So You’ve Been Diagnosed with Herpes Simplex Virus…Now What?
She sat in front of me, uncomfortable due to the lesions on her vulva and heart broken with the diagnosis of herpes simplex virus (HSV). I knew without her telling me that in that moment she was thinking:
I will never find a partner who will want to have sex with me. I am a pariah. I am dirty.
How will this affect my fertility?
How long before this goes away and how often will it come back?
What do I do now? I want to go back in time to the time before…
What I tell every patient/friend/family member that comes to me with this diagnosis is this:
Your sexual life is NOT over, but it is a little different.
You are NOT alone. HSV is really common. One out of six adults in the US has Herpes.
Your first outbreak is generally the worst, and they tend to decrease in severity and frequency after the first year. You may never have another outbreak in your life.
I would recommend telling your current partner any new partner that you are with, just like you would want to know from a partner.
You can shed HSV and spread it without having active lesions. In fact you are extremely contagious when you have the prodrome to the lesion. The prodrome is the feeling you get right before the outbreak. For some people it feels like a tingle, for some it feels like burning, itching or pain.
HSV lives in your nerve endings not your blood stream. This is why blood work for the herpes virus is not really diagnostic of how long you have had it. The blood work can show you if you have ever been exposed to herpes, but it will not tell you if you will ever have an outbreak or where it will be.
There are two types of HSV. (HSV - I and HSV- 2) Although HSV - 1 is usually considered oral and HSV - 2 is usually considered genital, they can both occur in either location. Type one generally is a little less aggressive and reoccurs a little less often in general. Type two tends to reoccur more frequently and tends to be more aggressively painful especially with the first outbreak.
An outbreak does not always mean that a partner has not been faithful. Outbreaks can happen remote from the exposure. You can have the virus living quietly in your nerve ending and when you are fatigued, stressed or immunocompromised it may present as the lesions or the blisters on your skin.
You can have children if you have been diagnosed with herpes on your genitals. You can even have a vaginal delivery as long as there is no prodrome or active infection. If there is an active outbreak a cesarean delivery is recommended to avoid possible spread to the infant during delivery.
HSV is transmitted from bodily fluids through breaks in the skin. Avoiding shaving is one way to decrease your risk of transmission. Condom us also decreases risk of transmission but there areas where you can have the virus that condoms do not cover (the mons pubis or the base of the penile shaft).
If you or your partner have any active lesions, avoid sexual contact. You can transmit HSV through oral as well as penetrative vaginal or anal sex.
There are a lot of great support networks like the American Sexual Health Association. Your doctor/gynecologist can also provide insight and help with prevention strategies. The American College of Ob/Gyn also has great information about the herpes virus (acog.org).
I tell all of my patients that have a new diagnosis of herpes that this is a chapter in your narrative, but it is not the entire story. This does not need to define you. You are worthy of BIG love.