Key Information for Health Professionals to Give Patients in Counselling
The following information contributes significantly to people being able to normalise the meaning of a viral STI. The challenge for health professionals is to convey that they understand that a relatively innocuous infection in medical terms may, however, be experienced as life-changing for the person. The following points are most likely to be effective when they are incorporated into the acknowledgement of the above psychosocial points:
Herpes is common, manageable and treatable.
Herpes simplex virus (HSV) causes cold sores on the mouth and cold sores (herpes) on the genitals. It is two strains of the same virus. HSV-1 causes most oral cold sores and causes 50% of genital herpes (through oral to genital transmission). HSV-2 mostly causes genital herpes.
It is a very common, relatively medically insignificant infection, but can cause significant psychosocial morbidity when it causes genital symptoms.
Up to one in three people have genital herpes, but only 20% of them experience symptoms (this includes genital herpes caused by both HSV-1 and HSV-2).
Most people (80%) who become infected with genital herpes will not have any symptoms or have such mild symptoms that they will not be recognised or diagnosed as genital herpes. 75% of herpes is acquired from partners unaware they have it.
For most people who experience symptoms, genital herpes is a sometimes-recurring cold sore on the genitals. It does not affect your overall health or longevity of life.
A small percentage of people who get genital herpes may experience problematic recurrences.
There is effective oral anti-viral treatment available.
People who experience the first episode of genital herpes will get better, lesions will heal and there will be no evidence of the initial lesions left.
Most people who experience the first episode of HSV-2 will have recurrences, but they are generally milder than the first episode. HSV-1 tends to cause fewer recurrences than HSV-2.
Getting genital herpes in a long-term relationship does not mean that the other partner has been unfaithful. However, a full sexual health screen may be reassuring.
Where both partners in a long-term relationship have the virus, use of condoms is not necessary as they cannot reinfect each other.
It is advisable to avoid sexual contact when lesions are present, as friction may delay healing.
Oral to genital transmission of HSV-1 is very common through oral sex. This can happen when cold sores are not causing symptoms.
Genital herpes does not affect your fertility or stop you having children. Vaginal delivery is usual for most women with a history of genital herpes.
Genital herpes does not stop you having sex.
Anybody with genital herpes, whether they get symptoms or have never had symptoms, may shed the virus from time to time with no symptoms present.
There is no evidence that genital herpes causes cancer of the cervix.
Condoms reduce the risk of transmission. The use of condoms in a long-term relationship should be a matter of discussion between the individuals. It is advisable to avoid genital-to-genital contact, even with a condom, until any lesions are completely healed.
Even if the virus is passed on, the most likely outcome is that the person will never experience symptoms.
Ensure patients have access to the NZHF patient pamphlets and/or the Helpline tollfree 0508 11 12 13, or www.herpes.org.nz.
Herpes in Pregnancy
Neonatal herpes is serious but extremely rare; one in 10,000 live births.
The commonest cause of neonatal herpes is a woman experiencing a first episode (often asymptomatic) in the last trimester. Early medical management will minimise the risk.
Recurrent herpes in pregnancy has a much lower risk of transmission. Maternal antibodies contribute to protecting the baby and viral shedding in recurrences is low. It is important to notify the health professional(s) managing the pregnancy of the previous history.
Vaginal delivery is usual for most women with a history of genital herpes.
While neonatal herpes is rare, it is important that parents are instructed on which symptoms to look out for if there is any possibility of transmission. Knowledge of the early symptoms of neonatal herpes will enable such infants to present early and will increase the likelihood of a good outcome for the infant.
The Guidelines are a consensus opinion of the STIEF Professional Advisory Group (PAG). The PAG has representation from nationwide medical, nursing and allied disciplines involved in the management of STIs. The Guidelines are produced by considering available literature, both New Zealand wide and international, and by basing the medical recommendations on the evidence in the literature or reasonable supposition and opinions of medical experts.