Sexually transmitted infections continued

Last week, we began to discuss STIs, in particular herpes infection. I was about to discuss the reasons why herpes does not go away and why the infections keep recurring, but with less frequency over time. This is because viruses, including herpes, need a “host” in which to live. They cannot, like bacteria and some other bugs, live outside the human or other living body on their own.{{more}}

Once herpes viruses infect the human body they take up residence in the nerves and here they live until the person dies. Normally the virus is dormant, but can be reactivated to cause recurrent infections or “breakouts”. These breakouts are more common during other viral infections like the common cold, flu and HIV. They are also more common during periods of stress, lack of sleep and excessive tiredness, as well as with the use of immunosuppressives like steroids and chemotherapy.

Incidentally, vigorous sexual activity, bruising of the genitalia, pregnancy and other sexually transmitted diseases also lead to breakouts.

Most patients can tell when they are about to have a breakout. It usually starts in the same general area, usually on the foreskin or penis head or the lips of the vagina, but it can occur on any part of the genitalia. The area usually become a little irritable or sensitive and can begin to itch. This is followed by the classic herpes rash which may be accompanied by fever and swollen glands in the groin area.

Avoiding the above where possible, as well as taking medications can therefore reduce breakouts. There are two different antiviral medications commonly used to treat herpes simplex infections, as well as other herpes virus infections like chickenpox. The medications are acyclovir, also called zovirax, and valacyclovir or valtrex. They both work the same way, but valtrex is longer acting and has fewer side effects, so as you would expect, it is more expensive. Valtrex is taken twice a day while zovirax is taken four times a day. The cost of valtrex is about EC$125 for a five-day course. Both medications can reduce the pain and duration of the rash in a full-blown breakout, or if taken early enough, may avert a breakout, but it has to be taken before the rash occurs, i.e. within the first 24 hours. Valtrex may also be given as a once a day treatment, as preventive or prophylactic treatment. This once a day treatment reduces the risk of breakouts and transmission of the virus by 50%. Unfortunately, valtrex is expensive and it does not prevent the transmission of the virus, only reduces it. The only way to prevent the transmission of the virus, is abstinence or the consistent use of condoms. Sleeping with “someone you know well” does not prevent it and even though a blood test can detect your exposure to the virus (that previous infection), it will not tell you if you are presently infective, as half of the patients who have the virus and do not have a rash can still spread the infection. You will certainly spread the infection if you have the rash and practise unprotected sex.

Overall, the best way to prevent transmission is to abstain or use condoms, both of which are practical if you are not trying to get pregnant. Practically, a combination of the use of prophylactic medication between breakouts and the use of condoms during a breakout will significantly reduce your chances of transmission and breakouts. This, combined with the use of preventive medication during pregnancy, can help to reduce transmission to the unborn child. This is not to underscore the importance of faithfulness within the relationship.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com