Resource for GPs to Counsel Patients

What to avoid saying to patients:

• Rather than using terms like "incurable," use softer language like "recurrence," "episode," or "flare-up."
• Refrain from saying "you'll have it forever" - this isn't commonly said for conditions like chickenpox, eczema, or psoriasis.
• Avoid insisting on partner testing unless they have symptoms; routine testing isn't necessary for asymptomatic partners.
• Don't alarm patients by saying they could face legal consequences if they don't disclose their condition. There's no legal obligation - provide them with accurate, informed advice. 

It can happen to anyone: First diagnosis of genital herpes

Genital herpes a common infection that affects 'ordinary' people

Myths and ignorance abound. Good information helps make sense of diagnosis.

Why do I feel this way?

Common reactions:

A diagnosis is often unexpected and you may feel

• Confusion
• Uncertainty
• Anger and blame
• Or just have some questions

What is the herpes simplex virus (HSV)?

• A common viral infection that's been around for centuries
• Most people have no symptoms
• Causes facial herpes (HSV1) passed by kissing and genital herpes (HSV1 or HSV2) passed by oral sex (HSV1) or genital to genital contact (HSV1 or HSV2)
• A fragile virus that dies when it leaves living human cells - not passed on through non-sexual contact e.g. toilets and showers, trying on clothes, medical examinations

When did I contract the virus?

Often not possible to work out because:

• Most people contract herpes from a partner who did not know they have HSV
• Most have very mild, or no symptoms and go undiagnosed - may have genital herpes for months or years before diagnosed, if ever
• Only small % of people have severe symptoms - and this may indicate new infection
• HSV is not routinely tested for in sexual health check-up

How do people contract genital herpes?

Through direct skin to skin sexual contact including:

• Genital to genital and oral to genital
• Therefore virgins can and do contract genital herpes
• Condoms reduce transmission (condoms do stop many STIs)
• Partner has to be infected either facially or genitally – sore may not be obvious & the virus may be on the surface of the skin without symptoms on small % of days

Who did I contract the infection from?

• May be impossible to work out how long a personhas had the infection & who HSV came from
• If genital HSV1 - probably transmitted through oral sex, partner may have or had 'cold sores' on face
• If first symptoms are mild, may have had the infection for months or years
• Significant first symptoms ('flu-like illness, lots of blisters) may mean HSV contracted in past 2-20 days.
• If several recent partners may be impossible to determine who the infection came from. Genital herpes may appear in a long-term relationship with no outside partners involved

What next? Recurrences and treatment options

• Recommend oral anti-viral medication and pain relief to treat first episode
• Recommend provision of ongoing antiviral management - there are two treatment modalities recommended:
  • Episodic treatment manages per recurrence. Needs to be started as soon as symptoms appear. Need to have tablets "on hand" to start immediately so provide "backpocket" antivirals.
  • Suppressive treatment, an antiviral taken daily for as long as you want, this reduces or prevents recurrences, significantly reduces changes of transmission and can provide psychological comfort.
• If unwell take time off work - rest
• Prescription needed for anti-viral medication
• HSV1 – may have few, if any recurrences
• HSV2 – may have 2-6 recurrences per year
• Recurrences usually mild and are over in a few days
• Most people don't use regular medication after 1st episode

What next? Relationships

• Talk to your partner - share information
• Partner may have HSV – once contracted the virus doesn't pass back and forth
• Reduce transmission by avoiding genital contact with partner when symptoms present
• Condoms reduce transmission of HSV
• If partner does contract virus, most likely to have few if any symptoms

What's next? Future plans

People with genital herpes can:

• Have normal lives
• Have normal fertility
• Have healthy babies and vaginal deliveries
• Donate blood
• Work in any occupation
• Use spa and swimming pools
• Cuddle with their kids in bed, share a bath
• Make choices with their partners about sexual practices and the use of condoms
• Have the same overall health, immune system and lifespan as others and no additional cancer risk

What next? Talking is good

• Tell trusted friend/family member
• Return to your GP, Sexual Wellbeing Clinic or sexual health clinic for follow-up
• Counselling available at sexual health clinics
• For information and phone counselling contact: Phone toll free 0508 11 12 13 or from a mobile 09 433 6526 or email [email protected]
• Check out information on: www.herpes.org.nz

NZ Herpes Foundation: Helping people to live ordinary lives

Toll free 0508 11 12 13
Or from a mobile 09 433 6526