A quiet epidemic

First of all, sorry for the delay in posting. I've been a little busy and haven't had the time to post. I thought that this would be a good topic and will definitely get you thinking.



Genital herpes is probably one of the most quiet epidemics in the U.S. to date. CDC states that that approx. 1:4 women are positive for herpes (1:8 for the men). One of the reasons that I believe that this disease continues to propagate is because there is no mandate to screen patients.



The disease is one that takes about 2 weeks to present itself after initial exposure. The problem is that only about 25% of infected patients will have the classic painful ulceration that will drive them to the doctor's office. The remainder of the patients will not have a single classic symptom. As a matter of fact the symptoms that most patients will have are similar to that of a yeast infection (women) or jock itch (men). What I have found in my office is that this is exactly what is happening on a daily basis. We have, in the past year to year and a half, started offering a full STD screening that includes herpes (Gonorrhea, Chlamydia, Trichomonas, Syphillis, Hepatitis, HIV, and Herpes). Just as an aside, if you haven't had blood testing for STD screening you probably haven't been tested for the last four diseases.



Now, the problem with offering testing for herpes is not the patient that comes in with problems but it is the patient who is asymptomatic. My problem has been telling a 43 year woman with no symptoms that she is positive for herpes. How does she tell her significant other, lover, husband that she is positive? When I have posed the question to some of my medical colleagues about screening the response has been, "Why open a can of worms?" For the asymptomatic patient why should she be screened for a disease process that may never cause her a single problem in her life (remember that the majority of patients will be asymptomatic)? The answer is HIV. Wait, wait, wait... I thought that we were talking about HSV (herpes)! HSV can increase any patient's susceptibility being infected with HIV. The thought is that because of the lesions the virus has a easier access.



Let's throw another wrench in the thinking. Herpes is classically understood to be classified as HSV-1 (oral) and HSV-2 (genital). It does not take a rocket scientist to understand this concept: anyone who participates in oral sex makes theirself a candidate for a outbreak of HSV-1 on their genitals. I bring this thought up because most would consider a new outbreak of herpes as a sign of infidelity of their partner. The truth is that the outbreak may be a HSV-1 or HSV-2. I adamantly oppose telling any patient that their partner has been unfaithful based on a positive test or symptoms pointing towards herpes. The reality is that the patient could have been infected with their first sexual experience.



So what's my recommendation? If you have been with one partner for the past several years and have never had a single outbreak don't run to the doctor to try and find out your status. Why?... Ignorance can be bliss in this situation. If you are positive more than likely your partner is positive and neither one of you can get more positive. What I have seen more than once is strife and fear being brought into a situtation that need not happen. Now if you are planning to hit the dating scene it would behoove you to know what you are bringing to the bedroom. For my patient's that either practice serial monogamy or that ... well don't I want them to know where they stand.



[At the risk of sounding preachy I must fall back to the biblical principal of one husband and wife concept. It's old fashioned but if you have a true covenant between the two this won't be a concern.]