Key points for counseling a patient about genital herpes

Initial Visit

When a patient is first diagnosed with genital herpes, he or she may not hear much of what you say. A herpes diagnosis may be difficult to accept because of the following:

• social stigma associated with the diagnosis
• fear of transmission to another
• absence of a cure
• uncertainty about infectious times
• anger associated with contracting this disease

Therefore, you should schedule a follow-up visit with them within the next two weeks to review all of the key points discussed at the first visit and to assess any new concerns.

During the first visit, try to assess the patient�s primary concern. Reaffirm his/her of their innate worth and be sympathetic and non-judgmental. Often a patient�s long term perception of the impact of disease is influenced by the manner in which they were initially counseled.

It is best to provide reading materials and lists of resources so that the patient can research the disease at his/her own pace. Check out the Links section of this website for resources for people interested in learning more about herpes.

Follow-up visits

At the follow-up visit, assess lesion healing and reassess the patient�s concerns. Be conscious of the patient�s psychological status. Oftentimes patients will experience profound distress or depression. These should be addressed but not over-dramatized. Review the patient understanding of the disease and discuss management options. Repeat the information provided on the checklist. Patients should be encouraged to tell their partner.

Recently, the new CDC guidelines offered some key counseling points that should be discussed with every newly diagnosed patient. They are as follows:

• Patients should be educated about the natural history of the disease, i.e. potential for recurrences, asymptomatic shedding, risk of sexual transmission
• Patients experiencing first episode of genital herpes should be advised that suppressive and episodic antiviral therapy are available and effective at preventing or shortening the duration of an episode
• All patients with genital herpes should be encouraged to tell their current and future partners
• Transmission can occur during asymptomatic shedding and that asymptomatic shedding is more frequent with HSV-2, within the first year after acquisition
• Latex condoms can reduce the risk of transmission if used consistently and correctly
• Sex partners of persons with genital herpes should be advised that they might be infected even if they have no signs or symptoms
• Risk of neonatal herpes should be explained both partners. Pregnant women with genital herpes should inform their doctors. Pregnant women who are not infected should avoid intercourse with HSV-infected partner in the third trimester. Pregnant women not infected with HSV-1 should avoid oral sex in the third trimester
• Asymptomatic patients should receive the same counseling as symptomatic.

(You may want to print this checklist as a counseling tool.)

Remember: Take a sympathetic, non-judgmental approach

Epidemiology

  Genital herpes is common and may be caused by HSV-1 or HSV-2

  1 in 5 people in the USA have genital herpes: 1 in 4 over 25 years of age

Natural History

  Most people (>90%) will experience symptomatic recurrences of genital herpes.

  About 80% of infections are not recognized because of mild or absent symptoms

  Most first episodes of herpes represent reactivation of previously latent infection rather than recently acquired primary infection

  People who experience a first episode will get better. Lesions will heal and recurrences will usually be less severe

  HSV-2 reactivates more frequently than HSV-1

Transmission / Acquisition

  Over 50% of people getting herpes get it from a partner who is unaware they have genital herpes

  Genital herpes can be transmitted by genital or oral sex (coldsores). Thus oral/genital sex should be avoided in the last trimester of pregnancy, if the partner has cold sores.

  Anyone with genital herpes may shed virus a few days per year without symptoms. The occurrences are as often as 15�25% of days.

  Transmission can occur during symptomatic and asymptomatic periods.

  Transmission of herpes can occur within committed long-term relationships and in people who have never had penetrative sex through close genital contact or oral genital contact

  Suppressive antiviral therapy can reduce the risk of transmission by 50%.

  Condoms reduce the risk of transmission when used consistently and correctly, but it is also advisable to avoid skin to skin contact when lesions are present.

  It is important to tell your partner that you have herpes. By disclosing that you have the disease, it can double the average time to transmission to to your partner.

Management Strategies

  Antiviral treatment is effective in reducing duration of lesions. The disease can be managed episodically to treat recurrences or suppressively to prevent recurrences. Daily suppressive therapy reduces reactivation nearly completely

Complications

  Genital herpes does not cause cervical cancer or affect your fertility

Herpes and pregnancy

  Neonatal herpes is serious but rare, especially among persons with HSV-2. Tell your obstetrician

  Women with genital herpes can have a safe pregnancy and vaginal delivery. New infections in the third trimester need especially close medical follow-up. Health care providers may consider antiviral therapy in the last four weeks to prevent transmission to the neonate.