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Herpes: the good news, the bad news, and the really bad news

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A new study out from the CDC shows that herpes is twice as common in women than men, and three times as common in blacks than whites. A massive 48% of new herpes cases are among black women. We called on Dr. Vanessa Cullins, an obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood, to get the story behind these depressing statistics.

Em & Lo: Can you briefly explain the difference between HSV-1 and HSV-2, and how they are related to oral vs genital herpes?

Dr. Cullins: Herpes is a very common infection caused by two different but closely related viruses — herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Both are easy to catch. They remain in the body for life, and can produce symptoms that come and go. Both forms of herpes can infect the oral area, the genital area, or both. When the infection is on or near the mouth, it is called oral herpes. Oral herpes is caused most often by HSV-1. When herpes infection is on or near the sex organs, it is called genital herpes. Genital herpes is caused most often by HSV-2.

The study shows that women are nearly twice as likely as men to be infected — why is this?

Herpes infections prefer moist environments and a woman’s sexual organs tend to be more continuously moist than a man’s.

The study also shows that the infection rate is three times higher amongst blacks, with 48% of new herpes cases being in African American women. Why the disparity?

Women of color are disproportionately affected by the current health care system that exists in this country. Women who face multiple barriers to accessing affordable health care, including being uninsured or under-insured, experience higher rates of sexually transmitted infections and other medical conditions.

We’ve heard that female condoms can sometimes better prevent the spread of genital herpes (we mean between outbreaks, not during outbreaks) because they cover more surface area. Is this true?

It is true that the female condom covers more of the vulva (the area outside the vagina that includes the vaginal lips and clitoris) than the male condom does. So it is likely that the female condom provides more protection than the male condom. But neither kind of condom provides 100-percent protection because herpes is spread by skin-to-skin contact outside the area covered by the condom.

Why do so many people with genital herpes not know that they are infected?

Most people with genital herpes have no symptoms or have very mild symptoms that go unnoticed or are not recognized as being a sign of herpes infection. The most common symptom is a cluster of blistery sores –usually on the vagina, vulva, cervix, penis, buttocks, or anus. People with herpes may think the sores are a rash from different soaps or too tight clothing or some other reason. Symptoms may last days to several weeks and go away. They may return in weeks, months, or might not return for years.

Is herpes something that people should be getting tested for regularly?

Testing is usually only done when a woman or man has symptoms and wants a correct diagnosis to decide what course of treatment may be best.

How is herpes tested for? Is there a difference in testing between men and women? And is it something one can just go to their doctor and ask for? Is it likely to be covered by insurance?

Only a clinician can diagnose herpes by performing a physical exam and tests. A blood test can tell if you have been infected with HSV-1 or HSV-2 — even if you don’t have symptoms. Clinicians can also confirm herpes infection by testing fluids taken from the sores. Testing and exam procedures are the same for men and women.

If you think you have herpes sores, see a clinician as soon as possible. It’s important to be sure that the sores are herpes. Other serious sexually transmitted infections, like syphilis, may look like herpes but need different treatment.

A lot of people don’t know that you can spread herpes even between outbreaks. How likely is this, and what can you do to lessen this risk?

It is very likely. Herpes is spread by touching, kissing, and sexual contact, including vaginal, anal, and oral sex. It can be passed from one partner to another and from one part of the body to another. Brief skin-to-skin contact is all that’s needed to pass the virus. Because herpes may have no symptoms for years, sometimes it is very difficult to know who passed it to whom. Suppressive therapy (daily medication prescribed by your health care professional) can reduce the risks of passing the virus to another person.

We know that herpes is for life, but do the outbreaks usually go away or get fewer and far between? Or do some people have outbreaks for life?

The symptoms of first episodes are usually more severe than later outbreaks. Outbreaks are individual and vary. Some people rarely have them. Others have them often. Recurrences are most common in the first year after infection. Oral herpes caused by HSV-1 is much more likely to recur than oral herpes caused by HSV-2. Genital herpes caused by HSV-2 is much more likely to recur than genital herpes caused by HSV-1. Recurrences may be more frequent for people with weakened immune systems. In most cases, outbreaks become fewer and weaker over the course of a few years.

Is there a chance that we’ll see a vaccine for herpes anytime soon?

Clinical trials are currently underway in various places around the world. It is possible that a safe and effective vaccine will become available in the next five to ten years.

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photo by Nathan Csonka