Preventing Genital Herpes

Because herpes can be transmitted from someone who has no symptoms, using these precautions is not enough to prevent transmission. Recently, the Food and Drug Administration approved Valtrex for use in preventing transmission of genital herpes. It has to be taken continuously by the infected person, and while it significantly decreases the risk of the transmission of herpes, transmission can still occur.

• Do not have sexual contact (vaginal, oral, or anal) from the time of first genital symptoms until symptoms are completely gone.
• Using barriers such as condoms during sexual activity may decrease transmission, but transmission can occur even if condoms are used correctly. Condoms may not cover all infected areas.
• Avoid touching the infected area during an outbreak, and wash your hands after contact with the area.

Patient Education and Counseling

Counseling has two main goals:

• To help patients cope with the infection; and
• To prevent sexual and perinatal transmission.

The psychological effect of HSV infection is often substantial. HSV-infected persons may express anxiety about genital herpes that does not reflect the actual clinical severity of their disease. The misconception that HSV causes cancer should be dispelled, because HSV-2 is not a primary etiologic agent in cervical cancer.

Common concerns about genital herpes include the severity of initial clinical manifestations, recurrent episodes, sexual relationships and transmission to sex partners, and ability to bear healthy children.

Although initial counseling can be provided at first visit, many patients benefit from learning about the chronic aspects of the disease after the acute illness subsides. Numerous resources are available to assist patients and clinicians in counseling.
Patient counseling and education should cover the nature of the disease, transmission, treatment issues, and risk reduction strategies.

Asymptomatic persons diagnosed with HSV-2 infection by type-specific serologic testing should receive the same counseling messages as persons with symptomatic infection. Asymptomatic persons should be taught about the common manifestations of genital herpes, as many will become aware of them with time.

Antiviral therapy is not recommended for persons without clinical manifestations of infection.

Nature of the Disease

Discussion of the natural history of HSV should emphasize the potential for recurrent episodes, asymptomatic viral shedding, and sexual transmission. Persons with genital herpes should be informed that:

• Sexual transmission of HSV can occur during asymptomatic periods.
• The frequency of outbreaks generally decreases with increasing duration of infection.
• Stressful events may trigger recurrences.
• Outbreaks may be preceded by prodromal symptoms.

Transmission

Persons with HSV infection should be counseled:

• That HSV can be transmitted when the patient is asymptomatic.
• To abstain from sexual activity with uninfected partners when lesions or prodromal symptoms are present.
• To inform current sex partners that they have genital herpes.
• To inform future partners before initiating a sexual relationship.
• About the risk of neonatal infection.

Treatment Options

Counseling should include education about:

• Effectiveness of suppressive and episodic antiviral therapy in preventing or shortening the duration of recurrent episodes.
• When and how to take antiviral medication.
• Recognition of prodromal symptoms.
• Strategies for relief of painful urination such as urinating in a tub and the use of topical analgesics.

Risk Reduction Strategies

The clinician should:

• Assess the client's behavior-change potential.
• Discuss prevention strategies (abstinence, monogamy with an uninfected partner, condoms, limiting number of sex partners, etc.)
• Inform the client that genital ulcer diseases can occur in male or female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of genital herpes only when the infected area or site of potential exposure is protected.
• Work with the client to develop individualized risk-reduction plans.
• Advise pregnant women and women of child-bearing age who have genital herpes to inform their prenatal and neonatal care providers of their history.

Partner Management

Counseling of infected persons and their sex partners is critical to management of genital herpes. Sex partners are likely to benefit from evaluation and counseling.

Symptomatic sex partners should be evaluated and treated in the same manner as patients who have genital lesions.

Asymptomatic sex partners of patients who have genital herpes should be asked about any history of genital lesions, counseled about the risk of asymptomatic transmission, taught to recognize symptoms of herpes, and offered type-specific serologic testing for HSV infection. Type-specific serologic testing of asymptomatic partners of persons with genital herpes can determine whether the risk of HSV acquisition exists.

Sources: CDC, DHHS