Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Patient Perspective of Transmission Fears
- Marian J. Nicholson, Nigel P. Scott (25 January 2005)
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Editorial Update
- Simon E Barton (11 February 2005)
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Disclosure is a major issue with regards to control of HSV transmission
- Assoc. Professor Niyi Awofeso (31 May 2007)
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Marian J. Nicholson, Director Herpes Viruses Association, 41 North Road, London N7 9DP, Nigel P. Scott
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Simon Barton’s editorial reports on a trial showing that antiviral therapy can reduce the risk of transmission of genital herpes by 1.5%. It is the experience of the Herpes Viruses Association that an understanding of the facts of the condition can lessen the shock of a diagnosis, and that most informed patients and their partners learn to manage their herpes simplex without undue anxiety. Many patients voice the concern that they don’t want a partner to suffer the same severity of symptoms that they have. They will be reassured to learn that only one out of five infected people will notice symptoms.(1) Many potential partners will be immune to contracting the virus. Up to 60% of new genital infections are now HSV type 1.(2) Patients with a type 1 infection can be reassured that they will not infect any partner who already has this virus and this is a majority (54-77%) of adults in the UK.(3) Patients with a type 2 infection can be told that the majority of potential partners with a type 1 infection have an increased likelihood of being unaware of contracting it, being asymptomatic.(3) Ultimately it is the patient’s perception of the importance of the condition that determines the degree of concern over transmission risk and it is this factor that drives research into reducing what is already a low risk. Society will be better served by improved sexual health education so that eventually herpes simplex resumes its proper place as a (usually) mild, infectious skin condition. Marian Nicholson, Director, Herpes Viruses Association 1. Fleming DT, McQuillan GM, Johnson RE, et al. Herpes simplex virus type 2 in the United States, 1976 to 1994. N Engl J Med. 1997;337:1105-11 2. Patel R, Cowan FM, Barton SE. Advising patients with genital herpes. BMJ 1997;31:85-6 3. Langenberg AG, Corey L, Ashley RL, Leong WP, Straus SE. A prospective study of new infections with herpes simplex virus type 1 and type 2. Chiron HSV Vaccine Study Group. NEJM Nov 4, 1999;314:1432-8 Competing interests: None declared |
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Simon E Barton, Consultant and Clinical Director Chelsea & Westminster Hospital, London SW10 9Th
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Have learnt that in November 2004,the MHRA approved a label amendment for Valaciclovir in the UK- The label now includes- 'Reduction of transmission of genital herpes when taken as suppressive therapy and combined with safer sex practices (including the use of condoms)' . This clearly reinforces the points made in my editorial and will hopefully ensure patients receiving antiviral therapy are properly counselled about the benefits/limitations of therapy and receive detailed sexual health advice . Competing interests: As for original editorial |
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Assoc. Professor Niyi Awofeso, School of Public Health University of New South Wales, Sydney 2052, Australia
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Given the lifetime carriage of herpes viruses once an individual is infected, low efficacy of preventive therapy in reducing transmission, potential for stigmatization of infected individuals, and low transmission risk of symptomatic infection, issues of disclosure become problematic. I know of a man in incarceration for murdering his girlfriend because he allegedly found out that she transmitted herpes infection to him. His ‘evidence’ that she failed to disclose that fact that she suffers from genital herpes was that he found out that she was on Valaciclovir. Disclosure issues can be problematic in relationships, as it tends to stigmatise the sufferers, while non-disclosure puts uninfected partners at risk. For most sexually active people, “Universal precautions” with regards to sexual practices are difficult to sustain. The onus should be on individuals engaging in (unprotected) sex to enquire about the STI status of their partners, rather than to expect such infected partners to disclose that they suffer from a disease with wide-ranging social implications, but relatively low transmission risk of symptomatic infection. Public health education on the need to ask sexual partners about herpes infection, use of condoms, and availability of affordable and effective suppressive therapy for this infection will help to reduce the occasional depressive and violent repressions that some patients with symptomatic infection exhibit. Competing interests: None declared |
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