A seemingly strange thing happens when Tosin Goje, MD, an Ob/Gyn specialising in infectious gynaecological diseases at Cleveland Clinic, gives a patient an STI diagnosis.
"I’ve noticed that you might tell a patient she has gonorrhoea or chlamydia and she'll take it pretty calmly," Dr. Goje tells Refinery29. "But when you give a diagnosis of herpes, a lot of patients are very emotional — they're angry or sad."
In a way, that dramatic reaction makes sense. For such a (relatively) mild infection, a herpes diagnosis — especially genital herpes — can have a lot of stigma wrapped up in it, despite the fact that it is thought around one in three people in the UK will have symptoms and get diagnosed with genital herpes. That emotion undoubtedly has to do with the fact that, unlike those potentially more serious infections, there is no cure for herpes — once you get it, you're stuck with a lifelong infection.
But that doesn't mean it's not manageable. The first time you have an outbreak, you might have a fever, headache, and flu-like muscle aches in addition to the characteristic blisters in your genital area. This is called "primary" herpes, Dr. Goje explains. Your doctor will diagnose you based on a combination of a physical exam and a secondary test, such as swabbing one of your sores.
And that first outbreak might be your only one ever. But if you get one after that, your herpes is called "recurrent." And that's where the real management work comes in, Dr. Goje says. The only major way to keep herpes under control is through the use of antiviral drugs. The most common one is valacyclovir (a.k.a. Valtrex), but the other two you might come across are famciclovir and acyclovir.
Although each of these drugs works in slightly different ways, they end up doing basically the same thing: Rather than specifically killing the herpes virus, they stop the virus from replicating, which keeps it from causing more symptoms. What does that mean for you? Usually it translates to less severe outbreaks, speedier recovery, and decreased chances of passing the virus on to your sexual partners. Which of those drugs you get and how often you have to take them is kind of up to you and how your body reacts, says Dr. Goje. For instance, some prefer to take larger doses for two or three days while others prefer smaller doses spread out over five days.
In some cases, you and your doctor will decide to only treat you with antivirals when you get an outbreak, which is called "episodic therapy." But for others, taking the antiviral drugs daily makes more sense. The hope is that, with "suppression therapy," taking your medication every day will help prevent future outbreaks, but Dr. Goje says some people still have "breakthrough" outbreaks anyways.
Unfortunately, not everyone can take the few drugs available for herpes. There are (very) rare cases in which someone might be allergic to this family of antiviral drugs, or they might already have a compromised immune system (thanks to HIV, for instance). "In those cases, you might have to send [the patient's sample] to the CDC for further testing," Dr. Goje says. But we want to reiterate: This is rare. Dr. Goje says she sees this once or twice a year, and gynos who aren't so specialised may go their whole careers without ever encountering a patient that can't use the existing treatments.
Still, if it sounds like treatment options for herpes are limited, that's because it's true. But Dr. Goje says researchers are working on a few potential herpes vaccines that have shown mixed (but, overall, promising) results so far.
You should also keep in mind that most people who have herpes never have any symptoms. And if you have one outbreak, you might never have another one. But some folks have a much more difficult time, getting outbreaks every few weeks. So, although treatment for herpes always involves the same kind of drugs, it also tends to be pretty individualised. And it might take some trial-and-error before you and your doctor settle on the best plan.
So no, herpes is no picnic — and it's understandable why a diagnosis might send you down a bit of a spiral. But remember that you're far from alone, and with the right doctor, chances are you'll be able to determine a treatment plan that works well for you.