 test , and it came back positive for herpes.
Julia got herpes from Tony. Though heâd never had any symptoms, he shed the virus silently.
Dr. Fâs Explanation
- Itâs very common for people to have herpes and not know about it. Only 20% of herpes-positive people have symptoms. Most people are asymptomatic for life.
- You donât need to have a herpes outbreak to pass the infection. It can be passed through silent herpes shedding. This means that James could have passed it to Julia without having symptoms.
- When people get âfully testedâ for STDs, the testing might not include a herpes test. The CDC doesnât recommend routine herpes testing. And Jamesâs past test results didnât show that herpes testing was performed.
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Qhow To Have The Herpes Talk With A New Partner
A. Its so normal and natural to want to avoid a conversation about STIs given a fear of being judged or rejected. Given that those with sexually transmitted infections feel stigmatized, just the thought of a conversation about herpes can induce anxiety. Yet, its important to be able to talk with a partner openly and honestly about everything.
But another way to think about it is this: youll have sex, watch sex , and think about sexso why wouldnt you talk about sex and all the important things that go along with sex, like STIsespecially with the person with whom youre having sex? Sex is natural, and a normal part of life and STIs are extremely common. And, to quote Mr. Rogers, Anything human is mentionable, and anything mentionable is manageable. But if youre unsure how and when to have this conversation, there are some ways to prepare and set the scene to help it go as smoothly as possible.