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For the 12th year in a row, Yale-New Haven has been highly ranked by U.S. News & World Report for its programs in gynecology.

Treatment options benefit genital herpes patients

Genital herpes is very widespread among adults in the U.S. One of the reasons it continues to spread is because many people with the virus are not aware they have it. The signs and symptoms vary person by person and from one episode to the next.

Diagnosis
Some people who have latent herpes infections never experience signs or symptoms. Some people have such mild symptoms that they may not recognize the infection. For others, outbreaks can be frequent and painful. These are the patients we see in our practice.

When people come to the office complaining of painful sores in the genital area that look like a pimple or an ulcerated lesion, we suspect herpes. There is a culture test for herpes, but it often results in false negative reports, so it's of limited use. There is also a blood test that identifies herpes antibodies in the blood, but this is not very useful clinically. We do use it occasionally to determine if individuals have had prior exposure to herpes.

Symptoms and transmission risk
Herpes sores are generally small but they can be very painful. Before an outbreak, many people experience warning signs that the virus is about to become active. The sign, which is called a prodrome, usually involves a tingling sensation as the virus travels along the nerves. Even though a sore may not yet be present, it's possible that people can spread the virus at this point.

The prodrome serves as a warning to refrain from sexual contact. Individuals with herpes who don't have warning signs are at risk of spreading the infection even before herpes sores appear. Once the sores erupt, they develop into painful blisters that crust over, form a scab and heal. Once a lesion has scabbed over, the individual can no longer spread the virus.

We once thought that sexual contact was the only way to spread genital herpes, but there may be other forms of transmission. Certainly the most common mode of transmission is sexual contact, but it is possible to touch an active sore and spread the virus to another individual. I counsel patients to use condoms, particularly if they know they have herpes. Although condoms may not be 100 percent effective in preventing infection, they do help.

Treatment
Valacyclovir and its cousins acyclovir and famcyclovir have been very effective in reducing the number of days patients are symptomatic and reducing the likelihood of recurrences. These drugs are all similar chemically; valacyclovir is frequently prescribed because a once-a-day dose can prevent recurrent infections.

This New England Journal study provides more good news for patients who are at risk of spreading the disease. These drugs do not cure herpes. Once the virus is in your system, it remains there, but its symptoms, recurrent infections and transmission risk can all be reduced with treatment.

We often recommend these drugs to patients who have recurrent infections—four to five infections a year. The drugs have a very high safety profile and are very easy to tolerate. People can take them for years although we've found that patients can often discontinue the drugs after successfully suppressing the virus for a year or more.

How serious is herpes?
Herpes is an infection; it is not a disease in the traditional sense. It does not progress to something more serious. In fact, outbreaks may become less painful over time and occur less frequently except in people whose immune systems are compromised by other chronic diseases.

It can, however, be devastating to a newborn child. Women who deliver vaginally during a herpes outbreak can transmit the disease to their newborn. It can result in a very serious, sometimes fatal, systemic neurological disease. That is why we follow pregnant women who have active herpes infections very closely.

There is no danger to the fetus during the first and second trimesters of pregnancy, but we may prescribe valacyclovir to some women as they approach their delivery dates. If a woman is close to delivery and either has a prodrome or develops anything that could possibly be a herpes sore, she needs to have an emergency Caesarian section.

Anyone who suffers from recurrent painful genital sores needs to visit her gynecologist to determine if she has herpes. While valacyclovir doesn't cure herpes, it does reduce symptoms, recurrent infections and transmission risk.

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Dr. Silidker is an attending gynecologist/obstetrician at Yale-New Haven Hospital and clinical professor in obstetrics and gynecology at the Yale School of Medicine. He is a partner of Obstetrics- Gynecology & Infertility Group.