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Diagnosing Herpes and Reducing Your Risk of Transmission
According to the
American Society for Social Health,
about 25% of
all adults in the US carry the virus for genital herpes (HSV-2). Unfortunately,
up to 90% of those who have the HSV2 virus DON'T EVEN KNOW IT.
This is because most people with herpes have mild, infrequent,
or even NO symptoms. Also, most doctors do NOT include a
test for herpes when they are testing you for other STDs.
And even when you ask them to test you for herpes, many doctors
will tell you that unless you are having an active outbreak,
there are no reliable tests for herpes available. These doctors are
NOT KEEPING UP WITH CURRENT MEDICAL RESEARCH.
Unfortunately, this seems to apply to most doctors.
Prior to 1999, little research had been done on herpes, and the
only way people could be properly diagnosed was to have a culture
done from an active outbreak. Therefore, many people went
undiagnosed or their outbreaks were misdiagnosed as a rash or
yeast infection or any number of other things. Also, prior to
2000, doctors used to tell patients that unless they were having
an active outbreak, there was no risk of passing along herpes to
their partners. Unfortunately, a lot of doctors and their patients
are STILL operating under these old, out-dated assumptions.
DIAGNOSING HERPES HAS CHANGED
As mentioned early, about 25% of US adults have the virus for genital herpes, but up to 90% of them don't even know it!
Accordingly, most of people who currently DO KNOW that they
have it were diagnosed from a culture from an active outbreak.
However, new blood tests have been developed since 1999 that
are extremely reliable, and will be able to determine with 97-100%
accuracy whether or not someone has the HSV2 virus. These blood
tests need to be taken 12-16 weeks AFTER your last intimate partner
in order to give the virus enough time to show itself in your
bloodstream. In any case, if you're doctor tells you that he/she
cannot test you for herpes unless you are having an active outbreak,
you should tell them that they need to get up-to-date about herpes -
or else you should change doctors. In this note, you will find
links to information that your doctors OUGHT TO KNOW about herpes.
Herpes Can Also Be Spread When You Are NOT Having ANY Symptoms
Recent studies have shown that 70% of new cases of herpes were
the result of sexual contact with a partner who had no signs or
symptoms of herpes at the time. So if you KNOW that you have
herpes, and think that you can safely have sex as long as you
are not having active symptoms - think again. Even people who
have NEVER had herpes symptoms are potentially contagious a
small percentage of the time. This is called "asymptomatic shedding."
A study from University of Washington that was reported in the
New England Journal of Medicine in early 2000 showed that people
with no previously reported symptoms of HSV2 - but who tested
positive for HSV2 in a blood test - were shown to shed the HSV2
virus asymptomatically at about the same rate as patients with
chronic symptoms (while they are asymptomatic). The rate of asymptomatic
shedding appears to go down the longer one has had the virus.
The number of people involved in that particular study was
pretty small - well under 100 people, and thus, may or may
not be representative of our larger population. Also, the
study did not test for rates of transmission - it only tested
for the the rate of asymptomatic shedding in people who were
serologically positive for HSV2. In this study, even people who
reported never having symptoms for herpes appeared to be
shedding the HSV2 virus between 2-3% of the time, which was
similar to the rate of asymptomatic shedding in people who
reported chronic symptoms. None of the subjects were taking
any sort of medication. For more information on this study,
go to:
http://www.pslgroup.com/dg/193542.htm
REDUCING THE RISK OF TRANSMISSION
There are a number of things that we can do to reduce the
risk of transmission to our partners, and by using these
practices, many people have been successful in NOT spreading
herpes to their partner(s). Some people who have HSV2 have
NEVER spread it to a partner. However, there are no
guarantees. Everyone has a different situation. And your
PARTNER'S health and immune system is also a factor. But if
you use some or all of these practices, your risk of
transmitting the virus to your partner(s) might be much lower.
1) Have your partner(s) tested. Reducing the risk of transmission of
herpes and other STD's requires that both partners KNOW their status
for herpes and other STD's PRIOR to becoming intimately involved.
Unless your partner has taken one of the
newer, very reliable type-specific herpes blood tests at least 12-16 weeks AFTER their last
intimate encounter, there is always the chance that they might
have acquired the herpes virus prior to sleeping with you.
This goes for other viruses as well. So if you have intimate
relations prior to your partner being tested, and they later
develop symptoms and test positive for herpes, you will NEVER
KNOW if your partner got herpes from you or if they had it
BEFORE you, but just didn't know it. Remember, 25% of US Adults
have genital herpes, but up to 90% of them DON'T KNOW IT.
