Genital Herpes in the USA - A Common STD but Ignored
Dr. Gunwant Dhaliwal is an internist practicing in New Port Richey, FL. Dr. Dhaliwal specializes in the medical treatment of adults. Internists can act as a primary physician or a consultant to a primary physician. They manage both common and rare diseases. Dr. Dhaliwal provides comprehensive care and manages treatment... more
Summary: Genital herpes is a common sexually transmitted disease in the elderly population. They may not be sexually active now at later age, but genital herpes could stay dormant in the body for years. Elderly people continue to suffer either not knowing how to convey the symptoms or due to shame as to having a disease at their age.
Genital herpes result from infection with herpes simplex virus type 2 (HSV-2). It is different from HSV-1 that causes cold sores. Statistics show at least 25% of the US population is infected with HSV-2 while 40% with HSV-1. Recent studies found HSV-2 antibodies in 36% of women ages 40-49 and approximately 30% of women ages 50-59. More women than men tested positive, almost 3 times more.
Many Primary Care Providers do not test their patients routinely for genital herpes, especially the elderly. Most of the times, women become infected with HSV when they were young and don’t realize that they have the disease unless tested in their 70's or 80's. With decreased immunity, they could present with recurrent urinary tract infections or vaginal irritation. On examination, patients show small painful lesions on the vaginal opening.
Even if the Primary Care Provider tries to discuss the possibility of genital herpes, patients often get upset since they have not been sexually active for over 20 to 30 years after their spouse died claiming they have never been promiscuous. They have a hard time understanding that they could be carrying the virus all these years especially if their spouse was in the armed forces, for obvious reasons.
The herpes virus can be transmitted by both; sexual intercourse as well as oral sex. Although HSV transmission is most likely when sores are present, but a person that has no symptoms can still spread the disease. Any infected person can pass the virus to another sexual partner at any time, even by an intimate kiss.
Most of the times, genital herpes is checked in pregnant women because the virus can be transmitted to their babies during vaginal delivery. A cesarean section can greatly reduce the risk. Newborns can have severe disabilities or even death from HSV-2 virus.
Typical outbreak of genital herpes: inflammation of the vaginal opening in females and on the penis in males, followed by a small cluster of blisters that break after few days leaving painful ulcers that eventually heal. Other possible symptoms are fever, headache, myalgia, difficulty urinating and possible lymph node swelling near the groin. Some women may get vulvar (rim of vaginal opening) irritation or fissures. The first outbreak is the worst and that ends in 3 weeks. Over time, recurrences decrease in frequency, duration and severity.
A blood test can check if patients have antibodies to HSV-2, and is available within 2 days. Oral antiviral medications (Zovirax, Valtrex and Famvir) shorten the herpes outbreak especially if taken within 24 hours of first signs. Acetaminophen or Ibuprofen can be taken for fever or myalgias. If there are 3 or more outbreaks per year, prophylactic suppressive therapy in the form of daily dose for 3 or more years is recommended with minimal side effects.
Although herpes can not be eradicated, it does not cause any long-term problems in healthy people. Although herpes can infect the cervix, it does not increase the risk of cervical cancer. The most troubling aspect of having genital herpes is the stigma. If patients feel distressed, they can talk to their doctor and request medication for stress or otherwise a referral to therapist or counselor.
There is even separate online dating site for singles that help people with STD's as genital herpes, HPV or HIV called PositiveSingles. There are 110 million people living with an STD in the US and an estimated 400 million worldwide. Remember 1 in 3 women and 1 in 5 men have genital herpes in the USA. Share on social media, spread the word. Do not let other women, especially the elderly suffer from the disease.
I appeal my fellow healthcare providers to consider and test their patients for HSV-2. There is already a recommendation to check every adult for Hepatitis C, why not add HSV-2 to it.
Gunwant Dhaliwal, MD, is a Board Certified Internist practicing in New Port Richey and Spring Hill, Florida for over 27 years. He can be reached at Primary Care Walk In Clinic, Tel 727-844-5555 or primarycarewic@gmail.com for any question or comments.
