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Dr. Komaroff

Dear Dr. K: I'm a young woman recently diagnosed with genital herpes. The doctor says there's no cure. Can you give me some advice on how to live with this condition?

Dear Reader I'd like to have a word or two with your doctor. Genital herpes is definitely a problem and not to be minimized, but the words "no cure" make it sound almost fatal.

Genital herpes is a sexually transmitted infection caused by the herpes simplex virus (HSV). What your doctor meant to say is that this virus can never be completely eradicated from your body — either by your immune system or by medicines. The virus continues to live "asleep" inside cells in your genital area. Now and then it reawakens, starts to multiply and causes recurrent symptoms.

Herpes outbreaks usually begin as small white blisters in the genital and anal area. These turn into wet ulcers, or sores, when the blisters break. With time, the skin heals over the affected area. But the virus remains in the body. (There's an illustration of what a herpes outbreak looks like on my website,

The virus spreads through skin-to-skin contact, including vaginal, oral or anal intercourse. A pregnant woman with an HSV infection can pass the virus to her baby during vaginal delivery.

When I was in medical school, there was no way of treating genital herpes outbreaks and no way of reducing the number of recurrent attacks. Fortunately, medical research led to the development of potent antiviral medicines. These include valacyclovir (Valtrex), famciclovir (Famvir) and acyclovir (Zovirax).

Antiviral medications can reduce the severity and shorten the duration of your symptoms. If you have severe or frequent outbreaks, a daily antiviral medication may help reduce the number of attacks that you have. Taking a daily antiviral might also reduce the risk of infecting any sexual partners.

So now that you have been diagnosed, focus on three priorities. The first is treatment to reduce the severity and frequency of your outbreaks. Talk to your doctor about whether your recurrent attacks are frequent enough to try taking a daily antiviral drug. Another option to discuss is having the antiviral drug with you at all times, taking it at the very first sign of a new attack.

The second priority is to prevent infecting a sexual partner. Specifically:

· Abstain from sexual activity when you have visible blisters or ulcers. This is when you are most likely to transmit the infection.

· Make sure your partner uses a condom during sexual activity.

The third priority is to protect your baby if you become pregnant. If you do, be sure you let your obstetrician know about your past genital herpes infections, even if you are not having any herpes attacks during the pregnancy. One option to discuss is whether to take antivirals for the last few weeks of your pregnancy. Also, if you have visible ulcers at the time of delivery, your doctor will probably encourage you to have a C-section to prevent the herpes virus from spreading to your newborn.
