What does it mean to have a positive Herpes Simplex Virus (HSV) diagnosis? How do you confirm it and manage it going forward?
“You have herpes.”
This is one of the most difficult diagnoses for me to give a patient. Why is this the case?
Herpes Simplex Virus (HSV), especially genital herpes, is stigmatized.
If you suspect you are HSV positive meaning that you have signs and symptoms of herpes, this post is for you.
You may have already been told you are HSV positive, but you want a confirmatory test and need to know the next steps. Continue reading.
Being told you have any sexually transmitted disease (STI) can be overwhelming. Sparking thoughts of infidelity and emotions, including embarrassment, fear, guilt, despair, and resentment.
It usually means initiating an awkward conversation with your sexual partner or partners.
Almost every other STI, including gonorrhea, chlamydia, and syphilis, can be cured with antibiotics. Even once-feared HIV can be made undetectable with antiretroviral agents. This makes HIV non-transmissible, allowing patients to have a normal sex life.
“HSV is a whole other ball game. It is a complicated virus and is not curable.
Patients panic. They have many questions about HSV that are not straightforward to answer. And the answers lead to more questions.”
Please read my other post about what Herpes Simplex Virus is and how and when you caught it. This information is essential for patients to come to terms with their diagnosis
Topics I will discuss are:
- How is HSV diagnosed?
- How do I reduce flares?
- How are flares treated?
- What about my partners?
What is the meaning of HSV positive?
How is HSV Diagnosed?
Examination and history
Most often, your doctor can diagnose by taking a good history and examination.
Doctors can confirm HSV just by:
- looking at the sore or lesion and
- listening to you describe the classic prodrome and relapsing nature of the sore.
Diagnostic tests
PCR
You are all familiar with the term PCR because of COVID.
PCR testing looks for genetic components of HSV.
Pros:
- A positive PCR proves that the Herpes Simplex Virus causes a lesion.
- The test differentiates between Types 1 and 2.
Cons:
- PCR can only be performed on an active lesion.
- It is expensive.
“I recommend that patients do this test if they can afford it. Somehow having a concrete answer, gives peace of mind. Uncertainty causes anxiety.”
Blood antibody tests
Rapid and laboratory blood tests detect antibodies to HSV 1 and 2.
They confuse patients and trigger more questions than give answers.
“I am not a fan of HSV antibody tests. My advice is don’t do them.”
Cons:
- You can have a positive result even if you have never had an active lesion. Find out why in my other article about HSV.
- A positive IgG only tells you that you have been exposed in the past. It does not confirm that any current lesion is HSV.
How do I reduce flares?
Keep your body healthy
A weak immune system will contribute to viral reactivation, so keep your body healthy.
This means:
- Don’t smoke,
- avoid excess alcohol,
- get enough sleep,
- eat a healthy anti-inflammatory diet,
- boost your immune system with vitamin C and zinc.
Photo by PhotoMIX-Company
Manage stress
Stress and anxiety are triggers of HSV and need to be managed.
Natural Prophylaxis
Lysine, an essential amino acid, is thought to be useful. Available over the counter at pharmacies. 1
Prophylaxis means medication that you take to stop a reactivation. It only works while you’re taking it.
Some people take 1 gram daily to prevent episodes. Doses less than this don’t seem to provide protection.
How are flares treated?
A flare would be an ‘active’ or symptomatic infection.
Natural Products
Here again, lysine is an option, but the dose is higher.
Take 1 gram of Lysine three times a day at the start of the prodrome. 2
Take it until the lesion is gone.
Topical Creams
Acyclovir cream is readily available in pharmacies. Apply it to the area as soon as you feel prodromal symptoms.
“Always have an emergency tube of this cream handy. It is cheap and tiny, so easy to keep in your wallet or purse.”
Prescribed Medication
Acyclovir, famciclovir, or valacyclovir are antiviral tablets that heal the lesions faster.
Start these tablets should within 72 hours of the prodrome symptoms.
“I provide my patients with an emergency script to keep with them. That way when the can start medication immediately with a flare.”
Each of these medications has pros and cons:
- Acyclovir, the first to market, is the cheapest option. But it must be taken 5 times daily, which is impractical for most of us.
- Famciclovir is the second most cost-effective option and only a twice-a-day dose. However, there are often stock shortages of famciclovir in South Africa.
- Valaciclovir is also only taken twice a day and is readily available. This makes it my first choice for patients who can afford it.
What about my partners?
This is often what weighs most on the patient.
Get it off your chest
“My recommendation is don’t delay. Sit down and discuss the diagnosis with your partner.”
Don’t be emotional.
State it: “I went to the doctor today, and she told me I have Herpes.”
It will be easier now that you are well-informed on the subject.
Encourage them to read this post and my other ‘what, how, and when’ article. They will understand that the diagnosis does not mean that you have been cheating.
Use condoms between flares
They must understand and accept that there will always be a very low risk of contracting the virus. Minimize this risk between episodes with the consistent use of condoms. 3
Abstain during a flare
As mentioned, the highest risk of transmission is during a flare-up.
“I recommend no sex from the first prodromal symptoms until at least seven days after the ulcer has completely healed.”
Unfortunately, there are no defined guidelines on when the high-risk time ends, so these 7 days are not law. 3
Does my partner need treatment?
Your partner does not need any treatment unless they develop active lesions.
Crystal Raypole has written this inspiring article about living with herpes that will help you in relationships.
HSV positive meaning in a nutshell
- Herpes simplex virus is a lifelong infection, has no cure, and is most often asymptomatic.
- It is almost impossible to know who you caught it from.
- You can reduce reactivations by living a healthy and stress-free life.
- Treat active lesions within 72 hrs.
- Wash your hands well after touching an active lesion.
- Talk to your partner matter-of-factly about your diagnosis. It is not the end of your sexual life.
This video is informative and very valuable to watch.
Towards the end, however, it is an example of ‘too much information’ for most patients testing HSV positive meaning meningitis, encephalitis, and neonatal herpes are rare and irrelevant to most of you.
References
- Mailoo, V. J., & Rampes, S. (2017, June). Lysine for herpes simplex prophylaxis: A review of the evidence. Integrative medicine (Encinitas, Calif.). Retrieved January 17, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419779/
- Anthony, K. (2018, October 5). Lysine for cold sores: Treatment, risks, and more. Healthline. Retrieved January 17, 2023, from https://www.healthline.com/health/lysine-for-cold-sore#treatment
- WebMD. (n.d.). How to have a fulfilling sex life when you have genital herpes. WebMD. Retrieved January 17, 2023, from https://www.webmd.com/genital-herpes/genital-herpes-sex-life
Most interesting! Keep up the good work!
I really appreciate your feedback. Another below-the-belt topic that needs to destigmatized.