Herpes virus is highly contagious; Ask the Doctors

Dear Doctor: What are the best ways to cope with herpes simplex 2?

Dear Reader: Herpes simplex 2 is a sexually transmitted disease, or STD. Herpes simplex 1, which is also called oral herpes, causes cold sores or fever blisters on or around the mouth and lips. Herpes 1 can also be transmitted to the genitals. However, the majority of cases of genital herpes are caused by herpes simplex 2. Both types of herpes are viruses.

Herpes is a common STD. According to the Centers for Disease Control and Prevention, one in every six Americans is infected with genital herpes. The infection is acquired through contact with the herpes virus, which can be present in lesions or sores on the genitals or anus, in mucosal secretions and even on the skin. Even without an active outbreak, the herpes virus can be transmitted to sex partners. In many cases of transmission, the infected partner doesn't realize he or she has the virus. It is estimated there are between 750,000 and 1 million new cases of herpes simplex 2 in the United States each year.

Symptoms of an outbreak include the lesions previously mentioned, as well as localized genital pain. Possible but less common are tingling sensations or shooting pains in the legs, hips or buttocks. Perhaps the most serious complication of a genital herpes infection is the chance of spreading it during childbirth. Neonatal herpes infections, while rare, can be fatal. Pregnant women with herpes should let their doctors know about their infection.

At this time, there is no cure for either oral or genital herpes. Antiviral drugs like acyclovir, famciclovir and valacyclovir can help to reduce the severity of symptoms and the frequency of outbreaks of herpes 2. That means that individuals who are infected with the virus have a lifelong condition that must be managed.

As for how to manage a genital herpes infection, the main concern is to not spread it to sexual partners. Herpes is at its most contagious when sores or lesions are present. However, we must repeat that it can be transmitted at any time, whether or not there are visible symptoms.

During outbreaks that involve sores, infected individuals should abstain from sex. (And if you're having sex with someone and see genital sores, stop.) The difficult truth is that, even when sores are not present, condoms are only partially successful at preventing transmission of the virus. That's because the virus can be present in areas that are not covered by the condom.

If either you or your romantic partner has genital herpes, the risk of transmitting the virus can be lessened by taking an antiviral medication. The medication lowers the incidence of visible outbreaks, which is when the risk of acquiring the virus is highest. You should also avoid any kind of sex with your partner during an outbreak. Anyone with herpes simplex 1, which causes cold sores, should never engage in oral sex, as it can result in a genital infection in their partner.

Anyone who suspects he or she has herpes should see a doctor. A visual examination of an active sore, culturing a sore or a blood test for antibodies will give you an answer.

Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.

Credit: Dr. Eve Glazier; Dr. Elizabeth Ko