Herpes simplex counseling

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Cafer Zorkun, M.D., Ph.D. [2], Lakshmi Gopalakrishnan, M.B.B.S.

## Overview[edit | edit source]

Counseling of infected persons and their sex partners is critical to the management of genital herpes.

* The goals of counseling include 1) helping patients cope with the infection and 2) preventing sexual and perinatal transmission.
* Although initial counseling can be provided at the first visit, many patients benefit from learning about the chronic aspects of the disease after the acute illness subsides.
* Multiple resources, including websites (http://www.ashastd.org) and printed materials, are available to assist patients, their partners, and clinicians who become involved in counseling.

Since there is currently no cure for herpes, some people experience negative feelings related to the condition following diagnosis, particularly if they have acquired the genital form of the disease. Though these feelings lessen over time, they can include depression, fear of rejection, feelings of isolation, fear of being found out, self-destructive feelings, and fear of masturbation.[1] In order to improve the well-being of people with herpes, support groups have been formed in the United States and the UK, providing supporting communities and information about herpes of message forums and dating websites.[2][3][4][5][6]

People with the herpes virus are often hesitant to divulge to other people, including friends and family, that they are infected. This is especially true of new or potential sexual partners that they consider 'casual'.[7] A perceived reaction is sometimes taken into account before making a decision about whether to inform new partners and at what point in the relationship. Many people choose not to disclose their herpes status when they first begin dating someone, but wait until it later becomes clear that they are moving towards a sexual relationship. Other people disclose their herpes status upfront. Still others choose only to date other people who already have herpes.

## Patient Counseling - CDC Recommendations[edit | edit source]

* Persons who have genital herpes should be educated concerning the natural history of the disease, with emphasis on the potential for recurrent episodes, asymptomatic viral shedding, and the attendant risks of sexual transmission.

* Persons experiencing a first episode of genital herpes should be advised that suppressive therapy is available and effective in preventing symptomatic recurrent episodes and that episodic therapy often is useful in shortening the duration of recurrent episodes.

* All persons with genital HSV infection should be encouraged to inform their current sex partners that they have genital herpes and to inform future partners before initiating a sexual relationship.

* Sexual transmission of HSV can occur during asymptomatic periods. Asymptomatic viral shedding is more frequent in genital HSV-2 infection than genital HSV-1 infection and is most frequent during the first 12 months after acquiring HSV-2.

* All persons with genital herpes should remain abstinent from sexual activity with uninfected partners when lesions or prodromal symptoms are present.

* The risk for HSV-2 sexual transmission can be decreased by the daily use of valacyclovir by the infected person. Episodic therapy does not reduce the risk for transmission and its use should be discouraged for this purpose among persons whose partners might be at risk for HSV-2 acquisition.

* Infected persons should be informed that male latex condoms, when used consistently and correctly, might reduce the risk for genital herpes transmission.[8][9][10]

* Sex partners of infected persons should be advised that they might be infected even if they have no symptoms. Type-specific serologic testing of the asymptomatic partners of persons with genital herpes is recommended to determine whether such partners are already HSV seropositive or whether risk for acquiring HSV exists.
* The risk for neonatal HSV infection should be explained to all persons, including men. Pregnant women and women of childbearing age who have genital herpes should inform their providers who care for them during pregnancy and those who will care for their newborn infant about their infection. Pregnant women who are not known to be infected with HSV-2 should be advised to abstain from intercourse with men who have genital herpes during the third trimester of pregnancy. Similarly, pregnant women who are not known to be infected with HSV-1 should be counseled to avoid genital exposure to HSV-1 during the third trimester (e.g., oral sex with a partner with oral herpes and vaginal intercourse with a partner with genital HSV-1 infection).
* Asymptomatic persons diagnosed with HSV-2 infection by type-specific serologic testing should receive the same counseling messages as persons with symptomatic infection. In addition, such persons should be educated about the clinical manifestations of genital herpes.
* When exposed to HIV, HSV-2 seropositive persons are at increased risk for HIV acquisition. Patients should be informed that suppressive antiviral therapy does not reduce the increased risk for HIV acquisition associated with HSV-2 infection.[11][12]

## References[edit | edit source]

1. ↑ Vezina C, Steben M. (2001). "Genital Herpes: Psychosexual Impacts and Counselling". The Canadian Journal of CME (June): 125–134.
2. ↑ Herpes Support Groups & Clinics
3. ↑ Herpes Viruses Association - a patient run group
4. ↑ Herpes message forum with over 4000 members
5. ↑ H-Date, a dating site for persons with either or both of HSV-1 or HSV-2
6. ↑ MPwH - Meeting People with Herpes, a dating site with over 65000 members
7. ↑ Green J, Ferrier S, Kocsis A, Shadrick J, Ukoumunne OC, Murphy S, Hetherton J. (2003). "Determinants of disclosure of genital herpes to partners". Sex. Transm. Infect. 79 (1): 42–44. PMID 12576613.CS1 maint: Multiple names: authors list (link)
8. ↑ Wald A, Langenberg AG, Krantz E, Douglas JM, Handsfield HH, DiCarlo RP et al. (2005) The relationship between condom use and herpes simplex virus acquisition. Ann Intern Med 143 (10):707-13. PMID: 16287791
9. ↑ Martin ET, Krantz E, Gottlieb SL, Magaret AS, Langenberg A, Stanberry L et al. (2009) A pooled analysis of the effect of condoms in preventing HSV-2 acquisition. Arch Intern Med 169 (13):1233-40. DOI:10.1001/archinternmed.2009.177 PMID: 19597073
10. ↑ Wald A, Langenberg AG, Link K, Izu AE, Ashley R, Warren T et al. (2001) Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. JAMA 285 (24):3100-6. PMID: 11427138
11. ↑ Watson-Jones D, Weiss HA, Rusizoka M, Changalucha J, Baisley K, Mugeye K et al. (2008) Effect of herpes simplex suppression on incidence of HIV among women in Tanzania. N Engl J Med 358 (15):1560-71. DOI:10.1056/NEJMoa0800260 PMID: 18337596
12. ↑ Celum C, Wald A, Hughes J, Sanchez J, Reid S, Delany-Moretlwe S et al. (2008) Effect of aciclovir on HIV-1 acquisition in herpes simplex virus 2 seropositive women and men who have sex with men: a randomised, double-blind, placebo-controlled trial. Lancet 371 (9630):2109-19. DOI:10.1016/S0140-6736(08)60920-4 PMID: 18572080

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