Yes, I know I have genital herpes:

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1 Counseling Messages for Herpes Simplex Type II (HSV-II) Genital herpes Always take the time to attend to the participant s feelings and emotional state; for some people, this is the most devastating news he/she has ever received. A positive herpes test result can result in substantial emotional distress and can disrupt, or even destroy intimate relationships. Check in with the participant as you review the following information to see how he/she is doing. Participant: What is my result? What does my result mean? Your blood test was positive for antibodies against herpes simplex virus type 2, which means you were probably infected with type 2 genital herpes virus sometime in the past. <pause>. Have you ever been told you had genital herpes? Yes, I know I have genital herpes: Do you have any questions about genital herpes that I can answer? Are you aware of the medications available to treat the symptoms (painful sores and blisters)? If female: It is important that you mention your herpes infection to your health care provider in the event you become pregnant. A woman with herpes can have a normal, healthy, uninfected baby, but only if precautions are taken. Herpes during pregnancy can cause premature labor and miscarriage. It can also cause blindness, brain damage, or even death in a newborn baby. Rarely, the herpes virus can be passed to a baby at birth (less than 0.1% per year in the US). However, if doctors know that you have herpes, they can use this information to take steps to reduce the baby s chances of getting the virus during delivery. If male: If your partner is pregnant, it is important that your herpes test result is mentioned to your partner s prenatal health care provider. Women who acquire herpes during their last trimester have the highest risk of passing it along to a baby at birth. No, but I have herpes infections around my mouth/lips, is that the same thing? Blisters and sores around the mouth or nose, or on the lips are usually caused by herpes virus type 1, which is a slightly different virus from the one that you were tested for. You were tested for herpes simplex virus type 2, which also causes blisters and sores, but usually around the genitals, buttocks and rectum.

2 No, no one has ever told me I have herpes. What is Herpes? Most people who are infected with herpes simplex virus type 2, do not have any symptoms at all (that is, they are asymptomatic). Let me review the more obvious symptoms with you, and you tell me if this has ever happened to you: o Outbreak of one or more blisters and painful or tender sores which heal within a few days to two weeks. These sores may appear:! Women on the skin around or inside the vagina and on the cervix, urethra, rectum, inner thighs, buttocks, or lower back.! Men on the penis or on the skin around the base of the penis, rectum, inner thighs, buttocks, or lower back. o Some infected individuals may never have lesions and may only have very mild symptoms just as tingling, redness or skin soreness. The participant may recognize these symptoms. Respond: that may be herpes. The next time you have this happen, you may want to have your health care provider examine you. Herpes is a viral infection that can cause recurrent outbreaks of painful blisters. Herpes virus is in the same family of viruses as Varicella Zoster Virus, the virus that causes Chicken Pox and Shingles. The test that you had was for herpes simplex virus type 2, the virus that causes most genital herpes infections. People with genital herpes infections may get outbreaks of blisters on the genitals, or around the rectum, or perineal area. People can also get oral herpes, with blisters in the throat, mouth and nose, but that is caused by a related, but different virus. o For those who ask: genital herpes is usually caused by HSV-2, and oral herpes is usually caused by HSV-1, however HSV-1 can also cause genital infections, and it is increasingly common cause of genital herpes infections in some population groups.! But, remind the study participant that s/he was not tested for HSV-1, only for HSV-2, and was found to have HSV-2, which causes genital herpes. Herpes infections do not go away, however, most infected people do not require treatment. For individuals who have symptoms or outbreaks, there are medications that can shorten or prevent outbreaks.

3 Is it serious? Herpes simplex virus type 2, the virus that causes most genital herpes infections, is a common virus. An estimated 45 million Americans have genital herpes (One in every 4 women and 1 in every 5 men over the age of 12). The health consequences vary quite a lot from person to person. Most people are not aware of any symptoms, while others have frequent recurrent outbreaks of sores around their genitals. Genital herpes is generally not life threatening, and will not damage your reproductive system. However, herpes - like other infections that cause genital sores - does make people more susceptible to HIV, if exposed to HIV. People with genital herpes and HIV may spread HIV to others more easily. How did I get infected? Herpes is transmitted by direct skin-to-skin contact. It is possible to get herpes even without having intercourse, because the virus is shed from the skin. It is not possible to tell when you got infected because the antibody test, like the infection, is positive for life. You may have been infected many years - even decades - ago. This test cannot tell us how long you have been infected or from whom you got the infection. I do not have symptoms now. Will I ever get outbreaks? Most people with genital herpes do not have symptoms, but many people who did not realize they had genital herpes can learn to recognize symptoms when they have been taught what to watch for. There is no way of knowing if you will ever get outbreaks. However, the frequency of outbreaks decreases with the time since initial infection. This test cannot tell us if you have ever had herpes sores, or if you will ever get them. Is there a cure for genital herpes? Herpes infections do not go away, however, most infected people do not require treatment. However, for individuals who have painful outbreaks, there are medications that can prevent or shorten outbreaks. Treatment can also decrease the chances of transmitting the virus to sex partners. What should someone with herpes be concerned about? Besides the pain and discomfort associated with symptoms of genital herpes, there are three major concerns with herpes:

