Could Herpes be causing my problems?
Dear Dr Mitchell,
Is it possible for someone to have Herpes and for their partner to remain uninfected? I’ve been having a problem with irregular bleeding for some time and I’ve been diagnosed with the infection. Could Herpes cause a bleeding problem? And will I be able to conceive with the infection?
Herpes Simplex viral infection Type 2 is a very common sexually transmitted infection which usually presents with a painful cluster of blisters or vesicles on the genital area or buttocks. It is also possible for the infection to be present on the cervix or in the vagina. The infection usually comes up at the same site all the time and some individuals tend to get recurrent infections especially when their immune system is down.
It is possible to pass on the infection during sexual activity if this occurs during an outbreak. It is quite possible for one partner to remain uninfected if sexual activity is avoided during an obvious outbreak of Herpes infection. Women who tend to have blisters on the inside of the vagina or on the cervix will not know when there is an outbreak so the infection may be transmitted to their partner unknowingly.
When there are frequent outbreaks, this can be reduced by antiviral treatment to reduce recurrence. This involves taking a tablet every day. This will also reduce the chance of transmitting the infection to your partner. The drugs available for the treatment of the Herpes infection are expensive. The disease usually goes away on its own after five to seven days even if there is no treatment, but the use of antiviral treatment will reduce the length of time for shedding of the virus during an attack and the risk of sexual transmission.
Most women with Herpes simplex Type 2 (HSV-2) do not know they have genital Herpes because recurrences tend to be mild and infrequent. In order for your partner to determine if he is infected, he would have to do a blood test because he might not show any obvious signs of the disease but might still be infected. Herpes simplex infection does not affect your ability to conceive. However, there is a risk of transmission of the virus to neonates at birth if delivery is done during an outbreak. If there is an outbreak then Caesarean section should be done as an emergency if the woman goes into labour. The Caesarean section should definitely be done within four hours of the rupture of the membranes (passage of liquor) to prevent transmission to the foetus.
The use of antiviral treatment to reduce the frequency of recurrent Herpes infections will also reduce the risk of transmission to the baby at birth. Suppressive therapy in which the medication is taken daily prevents approximately 80 per cent of recurrences and so does not totally prevent mother to baby transmission, hence the preference for a planned Caesarean section. The use of antiviral treatment reduces the transmission of HSV 2 between sexual partners by 48 per cent. If your sexual partner does not have HSV 2 then consistent use of condoms or dental dams should be practised although condoms do not offer total protection from contracting the HSV 2 infection.
Herpes simplex infection is not associated with abnormal uterine bleeding. You should get a detailed physical examination and appropriate investigations to determine the underlying cause of irregular bleeding that you experience. If you have not done a pap smear within the last year, then you should have one done.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaica observer.com; mail c/o Jamaica Observer, 40-421/2 Beechwood Ave, Kingston 5; or fax to 968-2025.
