Your Good Health: Antiviral drugs reduce frequency of herpes outbreaks

dr_keith_roach_with_bkg.jpgDear Dr. Roach: I am 57 and finally divorced my cheating husband a year ago. Now that I am interested in dating again, I went for a consultation and exam with my gynecologist, complete with STD testing. I am in excellent health and all tests were negative except the one I feared: herpes, both oral and genital.

I am not only upset but also confused because neither I nor any of my partners have ever had any lesions or cold sores. I have had terrible canker sores since childhood, but thought they were related to food allergies. I have eliminated most trigger foods to avoid the discomfort, but could they be related to the herpes? Maybe three times a year I have a tiny (smaller than 1 centimeter) red spot on my labia that I am aware of only when I urinate. My question and concern is about future relationships. Is there any treatment to prevent the spread of herpes? I am not suffering physically; it is the fear of not finding a future partner willing to risk intimacy with me that is most concerning.

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Anon.

A positive blood test for herpes is pretty strong evidence of past infection. It could have been from any time in your life when you have had intimate relations. Most people with genital herpes are not aware they have it, and can spread virus — and therefore be infectious — even with no symptoms. However, people with active herpes infection, with blisters or ulcers, are much more infectious.

Canker sores, also called aphthous ulcers, are ulcers in the mouth. They are not related to herpes or any other known infection. However, cold sores — which most often are blisters on the lips, but can be in other locations in the mouth — are usually caused by oral herpes, herpes simplex 1.

Genital herpes lesions do not always look like the standard picture in the textbook (“a dewdrop on a rose petal”). I don’t know if the red dot you have noticed is a genital herpes lesion, but it is certainly possible. Your gynecologist can do a viral culture, which could validate the diagnosis.

There is treatment for genital herpes. Acyclovir and similar drugs are specific antiviral drugs for herpes. They are effective at shortening outbreaks when taken immediately at onset of symptoms, and at reducing outbreaks if taken every day. These medications have improved the lives of people with symptomatic disease and reduce the likelihood of spreading herpes to their partners. People with a history of genital herpes should tell any potential partners before intimate activity.

There are two types of herpes vaccines in development. The first is the traditional vaccine to prevent getting the disease in the first place. One candidate vaccine was modestly successful in doing so but did not last more than 16 months. No safe and effective vaccine for genital herpes is going to be available soon.

A second type of vaccine is one to boost the immune system in people who already have HSV infection. One candidate vaccine reduced the number of outbreaks, and work is ongoing. Unfortunately, herpes simplex viruses are very good at evading the immune system.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu

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