ANNOUNCER: Although it's not always openly discussed, genital herpes remains one of the most prevalent sexually transmitted diseases. It is also one that carries the greatest stigma.
TERRI WARREN, RN, APN: I think we don't hear a lot about genital herpes these days because it's been overshadowed by HIV. In the eighties, we heard a lot about herpes. It was on the cover of Time magazine, the scarlet "H."
It's an interesting thing. Herpes is so stigmatized in our society way out of proportion to anything that might be true about this virus.
ANNOUNCER: There are two main types of herpes viruses, herpes simplex virus 1 and herpes simplex virus 2. Genital herpes may be caused by either. However, the majority of cases of genital herpes are caused by HSV 2.
TERRI WARREN, RN, APN: Genital herpes is incredibly common. One out of four people in the United States over the age of eighteen have herpes simplex virus type 2.
If you look at the number of people at any time who have chlamydia, genital wart virus, hepatitis B, HIV, they don't come close to totaling the number of people who have HSV-2 infection.
ANNOUNCER: There are many misconceptions about genital herpes and one of the biggest is how the virus is transmitted.
TERRI WARREN, RN, APN: Genital herpes is transmitted through sexual contact and that sexual contact can be intercourse, can be mouth-to-genital contact or could be just genital-to-genital rubbing. It doesn't take penetration to get genital herpes.
We don't believe that herpes is transmitted through inanimate objects with the exception of sex toys. Actively using sex toys between people when one has herpes and the other does not could transmit that virus.
It's not transmitted through hot tubs or swimming pools or toilet seats.
ANNOUNCER: When a person is infected with the herpes virus, it may not present with symptoms, and generally people are unaware they have been infected.
TERRI WARREN, RN, APN: We used to think that people who got first-episode herpes infections always knew it, that it was painful and dramatic and obvious. What we know now is that probably 75 percent of first-episode herpes infections go completely unnoticed by the people that are infectious.
ANNOUNCER: When symptoms do occur, they usually appear from time to time as outbreaks.
TERRI WARREN, RN, APN: The person who has genital HSV-2 infection, on average, has around five outbreaks a year. They may present with either a single sore or multiple sores. They could be very uncomfortable and sick, or they could be hardly recognizing what's going on with them.
They may have multiple, painful genital lesions, have difficulty initiating a stream of urine, headache, sensitive to light, flu symptoms. That happens, but that's much more unusual than getting herpes and being totally unaware that it's happened.
The person who typically gets a herpes outbreak will have symptoms the first time for perhaps a few weeks, maybe even longer, especially if they don't get treated appropriately. The person having a recurrence of herpes might have symptoms for five to seven days.
ANNOUNCER: Although there is no evidence about what triggers a herpes outbreak, they have been associated with certain factors.
TERRI WARREN, RN, APN: Friction, so intercourse could be a trigger, tight clothes could be a trigger. Some people think stress is a trigger. Perhaps not getting enough sleep could be a trigger for herpes or changing your life. Maybe those things have some impact, but we're really quite unclear about what triggers a genital herpes outbreak.
ANNOUNCER: Herpes may be treated supportively or with antiviral medications. Supportive treatment includes warm salt baths, analgesics and wearing clean, loose, cotton underwear. However, only antivirals can shorten the duration of an outbreak and they can sometimes reduce viral shedding. Viral shedding is when the virus is present on the skin and can be spread.
TERRI WARREN, RN, APN: There are three oral antiviral agents available for the treatment of herpes infections: acyclovir; famciclovir, Famvir; or valacyclovir, Valtrex. These oral medicines work much better than anything that we've ever had in the past with topical medicines.
All three of the medicines are all approved for use to treat outbreaks or to treat everyday to reduce viral shedding.
Valtrex or valacyclovir is the only medicine that's been approved to reduce transmission between two people; it's the only medicine that's been studied. And we know that, if you take valacyclovir or Valtrex everyday, that you can reduce transmission to a sexual partner by almost half.
ANNOUNCER: There are two methods of medical treatment for people infected with genital herpes: episodic treatment and suppressive treatment.
TERRI WARREN, RN, APN: Episodic treatment is treating outbreaks as they come up. It shortens the duration of an outbreak by one to two days. We use episodic therapy a lot less than we used to. So the idea that you treat outbreaks is useful for a person trying to shorten that outbreak, but it does nothing to reduce the frequency of outbreaks happening, nor does it do anything to reduce the risk of infecting another person.
So if the only issue that a patient has is dealing with their own outbreaks and they're not bothered by the frequency of them and they don't have a susceptible partner that they're trying to protect, than perhaps episodic therapy or treating outbreaks is an acceptable way to go.
However, I think that many people would like to have fewer outbreaks and are interested in protecting other sexual partners from getting herpes. In that case, suppressive therapy is the option that people should be using.
ANNOUNCER: With some 60 million people currently infected in the US and approximately a million new cases being contracted a year, stopping the transmission of the herpes virus is a top priority for healthcare professionals. And there are several things people can do.
TERRI WARREN, RN, APN: Before people can do risk-reduction techniques, they need to know that they're infected. If you don't know that you're infected, you're not going to do anything about it.
If someone's infected with herpes, they need to share that information with partners and then they, together with their partner, will decide on the techniques that suit them best as a couple to reduce the risk of herpes.
We know that, if they take suppressive antiviral therapy, the risk is reduced by about half. If they use condoms regularly with every intercourse, they can reduce the risk by about half also. So we have some really good tools to reduce the risks.
ANNOUNCER: But perhaps the biggest challenge facing someone who is infected with genital herpes is overcoming the social stigma associated with the disease.
TERRI WARREN, RN, APN: I'd like people to know that, if they're infected with genital herpes, that this does not, in any way, change the core of who they are. And I would encourage people to try to separate having this virus from the rest of who they are. This doesn't make you or break you as a human being. Your life will go on if you're diagnosed with herpes, you can live a full life, have families, have people love you. It doesn't define you, in any way.
I have a question. My Girlfriend was diagnosed Type 2 positive during a very painfull outbreak, apparently it was the primary. In september of 2008 she tested negative; September of 2009 she tested positive. Is the first oubreak alway around 3 weeks after infection?