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Genital herpes infections are one of the most commonly known STDs. Hitherto, there is no cure for the disease — it is a lifelong viral infection.
Genital herpes is caused by herpes simplex virus (HSV). Both type 1 and type 2 of HSV can cause genital herpes. It is known that one may present with a chronic recurring flare up of herpes ulcers after contracting HSV infection. Active HSV infection with ulcers can be transmissible to sexual partners. To make things worse, HSV infection can also be transmitted from a person to another person even when one is asymptomatic due to the continuous shredding of the virus.
In this article we want to understand the pattern of shredding of HSV virus, hence correlating to one’s clinical presentation, and the relevance of episodic versus suppressive antiviral treatment.
The recurrence of HSV-1 genital herpes flare up tends to be lesser in comparison to HSV-2 genital herpes. Shedding occur commonly after infection but decreases rapidly from 12% at 2 months to 7% at 11 months post acquisition of HSV-1. The shedding of HSV-1 virus reduces quickly throughout the first year of infection, leading to the risk of asymptomatic disease transmission to sexual partner lower after the first year. Shedding of HSV-1 genital herpes in comparison to HSV-1 oral herpes is higher. Long term shedding of HSV-1 is less common, though it is not completely impossible.
Nearly all patients with known first episode HSV-2 genital herpes will have recurring episodes of genital herpes. Viral shedding in HSV-2 genital herpes is higher than HSV-1 genital herpes, hence HSV-2 genital herpes is associated with higher frequency of recurrence. Even in a person without active genital symptoms in long run, intermittent viral shedding still occurs in HSV-2 person.
The classical clinical presentation of genital herpes is recurring blisters or punched-out ulcers over the genital region. Having said that, often, in clinical practice, visual diagnosis can be difficult or even absent in many infected patients during the time of clinical assessment.
When the genital ulcers are present, the diagnosis of genital herpes and herpes subtypes can be confirmed with further tests.
When there is absence of genital ulcers, HSV serology antibody blood tests can be used to guide the diagnosis of HSV subtypes of genital herpes.
The evidence-based benefits of considering long term suppressive treatment for herpes infection:
In episodic antiviral treatment, one can start antiviral medication when they notice the first signs of herpes disease such as tingling, itching over the site of herpes outbreak. Early episodic antiviral can reduce the time of the recovery and reduce viral shedding hence reduce transmission to others.
In those patients who have frequent genital herpes outbreaks despite episodic antiviral treatment, long term suppressive antiviral therapy can be recommended. In HSV-2 genital herpes, chronic suppressive therapy is recommended in comparison to episodic therapy as most patients with HSV-2 genital herpes invariably has higher frequency of recurrence and have chronic intermittent shedding of the virus. Chronic suppressive treatment is also beneficial to patients with genital herpes and has a weaker immune system (concurrent HIV, cancer etc). While chronic suppressive antiviral treatment can be beneficial to frequent outbreak in patients with HSV-1 genital ulcers, as the recurrence rate is lower than HSV-2 genital ulcers, some patients may only require episodic treatment.
Your decision on antiviral treatment option can be discussed with your doctor. Aside from understanding your herpes disease progression, It is worth discussing you and your sexual partner(s) concerns and expectations with your doctor before deciding on which treatment to opt for.
When a person is having genital herpes with clinical presentations of ulcers and blisters, these open erosions and wounds can be channel for a partner’s genital or body fluid to enter the body. Hence, if the partner has other STDs, the person with active genital herpes has a higher risk of contracting other STDs as well.
Clinical statistics have shown HSV-2 genital herpes increases twice to thrice risk of a person acquiring HIV infection. If you are exposed to possible sexually transmitted disease, do reach out to your trusted healthcare staff for further medical screening and early treatment if required.
Genital herpes brought in its wake overwhelming emotions of shame, fear, anger, distress and helplessness. Most patients do go through all these phases following diagnosis of herpes.
In an attempt to understand further on the medical condition, patients commonly rampaged through multiple channels such as chatgroup, chatGPT, internet sources and etc. These further muddle one’s disease understanding and create more fear and anxiety.
One should be reassured that the overwhelming emotions are normal human reaction following diagnosis of the condition. It is imperative to understand that genital herpes is a medical condition that is controllable with effective treatment. Proper health education on genital herpes is very important for the patient in managing the disease and reducing the risk to transmitting the disease to their partner(s).
Medical counselling may be useful in coping and coming to terms with the diagnosis of herpes. Importantly, do reach out to your doctor to obtain the right information and debunk myths about herpes infection.
References:
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