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Genital herpes – the answers

by Dr Laura Waters, a GU doctor at the Chelsea & Westminster
On Saturday 17th September [2005], Dr Laura Waters gave us a talk on ‘Herpes simplex –transmission and prevention’ supported by a ‘PowerPoint’ presentation. She covered herpes simplex from diagnosis, through symptoms (with photos!), treatment and transmission.

Incidence

  • At sexual health (GUM) clinics, more than 80% of people attending (not for herpes simplex) have antibodies to herpes simplex type 1.
  • 50% of new cases of genital infection are caused by herpes simplex type 1.
  • 20% of sexually active adults have herpes simplex type 2.
  • Most of these people with herpes simplex are unaware of it:
  • One in four will have clinical symptoms significant enough that s/he seeks diagnosis and
    treatment;
  • Two in four will recognise their symptoms after a counselling session describing all the
    variations they might have;
  • One in four has no recognisable symptoms – however even s/he has symptoms eventually.

Typical symptoms

It starts with flu-like illness and then blisters develop, burst and heal.  However some patients may have symptoms that are more like:

  • recurrent cystitis
  • thrush
  • eczema
  • sweat rash
  • flu

[Patients may also experience herpes simplex as: a little cut, a sore place, an itchy place or an infected hair follicle.]

Dr Waters told us that when doctors diagnose by appearance only [no swab test results] then they are likely to be wrong two thirds of the time!

Serological testing [blood test for herpes simplex antibodies]

The test is not used to diagnose herpes simplex as it takes 8 to 12 weeks for the antibodies to be formed.  So this test cannot be done during the first illness.
Partners of people who know they have herpes simplex can have this test at Chelsea & Westminster Hospital: if the partner tests positive then s/he cannot catch it again and they do not have to take care with prevention. [You will not reinfect the partner you caught it from, on any part of his/her body.]  According to 200 patients at Leeds GUM questioned by Fairley and Monteiro (1997), 92 per cent expect to be tested for herpes simplex when they go for a check-up. The reasons that the serological test is not part of a check-up are:

  • the test is only 95% accurate and is less accurate in people who are unlikely to be infected (and conversely more accurate in people who have been more at risk)
  • as a result of the this inaccuracy, medical staff are unsure how to explain the results to patients
  • tests cost around £25.00
  • a proportion of people don’t want to know (if they are not getting symptoms, they cannot protect partners anyway)

Types 1 and 2

The virus remains latent [asleep] in the sensory nerve ganglion [junction box] near the spine at the level where infection occurred. Recurrent symptoms occur in the area served by that ganglion.

Frequency of genital recurrences

  • Type 1 recurs on average 0.08 times a month in the first year, in other words: once a year
  • Type 2 recurs on average 0.34 times a month in the first year, i.e. 4 times a year.

Treatment

Aciclovir is the most commonly used antiviral therapy. It can be taken just when you have an outbreak, or on a regular basis to prevent outbreaks.  When lecturing to doctors, Dr Waters explains to them that it can be used:

  • to control symptoms
  • where there is complicated disease [such as urine retention, or erythema multiforme*]
  • when the patient has relationship concerns i.e. in a new relationship
  • where patients have multiple partners
  • to reduce transmission
  • to prevent an outbreak when giving birth – however C-sections are not necessary even if there is a recurrence at term.

Aciclovir has been under surveillance for 13 years and has shown no health implications. When a person stops taking it, they should expect a rebound outbreak 4-5 days later.

A trial followed 1484 couples, where the partners were all at risk of contracting herpes simplex. In the course of a year, taking antiviral drugs every day lowered the risk of infecting the partner from 3.6% risk to 1.9% risk. The drug used was Valtrex as this drug is still under patent. However herpes specialists are confident that taking aciclovir would give the same result. [This is relevant to patients as Valtrex costs the NHS five times more than aciclovir, so doctors are more likely to prescribe aciclovir.] No trial will be done with aciclovir as this is now a generic drug, so that no one drug company would make a large profit from this drug.

