MEDICAL PRACTICE - HERPESSYDNEY

Herpes viruses are responsible for a range of common conditions including chickenpox, shingles, glandular fever, cold sores – and genital herpes. The latter is probably the single reason why we’re unlikely to wear our support for herpes research on our sleeves.

Dr Catriona Ooi, Director of Sexual Health at Royal Newcastle Hospital, and spokesperson for National Herpes Day, believes that our reticence is because herpes can be sexually transmitted. “There’s still a stigma associated with herpes,” she says. “Having a sexually transmitted infection is most often associated with being promiscuous, having a lot of partners or being a loose person. But you don’t have to have sex at all to get herpes.”

In fact, herpes is surprisingly common. According to a study published earlier this year, about 12 percent of Australian adults are infected with herpes simplex virus 2 (HSV2), the genital herpes virus. But 76 percent of us are infected with herpes simplex virus 1 (HSV1), the virus known for causing cold sores. HSV1 can also cause cold sores down south.

Studies have found HSV1 implicated in 35 percent of genital herpes cases, compared with only 10 percent of cases in the early 1980s. This is most likely due to the increased practice of oral sex in the developing world.

Genital herpes means an infection in the genital or anal region with either HSV1 or HSV2. It is transmitted by close physical contact – genital-to-genital, anus-to-genital, or mouth-to-genital. The virus can’t easily penetrate intact skin, but readily enters dry or broken skin or the lining of the vagina. Women are twice as likely to become infected as men. Once inside the skin, the virus multiplies, causing blisters to form. Other symptoms may include soreness, itching, discharge, and pain during intercourse. Our immune system mounts an attack, but the herpes virus has a clever strategy for survival. It infects the nerve endings in the genital skin and travels along nerve fibres until it finds a cluster of nerve cells to hide among. Here the herpes virus lies dormant, out of reach of the immune system. Once we become infected, the virus stays with us for life. Occasionally it reactivates, traveling back down the nerves and causing lesions. Recurrent episodes are usually not as prolonged or severe as the first episode, but frequent outbreaks can make life miserable.

Up to 80 percent of people with genital herpes don’t know they have it. “That might be because they have no symptoms or the symptoms are minor,” says Dr Darren Russell, Director of Sexual Health at Cairns Base Hospital.

“They might assume they have gone at it a bit hard or caught their dick in a zip, or they might just think they have thrush. Most people who catch herpes get it from a partner who didn’t know they had it,” he says.

That isn’t to say transmission of the virus is inevitable. For every year a herpes negative person is in a relationship with a herpes positive person, there is a 10 percent chance that the herpes negative person will contract the virus.

“But by avoiding sex when lesions are present, using a condom and taking antivirals, the risk is significantly reduced,” Russell says.

Studies have shown that antiviral medications, which reduce the length and severity of outbreaks and reduce viral shedding, can reduce the risk by up to 50 percent.

“For most people with genital herpes outbreaks, symptoms will be well controlled on one to two valaciclovir tablets per day,” he says.

Last month, the Federal Government added higher strength doses of the antiviral drug famciclovir to the Pharmaceutical Benefits Scheme. According to Russell, this is particularly beneficial for people at an increased risk of outbreaks due to immmunosuppression, such as those with human immunodeficiency virus (HIV), transplant recipients, or those undergoing chemotherapy or radiotherapy.

Sufferers can now take two 500mg tablets instead of four 250mg tablets each day. “It means fewer tablets so there is less chance of missing a dose or underdosing,” he says.

Professor Tony Cunningham, director of the Westmead Millennium Institute and board member of the Australian Herpes Management Forum, says antiviral medications for genital herpes are being trialed in Africa and South America to determine whether they play a role in reducing transmission of another sexually transmitted infection, HIV.

Studies have shown that genital herpes increases the risk of acquiring HIV up to threefold, because herpes lesions make it easier for HIV to penetrate the skin and infect target cells.

Until a cure for genital herpes is found, prevention is the key.

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