Ask the Pharmacist

Q) I just saw my doctor about these stinging sores in the area of my genitals and she informed me that it’s herpes. I am devastated by this news although I confess I don’t know much about the disease. What can you tell me about it?

A) Genital herpes is a very common condition that doesn’t get talked out very much partly due to the undeserved stigma that some still associate with it. It has also been largely ignored by the pharmaceutical and research community possibly because the symptoms are relatively mild and there is still a reluctance in our society to openly discuss sexual health.

The condition gets its name from its cause, the Herpes Simplex Virus (HSV). About 1 in 7 Canadians are estimated to be infected by the genital version of this virus although many are unaware of this since they may not have any symptoms. There are two strains. When infected with HSV-1, the tell-tale symptom is cold sores around the mouth whereas HSV-2 more commonly presents as sores around the genitals.

Herpes is transmitted by skin-to-skin contact with someone who already has the virus. You get it when your genitals and/or mouth touch their genitals and or mouth usually during sex. You can get genital herpes from someone who has a cold sore during oral sex (the opposite is also true). Both HSV-1 and HSV-2 are at their most contagious when there are visible sores, but they can still be transmitted even if there are no visible symptoms. As such, a properly worn condom is the best way to prevent yourself from contracting or transmitting the virus (note that penetration is not required for transmission to occur).

Most people with genital herpes have either no symptoms at all or only very mild ones. Frequently mild symptoms can be mistaken for other common skin conditions like a pimple. As such, it’s not a surprise that many people with the virus are unaware of this fact and that they may be inadvertently passing it on to others. When symptoms do occur, the sores look a lot like little blisters on nor around the genitals and the rectum. The blisters are filled with fluid and can be either itchy or painful. The blisters may break or turn into sores that bleed or ooze a whitish fluid. These frequently painful sores usually take a week or more to heal.

During the first outbreak, flu-like symptoms may also occur (fever, swollen glands, body aches…). The first outbreak will usually appear a few weeks after one has become infected with the virus. People who do experience symptoms can have repeated outbreaks over the course of their life. Usually, the repeat flareups are both shorter and less severe than the initial infection was. As time goes on, the frequency of outbreaks tends to decrease. Fifty per cent of people who suffer from recurrences will experience symptoms such as burning or itching in the area before the sores reappear. This is known as a prodrome.

The other symptom that doesn’t get discussed enough is the mental stress that goes with having this diagnosis. Many people are mortified to find they have it and feel as if they are unclean. It makes the dating scene far more complicated and can greatly lessen self-esteem. Many feel alone with it since herpes is rarely talked about even though if they were to look around any classroom/ store they happened to be in, it would be statistically likely that there would be a number of other people around them who also carry the virus.

Sores in and around the genitals should always prompt a visit to your doctor. They can confirm the diagnosis, discuss treatment options and check for the potential that another sexually transmitted infection is also present.

A doctor can typically diagnose herpes just by looking at the sores. If they are unsure they can take a swab from the fluid in the sore. This is most likely to detect the virus within the first 48 hours of symptoms when the ulcers are new and open. A PCR test is a very sensitive test that looks for the virus even when it is in its dormant stages. A sample of blood is all that is required. There are some commercially available tests that can be purchased by an individual, but research shows that up to half of those tests that come back positive may in fact be negative, greatly limiting their usefulness.

There is currently no cure for genital herpes, nor a vaccine although plenty of research has gone into this without much to show for it so far. However, there are several effective antiviral pills that can be used- acyclovir, famciclovir and valacyclovir. These can decrease the severity as well as the duration of an outbreak by a few hours to a few days. To attain maximum effectiveness, they should be started as soon as possible, ideally no more than 72 hours after the sores appear. This is why some people keep a supply at home so that they can institute therapy promptly. Some people will choose not to treat a recurrence, particularly those with minimal symptoms or who are not sexually active, and it will eventually go away on its own.

Some patients who suffer from frequent recurrences will choose to go on “suppressive” therapy. Here a low dose of one of the three antivirals is taken every day in order to decrease the frequency and duration of flareups while reducing the risk of transmitting the virus to an uninfected partner (one study showed that it can reduce the risk of infecting your partner by 50%). There is no standard for how long suppressive therapy should continue. Some experts recommend taking a break every few years to determine if the therapy is still required.

A diagnosis of genital herpes can bring feelings of shame and distress, but it is important to remember that this is a very manageable condition and that there are literally millions of people who share this diagnosis that have gone on to have healthy and loving relationships. For more information about this or any other health related questions, contact the pharmacists