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Treatment of Herpes

One of eight North Americans (30 million) has genital herpes, but only 20 percent of those infected know it (1). Herpes is classified into type I that affects primarily the mouth, and type II that affects primarily the genitals, although both types can go both places. According to a study in the American Journal of Epidemiology almost one percent of North Americans acquire new cases of recurrent genital herpes each year (14). That's 1,640,000 new cases of recurrent genital herpes. (730,000 men and 910,000 women).

To get herpes, you need the virus and broken skin. Since rubbing breaks skin, sexual contact with infected partners causes herpes. Typically, a person develops grouped painful or itchy blisters that look like poison ivy and disappear after one to six weeks. For some, genital herpes never recur, but almost all people who have a painful first episode will have recurrent blisters in exactly the same place (2).

A person who has herpes can be contagious, even when there are no visible blisters. The only way to diagnose herpes is to have a culture done on a wet blister. There are no dependable blood tests to tell if you have herpes because more than 92 percent of all Americans have had herpes and therefore have positive blood tests.

Herpes is the most common cause of swelling and pain around the rectum or vagina; anyone with these symptoms should get a culture for herpes, even if they are not sexually active.

Almost all North Americans have had herpes, but only 7 percent get blisters recurrently. If you have had one bout of herpes, you do not need treatment. If you have fewer than four recurrent genital herpes attacks per year, your doctor will probably prescribe 21 500mg tablets of Famvir or Valicyclovir that you keep on hand all the time and take them at the first tingling or itching that precede an outbreak. If you have more than 4 attacks a year, your doctor will probably prescribe valicyclovir 500 mg once a day for several years (7) or Famivir 125 mg TID (8). By the third year on that regimen, as many as 82 percent have no outbreaks at all. Exciting new research shows that taking acyclovir every day can help to prevent a person from being contagious (4). Valicyclovir and Famvir are both approved by the FDA for long-term use.

People with recurrent herpes can be contagious any time, but they are less likely to be contagious when they do not have blisters. Virtually everyone in North America has had herpes, but only seven percent get it recurrently. If a person with recurrent herpes is on Valtrex every day, he or she will not shed as much and not be as contagious. Personally, I would not ruin a relationship because of herpes because you are not likely to find anyone who has not had herpes.

1) J Benedetti, L Corey, R Ashley. Recurrence rates in genital herpes after symptomatic first-episode infection. Annals of Internal Medicine 121: 11 (DEC 1 1994):847-854.

2) Sexually transmitted diseases treatment guidelines. CDC MMWR Recommendations and Reports. 1993(Sept 24);42.

3) A Wald, J Zeh, G Barnum, LG Davis, L Corey. Suppression of subclinical shedding of herpes simplex virus type 2 with acyclovir. Annals of Internal Medicine 124: 1 Part 1 (JAN 1 1996):8-15.

4) R Patel, NJ Bodsworth, P Woolley, B Peters, G Vejlsgaard, S Saari, A Gibb, J Robinson. Valaciclovir for the suppression of recurrent genital HSV infection: A placebo controlled study of once daily therapy. Genitourinary Medicine 73: 2 (APR 1997):105-109.

5) NJ Bodsworth, RJ Crooks, S Borelli, G Vejlsgaard, J Paavonen, AM Worm, N Uexkull, J Esmann, A Strand, AJ Ingamells, A Gibb. Valaciclovir versus aciclovir in patient initiated treatment of recurrent genital herpes: A randomised, double blind clinical trial. Genitourinary Medicine 73: 2 (APR 1997):110-116.

6) DM Huse, S Schainbaum, AJ Kirsch, S Tyring. Economic evaluation of famciclovir in reducing the duration of postherpetic neuralgia. American Journal of Health - System Pharmacy 54: 10(MAY 15 1997):1180-1184.

7) Tyring SK and the International Valicyclovir Study Group presented to the American Academy of Dermatology meeting March 21, 1997.

8) M Schomogyi, A Wald, L Corey. Herpes simplex virus-2 infection: An emerging disease? Infectious 9 NEJM, March 23, 2000 .

9) D Benedetti, L Corey, R Ashley. Recurrence rates in genital herpes after symptomatic first-episode infection. Annals of Internal Medicine 121: 11 (DEC 1 1994):847-854.

10) Sexually transmitted diseases treatment guidelines. CDC MMWR Recommendations and Reports. 1993(Sept 24);42.

11) A Wald, J Zeh, G Barnum, LG Davis, L Corey. Suppression of subclinical shedding of herpes simplex virus type 2 with acyclovir. Annals of Internal Medicine 124: 1 Part 1 (JAN 1 1996):8-15.

12) RR Gacek. Evidence-based drug reviews - Valacyclovir - New indication: for genital herpes, simpler administration. Canadian Family Physician, 1999, Vol 45, pp 1697-1700.

13) Disease Clinics of North America 12: 1(MAR 1998):47. 14) JAMA September 8, 1998.

14) Incidence of herpes simplex virus type 2 infection in the United States. American Journal of Epidemiology, 2001, Vol 153, Iss 9, pp 912-920.

Checked 11/22/14

January 1st, 2015
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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