Getting the lowdown on genital herpes

Dear Dr G,

I understand you don’t usually answer questions from women. However, I am trying my luck to enquire about a form of sexually transmitted infection.

I am a woman in my late thirties focusing on my career until recent years.

Being a bit behind in the dating game, I don’t get too many similar-aged bachelors who would be interested.

I recently met a divorcee on Tinder, the friendship has flourished so well, and we have been rather intimate in recent weeks.

Everything has gone smoothly until he started getting upfront about his sexual past.

Apparently, he contracted genital herpes from his ex-wife when they were married.

He confessed that genital herpes emerged as unpleasant blisters from time to time.

However, he assures me the infection is completely risk-free.

Naturally, I was devastated. I adore the man, but the thought of contracting herpes from my partner is simply unthinkable.

Therefore, I would like to pick your brain and put Dr. G on the spot.

Can you tell me what exactly is herpes? Can the disease come and go periodically?

Can someone unknowingly contract the disease and will it emerge at a later stage?

What would be my risk of contracting the disease, with or without condoms?

Is the infection curable? If not, what is the long-term treatment of herpes?

Lastly, if I were to contract herpes through sex, will I suffer anything beyond blisters in the pants?

Yours truly,
Blistery Betty

The word herpes originates from the Greek word “creeping in latency”. Genital herpes is a viral disease induced by the infection of HSV (herpes simplex virus). The pathogen is transmitted by direct sexual contacts of an infected individual, with or without outbreaks or bodily fluid exchange. Type I HSV usually involves the face or mouth, mostly termed as cold sore, and type II HSV is often known as genital herpes affecting genital organs and anus in both genders.

The worldwide estimation of prevalence of adults affected by herpes virus is between 60% and 90% of the sexually active population. The transmission risk is higher for men compared to women. An estimated 16% of the world population were infected with genital herpes. The incidence is much higher in developing nations with lower socioeconomic status. Most sufferers of HSV are unaware of the infections, as they may remain asymptomatic. This makes genital herpes one of the commonest sexually transmitted infections.

Genital herpes has minimal symptoms when dormant. During the outbreaks, it manifests with tingling sensations of the affected areas, followed by shooting pain, blisters and unsightly ulcers. Herpes cycles occur between periods of active disease followed by dormant intervals. The first episode is often frighteningly severe and associated with fever, muscle pain and even swollen lymph nodes. Generally, the infection is harmless, however the disease could also progress to life-threatening disease like meningitis and conjunctivitis in vulnerable individuals. After an initial incubation period, the virus may be transmitted along the sensory nerves to the nerve cell bodies, and the pathogens stay dormant in the bodies between outbreaks. Causes of the recurrence may vary, but are usually precipitated by immunosuppression, stress or even exposure to sunlight.

The diagnosis of genital herpes is clinical recognition of the lesions, which are characteristic blisters appearing on the penis, vagina, or anus. Blood tests for antibodies against the virus can verify recent or previous infections, however, the precise detection of the virus is determined by the presence of the virus DNA from the blisters during outbreaks.

The most effective mode of avoiding transmission of genital herpes to sexual partners is by avoiding vaginal, oral, or anal sex, especially during outbreaks. However, such restraints may be impossible for most intimate relationships. The use of condoms can reduce the risk significantly. In addition, scientific data also support the utilisation of daily antiviral medication to reduce the contagion. Despite the meticulous measures, the risk of transmission is never zero. The transmission risk of Herpes Simplex Virus from an infected male to female is 8-11% without the use of antiviral or condoms. The suppressive antiviral therapy can help to reduce the outbreaks of the disease and reduce the transmission risk by 50%. One study revealed that the transmission rate of 14 out of 214 couples may contract genital herpes despite proper usage of barrier technique.

Genital herpes is a taboo in society as it is classified as a sexually transmitted infection. Although the disease itself is incurable, the antiviral treatments during the outbreaks are usually effective with minimal side effects. As the disease itself is mostly harmless, most couples would “share” the disease once they are aware of the pathogenesis of the infection. Therefore, the key in dealing with the disease is disease awareness and minimising the stigma.