Dr. Kris Case: "I Have Herpes" — Telling a Partner and Living With It

The word "herpes" makes many people feel as if their world is collapsing, even though medically it is a very common virus that can be managed. This case stayed with me, because what helped him most was not medicine, but the courage to tell the truth.

Background

He was a man in his late 20s who came in with small clustered blisters on his genitals that stung and hurt. When I told him it was probably herpes, he was silent for a long time. Then he asked the questions I hear very often: "Who gave this to me?", "How do I tell my partner?" and "Is my sex life over?"

He said he felt guilty and dirty, which is a very common feeling after a diagnosis (read: guilt after an STI).

What I found

• The sores were consistent with herpes. I took a swab from a sore for PCR testing to confirm it and identify the type of virus (HSV-1 or HSV-2), which helps predict how often it may come back.
• Testing for other sexually transmitted infections as well, such as HIV and syphilis, because genital sores can have more than one cause, and open sores raise the chance of picking up other infections.
• On "who gave it to me", I explained that many people have been infected for a long time without ever having symptoms, and that the virus can be passed on even when there are no sores (asymptomatic shedding). So finding out who was the source is usually impossible, and it doesn't help.

First thoughts

• "Who gave this to me?"
• "My sex life is over"
• "I'm dirty"

The facts

• Many carry it for years without symptoms; the source usually can't be traced
• Recurrences usually become less frequent and milder over time
• Herpes is a very common virus and says nothing about who you are

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Care

1. Treating the first outbreak with antiviral medicine as prescribed by the doctor, plus keeping the sores clean and dry and pain relief.
2. Giving accurate information. Herpes cannot be cured, but for most people recurrences become less frequent and milder over time.
3. Planning to reduce transmission:

• Avoid sex while there are sores or during the warning tingling or itching beforehand.
• Use condoms consistently. They reduce the chance of transmission, though not completely.
• Consider daily suppressive antiviral medicine. A study in the NEJM (Corey et al., 2004) found it reduced HSV-2 transmission to partners by about half.

1. Helping him plan how to tell his partner. We practised what to say: choose a time when you are both calm, start with your feelings, then the facts, and invite your partner to get tested and come for advice together if they are ready (read: what to do if your partner has an STI).

He came back to tell me that he had told his partner. They cried together, but chose to understand each other and learn how to manage it together. They are still together and still enjoy their sex life; they simply pay more attention to each other.

1. 1Confirm the resultPCR from the sore, type HSV-1/HSV-2; also test HIV and syphilis
2. 2Treat the first outbreakAntivirals as prescribed; keep the sore clean and dry
3. 3Reduce spreadAvoid sex during sores, use condoms, consider daily suppression
4. 4Rehearse tellingStart with feelings, then facts; invite your partner to be tested together
5. 5OutcomeTold his partner, still together, and enjoys a sex life

Daily suppressive therapy cuts HSV-2 transmission to a partner by about half (Corey et al., NEJM 2004).

What I learned

• Herpes says nothing about what kind of person you are. It is just a virus in a sensitive place. The World Health Organization estimates that hundreds of millions of people worldwide have genital herpes.
• Blaming each other helps no one. What helps is testing, treatment and prevention together.
• Honesty builds trust. Many couples I have cared for became closer after going through this.
• The mind needs care too. Anxiety after learning you have an infection is sometimes worse than the infection itself (read: STI anxiety).

If you are going through the same thing

If you have blisters or sores on your genitals, come in for testing quickly, because a swab from a fresh sore gives the most accurate result, and don't diagnose yourself from pictures on the internet. At Dr. Kris Clinic, I provide STI testing, plan treatment, and help you prepare to talk with your partner, individually or as a couple. Consultations are available at the clinic and online, including in English.