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An interview with ISAAC VICTOR, M.D.
Attending Obstetrician/Gynecologist
Q.
A. There are actually several types of herpes virus, but the
types we most commonly associate with a sexually transmitted
infection (STI) are Herpes Simplex Virus Type-2 (HSV-2) and
less commonly Herpes Simplex Virus Type-1 (HSV-1).
HSV-1, or oral herpes, most commonly infects the oral area,
but it also can infect the genital area and produce sores.
Approximately one third of new genital herpes outbreaks are
caused by HSV-1 and they usually originate from oral sex.
HSV-1 in the genital area does not have the same recurrence
pattern as HSV-2.
HSV-2 is the most common cause of genital herpes. Studies
show that in the United States there are approximately one
to two million new genital herpes (GH) infections acquired
each year.
Q.
A. Approximately 20-25 percent of the population already has
genital herpes, or roughly 45 to 60 million people. Approximately
80 to 90 percent of people infected with genital herpes are
not aware that they are infected.
Q.
A. Herpes is spread by direct skin to skin contact. If you
have genital contact with an infected partner, you may acquire
GH. If you already have GH and have genital contact with
an uninfected partner, then you can transmit the herpes virus.
Research has shown that acquisition and transmission can
occur without a current symptomatic outbreak. Approximately
70 percent of transmissions occur during these asymptomatic
periods. Condoms and antiviral therapy can significantly
reduce this risk.
Q.
A. Initial symptoms, which can appear anywhere from two to
20 days after primary contact, include a blistery inflammation
that is painful and can last up to three weeks. After the
primary outbreak, the recurrence of symptoms is usually much
more subtle and can last two to five days. Genital to genital
contact during an outbreak is associated with the highest
risk of transmission.
Q.
A. There is a two-fold problem. As mentioned before, approximately
80-90 percent of patients may not know they have GH. Patients
do not think of herpes first if they notice something different,
especially if it goes away. The second barrier is physicians.
In the past, physicians may have hesitated to test because
older tests were inaccurate. Physicians also had no information
to offer the patient in regard to treatment options. This
has now changed.
 Q.
A. Blood work or skin culture testing can accurately differentiate
between HSV-1 and HSV-2. The approach to treatment depends
on the patient’s particular situation. If the patient
wants to reduce the number of recurrent outbreaks or wants
to reduce the likelihood of transmission to a partner, then
daily antiviral therapy is used to suppress the virus. Daily
suppressive therapy is well tolerated and can be continued
for long periods of time.
Modern information allows the mindset of physicians and
patients to change in terms of herpes testing and treatment.
With accurate diagnosis, we can offer our patients a plan
that suites their particular needs and allows them to move
on from this diagnosis feeling confident that they have control
over their lives. We should embrace the fact that with communication
between physicians,patients and their partners, this condition
can be managed with minimal stress.
Q.
A. Theoretically, condoms prevent a point of entry of infection
where the condom is placed. However, studies show that while
condoms are 50-80 percent protective, most people are not
diligent about using them. Also, genital herpes can exist
in areas not covered by the condom.
Q.
A. Any sexually active individual is at risk. High-risk behavior
includes early onset of sexual activity, multiple sex partners
and a history of a prior or current STI.
Q.
A. There is a push for universal testing of pregnant women.
For the pregnant woman who already has genital herpes, the
baby is already protected by the mother’s antibodies.
However, at the end of pregnancy, if there is an active lesion
during labor, then a cesarean section is performed to minimize
any risk of transmission to the baby.
The highest risk for the baby is when the pregnant woman,
who initially does not have genital herpes, acquires a primary
herpes infection in the latter part of pregnancy. When this
happens, the baby has no immunity and can acquire herpes.
In newborns, herpes can cause severe permanent disability
or death. Fortunately, this situation happens rarely.
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