4 Other Information What was the test you used? 1. Risk to unborn babies 2. Spreading the disease to others 3. Facilitating the spread of HIV Risk to unborn babies: If female participant is pregnant, is important that you mention this test result to your health care provider in the event you become pregnant, and also tell the health care provider who will be caring for your newborn infant. Since infection of the baby is a rare complication of genital herpes infection, your doctor should know your herpes test result. If a male participant with a positive herpes test ever has a pregnant female partner, it is important that his partner s health care provider be informed of this test result, because women who contract herpes during the last trimester of their pregnancy have the highest risk for passing along infection to a newborn baby. Herpes can be a serious disease for babies; it can cause blindness, neurologic damage and even death (this is rare, less than 0.1% per year in the US). Transmission: When a person has an outbreak (when symptoms are present) he/she can easily spread the disease. But the disease can also be spread even when a person has no symptoms. A person cannot know on which days this is occurring, or from what parts of the skin the virus is being shed. o Ask SP if he/she is in a monogamous long-term relationship. In a long-term relationship, it is probable that both partners are infected, since there has been much potential exposure. o If SP is not in a long-term relationship, explain that condoms may help decrease the chances of transmission, however, some lesions (on the thigh, buttock or lower back) may not be covered by a condom, and the virus can be shed from normal-appearing skin. Encourage the individual SP to discuss this infection and transmission risk with any new partner. Facilitating the spread of HIV: Genital infections characterized by ulcers and sores, such as genital herpes, can greatly increase the risk of acquiring HIV, if exposed to HIV infection. This is partly because breaks in the skin make HIV transmission easier. Persons who have both HIV and herpes infection may transmit HIV more easily.

5 Your blood was tested by a type-specific immunodot assay developed and performed by scientists at the Emory University School of Medicine to detect antibodies to herpes simplex virus type 2. Antibodies are proteins in the blood that indicate previous infection with specific viruses or bacteria. The term type-specific refers to a test that for herpes that can differentiate between HSV-2 and other herpes types, like herpes simplex type 1 (the virus that causes sores in the throat, and around the mouth, and nose). The immunodot test that you got is very accurate, and is considered a Gold Standard Test. Among people who are known to have genital herpes infection, the immunodot test agrees with the best possible blood test (that test is known as the Western Blot ) 98% of the time. In other words, the immunodot assay might miss 2 in every 100 infections detected by the Western Blot. For people who do not have genital herpes infection the immunodot assay agrees with Western Blot 100% of the time (that is, if the Western Blot test is negative, the immunodot test is also negative) Are there other tests for genital herpes? There are a number of commercially available blood tests that are described as being type-specific (that is, able to differentiate between antibodies against herpes simplex virus type 1 and those against herpes simplex virus type 2), but some of these tests are not as accurate as the one you had. It is not helpful to have a non-specific herpes test.the only typespecific blood test that is commercially available and is cited by the Centers for Disease Control and Prevention 1 is called HerpeSelect, and is manufactured by Focus Technologies. The test that you had (the immunodot assay) is considered more accurate than the commercially available HerpeSelect. Another blood test that can accurately distinguish between herpes simplex type-1 and type-2 is the Herpes Western Blot. This test is used primarily for research purposes and is not readily available. If you are interested in the Herpes Western blot, your doctor will need to call the University of Washington in Seattle, WA at to order the test. The test that you had, the immunodot assay, is comparable to the Western Blot. There are also other kinds of tests for herpes, like herpes culture, but culture is generally done only when there are blisters, or healing sores present. 1 Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines MMWR 2002;51(No. RR-6):13.

6 What do you recommend? If you have sex, there is chance you can give the virus to your sex partner. Chances are that a steady partner is already infected. In a monogamous relationship, however, there are few medical consequences. If you want to reduce the risk of transmission, we suggest using a latex condom during sex. Using a condom will reduce the chance that your partner will become infected, but condoms are not completely effective because the virus can be shed from normal-appearing skin. Facts One out of 5 adolescents and adults are infected. (One in 4 women and 1 in 5 men). There is no cure for Herpes; once infected, you carry the virus for life. However, if you get symptoms, there are medications that can shorten the duration of symptoms, help to prevent outbreaks, and decrease the chances of transmitting infection to someone else. Condoms may help decrease the chances of infecting a partner during sex, however, some lesions (on the thigh, buttock or lower back) may not be covered by a condom. Transmission can occur even in the absence of a lesion. Infected men should be careful not to expose a pregnant woman, especially if she was not infected before the pregnancy. Infection is rarely a problem for the baby if the mother is infected before she becomes pregnant, but the chances of the baby becoming infected increase if the mother becomes infected during her pregnancy, or is having an outbreak at the time she delivers the infant. HSV-2 positive pregnant women, or women who are thinking about getting pregnant in the future should discuss this diagnosis with their health care provider. The baby can possibly become infected on the day of birth if the mother has an outbreak at that time. However, doctors who know you have herpes can take steps to reduce the baby s chances of getting the virus. An SP with a positive result may have been having signs and symptoms but not recognizing the symptoms as Herpes o Inform him/her of the signs and symptoms of Herpes o Check to see if there are any questions o Recommend that she/he see a doctor for suppressive therapies

7 Referral Resources: o Recommend that she/he tell his or her health care provider about the test results if a female participant is of reproductive age, or if a male participant has a pregnant female partner or a female partner who is thinking of becoming pregnant An SP with a positive result may have had no signs or symptoms o Inform him/her of the signs and symptoms of herpes, should these develop s/he will know what is happening o Talk with her/his doctor and partner(s) o New treatments, and recommendations about treatment are always being developed o Research has shown that infected persons may shed the virus, even if they do not have symptoms It takes 6-8 weeks after infection with herpes for a test to be positive. For some individuals the test takes a few months to become positive. Some studies have shown that infection with herpes may increase the risk of HIV transmission. CDC National STD Line ASHA Herpes Hotline ASHA web site for teens ASHA web site

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