Time To Talk About Herpes

All things considered, we've come a long way. We're getting better at discussing what were once delicate topics. For example, many women now freely and openly discuss menopause, while 50 years ago it was still often referred to in hushed tones as 'the change'.

However, there is still some way to go in breaking down the stigma around a virus that's so common, it affects one in eight people – genital herpes.

What is herpes?

There are two types of the herpes simplex virus – HSV1 and HSV2. Oral herpes, commonlyknown as cold sores, is caused by HSV1.

In the past, genital herpes was typically always caused by HSV2. However, that has nowchanged, says Dr Joanne Peel of the Melbourne Sexual Health Centre. "More than half ofgenital infections today are due to HSV1," says Dr Peel. "This is believed to be as a result ofthe increase in oral sex, particularly among young people."

HSV1 is transmitted via oral to oral, oral to genital, and genital to genital contact. HSV2 istransmitted only via genital to genital contact.

Today, children are less likely to be infected with cold sores, for example, from kissingparents and other young children. However, HSV1 still remains far more common thanHSV2, says Dr Peel. "In fact, it is estimated that up to 80% of people in Australia carryHSV1, compared to around 12% for HSV2," she says.

Young women more at risk

Anyone who is sexually active is at risk of getting genital herpes, even if they don't havevaginal or anal sex because the HSV1 virus can be transmitted by oral sex. Dr Peel saysyounger people, "particularly young women under 25 years of age", are at a higher risk ofgenital HSV1 versus HSV2."

"We strongly encourage young women to advocate for their own health and try to negotiatecondom use assertively," she says.

How is herpes spread?

First, let's talk about how it's not spread. Despite what you may have been told, you can't getherpes from toilet seats, bedding, or swimming pools, or from touching objects around yousuch as taps, soap, or towels.

The herpes virus enters the body through breaks in the skin, or tiny skin abrasions aroundthe mouth, genitals or anus. These abrasions are generally caused by friction during sex,and are often so small they cannot be seen. The virus will then live in nerve cells, "where itwill essentially stay for life", says Dr Peel.

For most of the time the herpes virus won't cause any problems. In fact, a person "may noteven know they are infected with the virus," says Dr Peel. However, at certain times, thevirus will infect skin cells at the surface, causing an outbreak.

Signs and symptoms of herpes

Despite how common herpes is, Dr Peel says it's often under-recognised because it oftenhas no, or very mild, symptoms. However, others can have noticeable symptoms, which mayinclude:
• itching or irritation around the anal or genital area

• sore genitals that may cause pain and difficulty urinating
• skin splits
• painful blisters
• open sores (ulcers) in or around the mouth, the genital area or the anus.

To confirm genital herpes, a swab is taken from an ulcer or sore and sent to a lab for virusDNA detection. This will confirm HSV and identify if it is HSV1 or HSV2.

How it's treated

Dr Peel says initial painful bouts of herpes can be treated with an antiviral medication for 7-10 days.

After that, bouts of it can then be treated with short (one-day) courses, started at the veryfirst sign of symptoms.

Recurrences tend to be less severe, with fewer sores in a more localised area. People maynot realise they even have it as the symptoms can be so minor – such as a mild itch orirritation.

Dr Peel says frequent recurrences can be suppressed by taking a continuous daily dose ofas little as one antiviral tablet daily. Continuous daily dosing has been shown to reducetransmission to partners, she says.

How can people protect against genital herpes

To protect yourself from genital herpes, it's important to avoid sex with people with activesores; this includes avoiding oral sex with anyone who has an active cold sore, says Dr Peel."Use condoms – which should be put on before there is any genital skin-to-skin contact," shesays.

She says using a lubricant during genital to genital contact is also important, as it will helpreduce the chances of friction that can cause the tiny abrasions that may let the herpes virusenter the body. However, she says although condoms can greatly reduce the risk oftransmission, they do not prevent it completely, as outbreaks of genital herpes can occur inareas not covered by a condom, such as during oral sex.

Even though herpes is very common, genital diseases in general carry more stigma thanother diseases. Although this attitude is starting to change, it can still be distressing for aperson to be diagnosed with genital herpes, particularly as the virus will stay with them forlife.

"People can often become anxious at the prospect of a herpes diagnosis and feel like theirsex life is over," says Dr Peel. She says referring to herpes as a skin condition affecting thegenitals, rather than a sexually transmissible infection, may be helpful in reducing stigma.A herpes diagnosis doesn't mean the end of your sex life. "We want people to feel reassuredthat herpes is very common and that the episodes can be treated," says Dr Peel.

Find more information on safer sex and STIs.

Download a useful resource from the Melbourne Sexual Health Centre: Herpes fact sheet.
Published with the permission of Jean Hailes for Women's Health jeanhailes.org.au 1800 JEAN HAILES (532 642)