Clinicians, patients need to boost herpes IQ

What is your level of knowledge when it comes to genital herpes, its methods of virus transmission, risks to others, and appropriate treatment? If results of an online survey are any indication, many health care providers and patients with herpes are poorly informed about herpes.1

In an online survey of 200 Canadian family physicians and 401 patients, 45% of doctors and 51% of patients underestimated the risks of passing on the infection during periods when there are no obvious outward symptoms. (Research indicates up to 70% of transmission of herpes may occur during periods of asymptomatic viral shedding.2) In addition, only 40% of patients were aware that daily antiviral therapy is available to reduce the risk of transmission.

The survey was prompted by researchers' belief that management of genital herpes can be improved, says Barbara Romanowski, MD, FRCPC, FACP, a clinical professor in the Division of Infectious Diseases in the Department of Medicine at the University of Alberta in Edmonton. To achieve that goal, the researchers wanted to have a better understanding of the issues for patients and physicians, she explains.

Why did physicians and patients get it wrong when it comes to the risk of transmission during periods of asymptomatic viral shedding? Romanowski cites lack of information as the culprit.

Review the basics

Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). Most genital herpes is caused by HSV-2. Most patients have no or minimal signs or infection; when signs do occur, they typically present as one or more vesicles on or around the genitals or rectum. When the blisters break, they leave small sores that may take two to four weeks to heal at the first time of occurrence. The initial outbreak typically is followed by subsequent outbreaks that can appear weeks or months after the first. Such reoccurrences almost always are less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.3

While HSV-1 and HSV-2 can be found in and released from the sores that the viruses cause, they also are released between outbreaks from skin that does not appear to be broken or to have a sore, known as asymptomatic shedding. Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection, according to the Centers for Disease Control and Prevention. Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected.3

While there is no cure for herpes, antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners. Correct and consistent use of condoms also helps to prevent viral transmission.

Reduce the stigma

According to a Harris Interactive poll of U.S. adults, participants ranked genital herpes second for social stigma, out of all STDs, with only HIV outranking it. For those with genital herpes, 61% said that revealing their condition to their partner(s) was troubling to them, and only 32% said they were open about their condition with their close family and friends.4

What can providers do to help lessen the stigma of herpes? First, it's important to understand what stigma represents, says Terri Warren, RN, ANP. Warren is the owner of Westover Heights Clinic in Portland, OR, a private clinic specializing in the diagnosis and treatment of STDs, and the co-author of two books, The Updated Herpes Handbook and Tender Talk, a Guide to Intimate Conversations.

Stigma is defined as occurring when someone has a characteristic, in this case genital herpes infection, that is considered to be universally undesirable, is uncommon, and is within the control of the person who has it, explains Warren. Herpes is not uncommon. According to the American Social Health Association, about one in five persons in the United States has genital herpes; however, as many as 90% are unaware that they have the virus.

Encourage patients to utilize educational materials that also include the discussion about the emotional aspects of having herpes, not just the facts about herpes, says Warren. Give patients the information they need to take charge of their diagnosis, she advocates.


  1. Romanowski B, Zdanowicz YM, Owens ST. In Search of Optimal Herpes Management and Standard of Care (INSIGHTS) Physicians' and Patients' Perceptions of Genital Herpes. Sex Transm Infect 2007; Nov 22 doi:10.1136/sti.2007.027631.
  2. Mertz GJ, Benedetti J, Ashley R, et al. Risk factors for the sexual transmission of genital herpes. Ann Intern Med 1992; 116:197-202.
  3. Centers for Disease Control and Prevention. Genital Herpes. Fact Sheet. Accessed at:
  4. American Social Health Association. Survey Reveals Topic That Few Discuss in Today's Dating Scene. Press release. Research Triangle Park, NC. Aug. 9, 2007.


Download a free copy of English or Spanish versions of The Updated Herpes Handbook from the Westover Heights web site, Click on "Genital Herpes" and "Updated Herpes Handbook." Also, view Taking Charge of Your Life: Learning to Live with Genital Herpes, a free video resource designed to answer the most common questions and concerns. Click on "Herpes" and "Counseling DVD."

Direct patients to browse the WebMD Genital Herpes Health Center web site, which features a community board and a blog authored by Terri Warren. Go to the Web MD site, Under "Health Centers," click on "Genital Herpes." While at the Westover Heights site, click on "Herpes," "Resources & Links," and "WebMD Genital Herpes Health Center."