Asymptomatic shedding

Over the course of 6 months, women rubbing a swab around their genitals twice a day were found to have virus present on 6% of days without drugs and on 0.4% of days if they were taking antiviral pills.
Asymptomatic shedding occurs less over time: 10% in first year – less in following years. It occurs less in people with fewer symptoms [and more in people with more symptoms.]

Solution

Dr Waters wound up her talk by telling us that the solution to herpes simplex will be a vaccine still to be developed, that would prevent it being caught in the first place. Tests are proceeding on young women. [This vaccine did not work out and has been shelved.] She did not expect new drugs to be available in the near future but hoped that existing drugs and tests would be used more extensively.

She ended by pointing out that destigmatising herpes simplex would be the ultimate solution.

Report compiled from Dr Waters talk by Marian Nicholson

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Dr George Kinghorn’s talk, 2002: “An Update on Herpes Simplex”

Dr Kinghorn is the consultant in genitourinary medicine at the Royal Hallamshire Hospital, Sheffield. He is very interested in the herpes simplex virus and is a member of the Herpes Simplex Virus Advisory Panel, which is a sub-group of the prestigious British Association for Sexual Health and HIV. He is also a member of the Independent Advisory Group for Sexual Health and HIV/AIDS which advises the government on sexual health services. Over the years, we have sent him some ‘difficult cases’ which he has been able to sort out with ease!

He gave the ‘annual talk’ to members of the Herpes Viruses Association in 2002. Afterwards, he answered our questions – read on Continue reading Dr George Kinghorn’s talk, 2002: “An Update on Herpes Simplex”

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The Sun’s Story About a Baby and a Cold Sore

The Sun (23-9-15) Wrote About a Mum Who is Asking People Not to Kiss New Babies

Because Claire Henderson had never had a cold sore (or any other herpes simplex virus) her baby did not have any antibody protection when someone with a cold sore kissed baby Brooke.  The newborn baby became very ill. Luckily, the hospital put the baby on an aciclovir drip and this ensured that she made a full recovery.

If you have genital herpes, cold sores, or whitlows (on the finger), your new babies have ‘borrowed’ antibody protection that will last them until they are old enough to catch things without danger.  So you do not have to worry about infecting your baby.

Since no one knows the antibody status of a new baby, don’t kiss a baby that is not yours!

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Confidentiality at Clinics…

There has been a law since 1917 that ensures that information about you – when you visit a sexual health clinic – is kept confidential. The government is proposing to scrap this law and replace it with woolly rules on confidentiality… Read more about this on our blog. Or go straight to the (short) survey organised by BASHH (sexual health doctors’ organisation).

Send the survey on to anyone else you think will help.

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Result of the Case Review of the Trial of David Golding

“The conviction was sound” said the judges at the Case Review, requested by the Crown Prosecution Service. Read our press release, May 2014 and our blog.

This is the only case that has ever reached court, regarding herpes.  It happened only because neither David nor his lawyer did anything to find out about herpes.  David just went to court and pleaded guilty. There was no trial, therefore this cannot be said to create a precedent.  Read more about this in the article by Nigel Scott.

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Vaccine Trial in London

In December 2012, the Amgen PR lady informed us that their report re the phase I Immunovex vaccine trial was not ready for publication. However she assured us that Amgen is committed to following pharma’s guidelines which say that the results of every trial involving volunteers (42 in this case) must be made public. This vaccine was created by the Biovex company, and Amgen has bought Biovex. Phase I is the safety stage – and, so far, the vaccine has proved safe. So it will be a commercial decision as to whether a phase II trial is undertaken. The hope is that this jab could prevent genital herpes in those as yet uninfected and also act as a treatment for people who are getting too many genital herpse outbreaks.
Continue reading Vaccine Trial in London

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Our Own Wikipedia Page

NOW DELETED BY WIKIPEDIA

The history of the HVA – why and how we started up – a bit about the creation of the stigma – you can see it on the Herpes Viruses Association Wikipedia page now! It needs someone to go in and ‘edit’ into the text all the links to other pages of Wiki.  Whilst creating this page, it became obvious that we could add a lot more about how the stigma was invented on the regular herpes simplex page.