Blisters under my trousers

Dear Dr G,

I am a 35 year-old-man who after nearly fifteen years of searching have found someone whom I am ready to settle down with. Although I do not consider myself to be a wild lover, I confess to have taken some risks sexually along the way, which I am not proud of.

Over the past two years, I have encountered some ulceration in my genitalia. A visit to the doctor’s told me that the likelihood I have genital herpes is high – I was devastated and regretted my past sexual encounters! I was given some antiviral cream and medicine and the ulcers seemed to settle with the treatment.

However, the blisters tend to emerge when I am dehydrated or under stress. I have never had myself tested and confess I am too scared to face reality but now, I think it is time for me to man up and own up.

Before I go for the appropriate tests, I would like to put Dr. G on the spot and find out more about herpes?

What exactly is herpes? Are the ulcers in my manhood transmitted by oral sex? What are the chances of transmission to my partner with unprotected sex? Should I tell my partner the truth of the ulcers in my trousers?

Regards,
Blistery Benjamin

The word Herpes is derived from the Greek word which means “to creep”. This generally refers to the tendency for the blisters to spread. Herpes is a skin infection caused by the Herpes Simplex Virus (HSV) that can affect the oral cavity and the genitalia. Infections to the mouth may result in small blisters in groups simply referred to as cold sores.

However, when the virus involves the penis or vagina, it gets the horrible label of genital herpes. There are two types of the Herpes Simplex Virus, HSV-1 which typically involves the oral cavity and HSV-2, which is generally for genital infection. However, cross-infection of the viruses between the two sites are also well documented.

Transmission of the virus is by direct contact of an active lesion or exchange of bodily fluids. Hence the virus is contracted through infected saliva, semen, vaginal fluid and secretions from blisters. The prevalence of Herpes is estimated to range from between 60% and 95% of the adult population.

HSV-1 is generally acquired during childhood, with infection rates of 70% among the lower socio-economic population and 40% amongst the improved status demographic. On the other hand, some studies reveal that 16% of the HSV-2 positive, sexually-active adult population are oblivious to their infection. The 2003 study estimated 536 million people worldwide are infected with HSV-2, with greater rates observed among women, especially in the developing world.

The HSV virus enters the nerves from the site of infection and becomes latent, with most infected individuals displaying no symptoms. Despite this subclinical state, however, the individuals are still infectious.

In the 1980s, the serological test (looking for antibodies in the blood) for the virus’ antibodies was the gold standard. As the Immunoglobulin M (IgM) antibodies cannot be used to differentiate the two viruses and the Immunoglobulin G (IgG) tests also lack specificity and sensitivity, these investigations are no longer routinely used.

The definitive diagnosis of virus nowadays is PCR to detect the virus’ DNA – however, the result may also be falsely negative during the dormant phase. As with most sexually transmitted infections, women are more susceptible to acquire HSV infection from the male partner. The male-to-female transmission rate is recorded to be 11%, as compared to 5% the other way round.

Although the asymptomatic carriers of HSV are also contagious, the risk of transmission is significantly lower than during the active state. As the daily consumption of antiviral medications can suppress the emergence of blisters, this can potentially reduce the transmission rate by 50%. Condom usage also does not eliminate the transmission completely, one study revealed 14 transmissions out of 214 couples with regular intercourse.

Mankind has known herpes for at least two thousand years, as Emperor Tiberius was recorded to ban kissing in Rome, preventing the spreading the virus. Even Shakespeare’s Romeo and Juliet mentions blisters on ladies’ lips.

Although Herpes is a disease cause by love (making), in many ways it also an infection of love and forgiveness. The American advice columnist, Ann Landers once stated: “Love is friendship that has caught fire. It is quite understanding, mutual confidence, sharing and forgiving. It is loyalty through good and bad times. It settles for less than perfection and allowances for human weaknesses.”

When Dr G is put on the spot by the men (and women) about the past emerging its head as an ugly blister, his advice is “Active herpes is like a blister that that has caught fire. But it is also quietly dormant, with the confidant understanding that sharing will result in spreading!”

Being truthful with each other can ensure loyalty through good and bad times. On that note, man up, own up and open up to the past and this can ensure the sharing of everything, even the blisters in the pants!