Asking your partner(s) to get tested prior to your getting
involved may seem awkward, but unless you and your partner
don't care about spreading STD's, it's a very reasonable thing
to ask someone to do. Frankly, now that herpes is so easy to
diagnose via type-specific blood tests, everyone should be
doing this. The medical profession will eventually catch up...
but in the meantime, we need to ask our partners to get tested
for herpes and other STD's as soon as a physical relationship
looks likely. Also, wouldn't it be nice to find out that your
partner is one of the 25% who already has herpes, so you don't have to worry
about giving them an STD that they ALREADY have?
Testing is part of the solution. Let's be pro-active on the
testing front.
For a current list of reliable blood tests for herpes, from the
American Society for Social Heath (ASHA), go to:
http://www.ashastd.org/pdfs/blood_test.pdf
For free or low-cost herpes blood tests, see your city's local
public health clinic for STD's or Planned Parenthood.
In San Francisco, visit the SF City Clinic at:
http://www.dph.sf.ca.us/sfcityclinic/
2) Condoms: These will only help prevent transmission if the
area that they cover is the same as the area where you or
your partner has outbreaks or asymptomatic shedding. In many
cases, condoms do not cover the area where the outbreaks or
shedding occurs. Condoms still may be effective as
contraceptives.
3) Suppressive Therapy: In studies, Valtrex (a derivative of
Acyclovir/Zovirax) taken daily was shown to reduce the risk
of transmission to a non-infected partner by 50%. So basically,
if you take Valtrex daily (or it might be Acyclovir or Famvir),
you can potentially reduce your risk of transmission to a
partner by one half! This is great news! However, keep in mind
that the only people who participated in the Valtrex study were
those people who had chronic symptoms. There was no study to
determine how effective suppressive therapy would be on people
who already had few or no symptoms. We can only ASSUME that
suppressive therapy is at least as effective in reducing
asymptomatic shedding in people who have few or no symptoms as
it is for people who have chronic symptoms. To read the FDA Paper
on Genital Herpes, which includes guidelines for prescribing
suppressive therapy does of common antiviral drugs, go to:
http://www.fda.gov/fdac/features/2002/202_herp.html
4) Herbal/natural remedies: In addition to prescription drugs,
there are a number of herbal remedies that claim to have some
positive benefits for people with herpes. Some have proven
benefits, while others are bogus, and still others need more
study. It has not been determined whether or not any herbal or
natural supplements have any effect on reducing the risk of
HSV2 transmission. Maybe yes, maybe no. But it would be nice
to think maybe yes.
5) Self-Monitoring: Some people can *tell* that they might be
having an HSV2 outbreak - because they feel a tingling or
other sensation - even if it never turns into a sore or any
other visible symptom. Many people feel things like this in
advance of a real outbreak. Other people may feel things like
this - but then the outbreak never happens. In any case, if you
abstain from intimate contact - from the moment you start feeling
some tingling or any other unusual sensation - whether or not it
turns into an actual outbreak - then you are likely to
significantly reduce your risk of transmission. There are no
published studies about self-monitoring, so you just need to
go by common sense.
6) Low-stress Lifestyle: Many believe that stress increases
the occurrence of herpes outbreaks. Stress may also decrease
your auto-immune defenses. So if you and your partner both
avoid stress, you should theoretically lower your risk of having
outbreaks and being potentially infectious - as well as lowering
your risk of "catching" this or another virus from other people.
There are so many things that you can do to help lower the
potential risk of transmitting HSV2 to your partner. Depending
on your particular situation, your risk might be higher - or
lower.
Bottom line - is that you CAN significantly reduce your risk
of transmitting HSV2 to your partner, even when you are having
no outbreaks. If you take all of these precautions, you might,
in fact, be a safer partner than someone who has not been tested
recently for STD's and is taking no particular precautions. Just
using a condom, for instance, does not guarantee against the
spread of many STD's, including herpes. Since most people have
not taken an HSV-2 type specific blood test at least 12-16 weeks
after their last sexual partner, they might possibly be carrying and spreading the HSV2 virus without their knowledge, and may
display no particular symptoms.
The only difference between US and THEM (the general population)
is that we KNOW what we have and we can do something about it.
At least 1/4 of THEM are really part of US, but they just don't
know it. Asking our potential partners to get tested may seem
awkward, but just think of the favor you will be doing for
yourself and everyone else - if someone who has it, finally
learns that they have it and can start doing something about it.
For more information, we recommend that you check out the Herpes
Links and Information on Bay Area Friends' public website at:
http://www.bayareafriends.org/links_&_info.htm
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