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Genital herpes: the low down on the down low

Small college campuses are ideal incubators for colds, viruses and infections, and unfortunately, those ailments include a lot of common sexually transmitted infections.

Herpes is one of the most easily transmitted STIs because it’s a virus, it lives in a body for life once infected. But the dreaded H doesn’t have to be a death sentence for a social and sexual life.

Despite the stigma associated with the infection, as many as one in four adult Americans have genital herpes, while up to 80 percent have been exposed to oral herpes. According to the American Social Health Association, most herpes carriers – about 90 percent of those infected – don’t know they have the virus because symptoms can be slight, unnoticeable or misdiagnosed, and may even be invisible for years after infection.

Herpes is actually caused by two closely related viruses. Herpes simplex virus type 1 (HSV-1) causes sores, called lesions, in and around the mouth, and herpes simplex virus type 2 (HSV-2), most often afflicts the genital region. The virus prefers to migrate to areas rich with mucous membranes, like the mouth, vagina, vulva, penis and anus, but active lesions can also spread to other body parts like the buttocks.

Some people infected with the virus never experience an outbreak, while others may have four to five per year, the average number for those with genital herpes. The appearance of outbreaks varies but occurs during periods of physical and emotional stress, menstruation, concurrent illness, or even after sexual activity.

While incurable, new research shows that daily suppressive therapy with the anti-virals valacyclovir and acyclovir greatly reduces the frequency, intensity and duration of outbreaks, as well as the risk of transmitting the virus to an uninfected partner. Herpes is spread through skin-to-skin contact, when a contagious area touches a tiny lesion in the skin or mucous membrane tissue in the mouth or genitals.

Most skin is too thick for the virus to pass through, and there are no cases documented of infection through an inanimate objects such as a toilet seat or clothing. Herpes does not live long on surfaces.

The virus is most easily transmitted during an outbreak or the few days before one; however, it is possible to spread to a partner at any time, even when he or she has no symptoms. This is called asymptomatic viral shedding, when viral cells become active and “come up” to the surface of the skin and mucous membranes without being visible or noticeable.

It is crucial for someone with herpes to not engage in sex during an outbreak. He or she, like everyone else, should use condoms every time for penetrative as well as oral sex, and women should wear a latex barrier over the vulva, called a dental dam, when receiving oral sex.

While condoms and the like may not cover the entire site of potential shedding and do not guarantee infection prevention, they cover the most likely sites of transmission and protect against other STDs. Experts also discourage using spermicides, as they tend to irritate the genital area and therefore cause breakage in the skin that may allow for herpes infection.

Someone with oral herpes who performs oral sex may infect their partner with genital herpes, while someone infected with genital herpes who receives oral sex may cause their partner to have more severe oral lesions than if the partner had just been infected with HSV-1, according to Debbie Bamburger, lead clinician at Planned Parenthood Central Richmond.

People with herpes should always tell their sexual partners that they carry the virus so they can decide how to reduce the risk of transmission. “The best thing is to be open about it,” Bamburger said.

She also stressed the effectiveness of taking 500 mg of valacyclovir daily to greatly reduce the risk of transmission to an uninfected partner.

There are three anti-virals, taken as pills, approved by the Food and Drug Administration to treat herpes: Zovirax (acyclovir), Famvir (famciclovir), and Valtrex (valacyclovir). All three disrupt herpes’ ability to multiply, reducing viral shedding, and can be taken during outbreaks to speed healing, but valacyclovir has shown the greatest effectiveness so far in studies, some showing viral shedding reduced by 80 percent.

Many people also advise alternative therapies to ease outbreak symptoms and expedite healing, like avoiding strong ultraviolet light, wearing loose cotton underwear, keeping lesion areas as clean and dry as possible, and alternately, taking baths to ease pain from sores. A person with herpes can also reduce the frequency of outbreaks by effectively managing stress and getting adequate rest, nutrition, and exercise.

Although the anti-viral drugs are expensive and no generic versions yet exist, people without health insurance can obtain them for free through Planned Parenthood. Bamburger said that anyone can visit, call the closest Planned Parenthood clinic and be screened for eligibility to receive free medical services and prescriptions.

Most students would qualify, Bamburger said, because parents’ income or insurance status isn’t considered. She emphasized that Planned Parenthood’s free services include even long-term prescriptions, but for the treatment of herpes they only provide acyclovir, which must be taken twice daily.

“I would be happy to see any Mills students,” she said, laughing. “I love talking about this stuff.”