Living Well Expert Dr. Jennifer Shu Pediatrician,
Children's Medical Group

Expert answer

Thanks for your question. To address your concerns, I consulted with a colleague, Dr. Jill Grimes, a family physician and author of "Seductive Delusions: How Everyday People Catch STDs" (John Hopkins University Press).

Grimes shared the following information:

Genital herpes can cause outbreaks anywhere within the "boxer shorts" area, and the specific location does not make the disease any more or less severe. Herpes simplex has two types: type 1, which most often occurs in the mouth, and type 2, which prefers the genitals. However, each type can easily be passed from one partner's mouth to the other partner's genitals, or occasionally vice versa. In fact, some studies show that almost half of new cases of genital herpes are type 1. The good news there is that HSV type 1 in the genitals tends to have fewer recurrences than type 2.

The herpes virus as a group likes to sit quietly in the nervous system and then erupts sporadically along one nerve route, often when the body is stressed in some manner. The great news is that herpes does not cause any type of cancers.

HPV, the human papillomavirus, is the cause of the vast majority of cervical cancers and a significant contributor to anal, penile and oral cancers. Having herpes lesions in the inner vaginal area does allow easier passage of other sexually transmittable infections since your natural barrier of intact mucosa (skin) is broken down in the setting of an active ulcer. Therefore it is especially important to be sure to abstain either from physical intimacy or faithfully use condoms to decrease your risk of getting another sexually transmitted infection. Even when you cannot feel or see a herpes outbreak though, remember you are potentially shedding the herpes virus and are therefore potentially contagious to others.

As for treatment, it really depends upon the frequency and severity of your outbreaks as well as the herpes status of your partners. If you have only one or two outbreaks per year, most people opt for antiviral treatment (pills) taken only when there's a flare-up.

The key is to start the medicine as soon as you feel any tingling or burning in the area where you typically break out rather than waiting to see the blisters. When you start the medicines early, they are more effective in shortening the duration and decreasing the severity of the outbreak.

For people who suffer frequent outbreaks or who have partners who are not infected, suppressive therapy is the way to go. In this situation, you would take an antiviral medicine every day preventively rather than waiting for outbreaks.

Currently, valacyclovir (Valtrex) is the only medicine proven to decrease transmission of genital herpes to a partner. Acyclovir (Zovirax) and famciclovir (Famvir) are other anti-herpes medicines that also may be used either episodically or for suppression. Your doctor can discuss the variety of treatment options with you.