Dr. Eva’s advice on herpes infection

Dear Dr. Eva,

Years ago I had one herpes outbreak, and I’ve never had another. I didn’t think I needed to tell sex partners about this, since I got over it so long ago. Recently, this came up in a conversation with a friend and sometime sex partner, and she was really upset that I hadn’t told her. I think she is overreacting. We agreed to ask you.

Over It

Dear Over It,

Your friend and sometimes partner is right. No one completely gets over herpes infection. Once a person is infected with the herpes simplex virus (HSV), that person becomes a chronic carrier of the virus. Even though they may not be aware of having any outbreaks, on average, people with herpes shed herpes virus through the skin in the area of infection more than one day a week. Herpes suppressive medications, which include once daily doses of valcyclovir or twice-daily doses of acyclovir or famciclovir, decrease this shedding to one day in 30. That represents a much lower risk, but it is important to realize that there is some risk of herpes infection to the partner of a person with herpes even if the infected person is taking herpes suppressive medication. So, difficult as it is, I do think your partners have a right to know.

You didn’t mention your HIV status, so I am guessing you are HIV negative. You should be aware that using condoms and/or dental dams is an important protection for people who have herpes as well as for their partners. This is because the HSV virus causes chronic inflammation in the skin of the penis, anus, or vagina, even when there are no visible outbreaks. This inflammation makes a person who has HSV more vulnerable than others to becoming infected with HIV. This is true even for people who are taking herpes suppressive medication – the medication decreases the viral shedding but does not decrease the inflammation.

Dr. Eva

Dear Dr. Eva,

How do herpes and HIV affect each other, if a person is infected with both? I have had herpes for many years and a couple of years ago became infected with HIV as well. So far my CD4 count has been over 500 so I have not needed to go on HIV medication. But it seems as if I have been having more herpes outbreaks since I became infected with HIV. Can I expect the herpes outbreaks to be less frequent if I get started on HIV medication? Or would taking herpes suppressive medication help more?

Double Dose

Dear Double,

Because of your frequent outbreaks, many HIV experts would suggest that you start on both HIV medications (antiretrovirals) and herpes suppressive medication.

The herpes and HIV viruses affect each other in several ways.

Herpes outbreaks are more frequent in people with HIV. Also, outbreaks are more severe and last longer. This gets worse as the CD4 level drops, but more frequent and severe outbreaks can occur even in people with high CD4 counts, as in your case.

Herpes can worsen HIV. Proteins produced by the HSV virus cause increases in the blood levels of the HIV virus. Because of this, people who are infected with both viruses have more HIV virus in their blood than HIV-positive people who do not have HSV .

Herpes sores or rashes shed high concentrations of HIV virus as well as HSV virus, so people with both HIV and HSV are more likely to pass on HIV to others. High levels of HIV virus are present in the rectum, penis and vagina of HIV/HSV infected people even when there is no apparent outbreak.

In addition to protecting their partners, suppressive treatment for HSV has benefits for people with HIV and HSV who are not yet taking HIV medications. When herpes is treated, progression of HIV disease is somewhat slower.

Dr. Eva

Dear Dr. Eva,

What are the prospects for a herpes vaccine to be available sometime soon? Herpes has been known about for way longer than the HPV virus which causes warts, and there is already a vaccine for HPV. WN

Dear WN,

Unfortunately, recently released results of trials of a new vaccine for herpes showed that the vaccine did not work, meaning that it did not prevent new herpes infections. No other herpes vaccines are currently under study.

Dr. Eva

Ask Dr. Eva is distributed by Healthy Living News. Email comments and questions to [email protected]

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