Genital Herpes

The absolute LAST thing I want to discuss with a patient.  Ever.  Is genital herpes.

Maybe you’ve had that talk with your doctor.  Sitting, standing or lying naked from the waist down, covered only by a thin paper sheet, you hear the dreaded words “This sure looks like a herpes outbreak.”

Maybe you visited Dr. Google and searched for your symptoms (yes, I know you do that).  Maybe it’s not a complete shock.  But maybe it is, and you truly thought it was just a yeast infection.  Or you got something caught on a zipper.  Or are having a reaction to your new body wash.

Whether the patient has an inkling this topic is coming or not, it is one of my least favorite diagnoses to give.  It is like no other infection for causing angst and heartbreak.  Patients are afraid I’m going to judge them, they generally know it’s not curable, and they immediately question their partner’s faithfulness.

If you have genital herpes, you probably remember what it was like the day you were diagnosed.  If you don’t have it, you may know someone who does, or (God forbid) you may be told sometime in the future that you have it.

I have 4 things I wish I could tell all patients with genital herpes on the day they are diagnosed.

  1. You aren’t alone.  According to the most recent data available to the CDC, 16.2% of Americans have genital herpes.  Black people, particularly black women, are at much higher risk, sometime estimates are over 40%.  Up to 40% of adults with genital herpes do not know that they have it.
  2. Herpes doesn’t always look or feel like herpes.  The “my-parts-are-on-fire” burning itching pain that is how herpes is described is not always how it feels.  I want people to know that recurrent discomfort of ANY sort in the area of the body that would be covered by a pair of boxer shorts could be genital herpes.  Recurrent yeast infections, recurrent “shingles” on the buttocks, recurrent urinary tract infections (especially if cultures keep coming up negative), hemorrhoids and recurrent jock itch could all be herpes.  Not all doctors are on the lookout for it, though, so asking the doctor if your symptoms could be genital herpes would be reasonable.
  3. Being diagnosed with a new genital herpes infection does NOT mean your partner was unfaithful to you.  DO NOT call and pick a fight with your partner!  Research has shown that if partners avoid sex during an outbreak (and let’s face it, who wants to have sex when you have what feels like a yeast infection?), there is a 4% per year chance that a woman will give herpes to her male partner and an 8% per year chance that a man will give herpes to his female partner.  Over a 10-year relationship, that’s still a 43% chance that a woman will stay herpes-free, and a 66% chance that a man will avoid infection.  (I’m not sure of the figures for same-gender sexual partnerships.)
  4. It’s important to find out if your partner has herpes too.  As I mentioned above, transmission rates are surprisingly low for this infection (although I had one very sweet teenager who was unlucky enough to catch genital herpes with her very first sexual experience).  If your partner does not have it, taking daily oral medication and using condoms will further decrease the chance of transmission.  Any skin-to-skin contact, especially during an outbreak, can share the infection, so preventing virus shedding with oral medication is important.  If you love your partner, do what you can to decrease the risk that you’ll infect them with an incurable virus.

This is a common infection.  Any time you begin a new sexual relationship there’s a chance you will be exposed to a sexually transmitted infection.  You’re a grownup, I know you know there are cooties out there!  Be careful and be smart, ask to be tested and ask your new partner to be tested too.

God knows if I never have to tell another patient they have genital herpes, it will be too soon.

QUESTION:  Did anything in this post surprise you?

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