Three Minute Toolkit: Counselling Your Patient

A new herpes diagnosis can feel distressing, even though genital herpes is common, manageable and usually medically straightforward. The aim of the first conversation is to reduce fear, explain what HSV means, offer treatment and pain relief, discuss transmission in a realistic way, and make sure the person knows where to get follow-up and support.

Avoid leading with words such as "incurable" or "lifelong infection". These may be technically true, but they can increase fear and shame. Use softer, accurate language such as "HSV", "episode" or "recurrence".

Avoid saying "you will have this forever" as the main message. We do not usually frame other dormant viral infections in this way.

Avoid implying that a diagnosis means recent infection, infidelity or blame. It is often not possible to know when HSV was acquired or who it came from.

Avoid routine partner testing if partners have no symptoms. Blood tests can be difficult to interpret and are not usually helpful for asymptomatic partners.

Avoid frightening people with legal language. Instead, give practical, supportive advice about disclosure, risk reduction and shared decision-making.

"You are not alone. Herpes is very common, and many people who have it either never have symptoms or have symptoms so mild they do not realise what it is. I know this diagnosis can feel upsetting, but it is manageable, treatment is available, and it does not stop you having relationships, sex, children or a normal life."

Herpes simplex virus, or HSV, is a common virus. HSV-1 commonly causes cold sores on the face, but it can also cause genital herpes, usually through oral-genital contact. HSV-2 more commonly affects the genital area.

Most people with HSV do not know they have it. Symptoms may appear days, months or even years after someone first came into contact with the virus.

HSV is fragile outside the body. It is not passed on from toilet seats, showers, swimming pools, towels, bedding, trying on clothes, medical examinations, or sharing cups or cutlery.

It is often not possible to know. Many people get herpes from a partner who did not know they carried HSV. A first recognised episode does not always mean a new infection.

More severe first episodes, especially with flu-like symptoms and multiple painful blisters or ulcers, can suggest a more recent infection, but this is not always certain. Mild first symptoms may reflect an infection that has been present for months or years.

A diagnosis in a long-term relationship does not automatically mean that either person has had another partner.

Genital herpes is passed on through direct skin-to-skin or mucosal contact with the area where the virus is active. This can happen through genital-to-genital contact, oral sex, vaginal sex, anal sex or genital skin contact.

The risk is highest when symptoms are present, including tingling, burning, pain, blisters, ulcers or healing sores. During this time, it is best to avoid oral or genital sexual contact until the skin has fully healed.

The virus can sometimes be present on the skin without symtpoms. This is called asymptomatic shedding. It means the risk is not zero when someone feels well, but there are practical ways to reduce the chances of passing it on.

Condoms and barriers reduce the risk, although they do not remove the risk completely because HSV can affect skin that is not covered. Daily suppressive antiviral medication can also reduce recurrences and reduce the chance of transmission.

Offer oral antiviral treatment for a first episode (Valaciclovir 500mg BD for 7/7). Treatment works best when strted early, but it may still be helpful if symptoms are ongoing or new sores are appearing.

Offer pain relief and practical self-care advice. This may include regular paracetamol or ibuprofen if appropriate, topical 2% lignocaine gel for painful ulcers, advise them that passing urine in a bath or shower can be helpful if urination stings, keeping the area clean and dry, and resting if the person feels unwell.

Safety-net carefully. Seek urgent review if the person cannot pass urine, has severe pain, is systematically unwell, has symptoms near the eyes, has neurological symptoms is immunocompromised, or is pregnant.

Some people have repeat episodes; others have few or none. Recurrences are usually milder, shorter and less painful than the first episode.

Genital HSV-1 usually recurs less often than genital HSV-2. HSV-2 is more likely to recur, especially in the first year, but this varies between people.

Episodic treatment: antiviral tablets are kept "on hand" and started as soon as symptoms begin. Provide them with a back pocket script (Valaciclovir 500mg BD for 3/7), ensure they have enough supply to cover a couple of episodes.

Suppressive treatment: antiviral tablets are taken every day (Valaciclovir 500mg OD). This can reduce or prevent recurrences, reduce transmission risk, and provide reassurance for people who feel anxious about passing HSV on.

Most people do not need daily medication long term, but it is a useful option for people with frequent recurrences, significant distress, or a regular partner who does not have HSV.

Encourage an open conversation, but keep it calm and non-apologetic. The aim is not to create fear; it is to support honest, respectful decision-making.

A simple script might be:

"I carry the herpes virus. It is common and manageable. I avoid sex when I have symptoms, and we can use condoms or I can take daily antiviral medication to reduce the risk."

Reassure the person that many partners respond better than expected. A herpes diagnosis does not mean someone cannot have healthy sexual relationships.

If a regular partner already has the same HSV type in the same area, they cannot keep passing it back and forth.

People with genital herpes can:

• Have normal relationships and sex lives
• Have normal fertility
• Have healthy pregnancies and babies
• Usually have vaginal births
• Donate blood
• Work in any occupation
• Use swimming pools and spas
• Cuddle their children, share a bath, and live normally with family or flatmates
• Have the same overall health, immune function and life expectancy as other people
• Know that HSV does not cause cancer.

Ask if the person is pregnant, planning pregnancy, or has a pregnant partner. Most people with HSV have healthy pregnancies and babies, but first episode herpes in pregnancy needs prompt medical advice - consider discussion with an obstetrician and encourage open discussion with the patient's LMC.

Offer a follow-up appointment about one week after diagnosis or after starting treatment for the first time. This can be in person or by phone. It is a chance to check that symptoms are improving, answer questions, discuss partner conversations, and consider whether ongoing antiviral treatment is needed,

Encourage trusted support where appropriate. Many people feel better after talking with a clinician, partner, friend, whānau member or counsellor.

Helpline: 0508 11 12 13 from a landline or 09 433 6526 from a mobile.

Share the website herpes.org.nz for further information.

"Herpes is common, manageable and not a reflection of who you are. The first episode is often the hardest emotionally and physically. You have treatment options, you can reduce the chance of passing it on, and you can still have healthy relationships, sex and future plans."