GENITAL HERPES: ALL YOU NEED TO KNOW

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Just got diagnosed with genital herpes? You are not alone! You should know that this is a very common condition, and that usually does not cause any serious health problem; however, anxiety, anger or even depression are common feelings every time the virus makes its appearance… And, as with HPV infection, misinformation makes things worse…

In this article you will find the most important facts regarding genital herpes:

Getting to know genital herpes

Genital herpes is a sexually transmitted infection (STI). It is caused by a virus called herpes simplex virus (HSV).

The herpes virus causes painful sores and blisters in the genital area, the anus, the thighs and the buttocks. Sometimes though, the HSV infection causes no symptoms at all; in fact many people are infected with HSV and don’t know it.

There are two types of HSV: HSV-1 and HSV-2. In general, type 2 affects the genital area and HSV-1 is the main cause of cold sores on the mouth or face. However, both types can cause either genital or oral infections.

How common is it?

It is estimated that 1 or 2 in 10 people (10-20%) are infected with the HSV; of those, 80% don’t have any symptoms. Genital herpes is more common in women than in men.

How did I get genital herpes? 

  • As stated before, genital herpes is sexually transmitted: the HSV is spread through direct contact with herpes sores during vaginal, oral or anal sex. The virus can be passed to others during a first infection, with subsequent outbreaks or even if there are no evident sores (see below).
  • The HSV dies quickly away from the body; thus, it’s extremely unlikely -if not impossible- to get genital herpes any other way than by sexual contact, such as from towels, toilet sits or hot tubs.
  • It is possible to get infected by sharing sex toys with a partner who has the virus.
  • Infected people can transmit the virus to other parts of their own bodies (for example if you touch your cold sore on the mouth and then you touch your genitals). This process, known as autoinoculation, although theoretically possible is extremely rare, as our body develops -in most cases- antibodies that protect us against autoinoculation.

Is there any way of knowing how long I’ve had the herpes virus?

When a person is first infected with HSV, symptoms appear about 2–20 days after the virus enters the body.

However, many people have genital herpes for years or even decades without knowing it; that is, the virus remains silent for years, and at some point it becomes symptomatic. This situation can create misunderstanding in a monogamous couple, as a person assumes his/her partner was unfaithful, which may not be true.

What are the symptoms of genital herpes?

The symptoms are different the first time and the recurrent episodes.

During the first herpes infection you may have:

  • flu-like symptoms: such as fever, chills, muscle aches, fatigue and nausea;
  • swelling of the lymph nodes in the groin;
  • stinging or burning feeling while urinating.
  • sores: initially small, fluid-filled blisters, often grouped in clusters; the area where the sores appear may be swollen and tender. Over a period of days, the sores open and release fluid, become crusted and then heal without leaving scars.

The first outbreak of genital herpes may last 2-4 weeks.

After this first infection, HSV remains in the body for life, within some specific nerve cells. Under certain circumstances (see below), the virus becomes active again: it travels along the nerves back to the genital area, and causes a new outbreak of sores. This is called a recurrence.

-During the recurrent outbreaks the symptoms are:

  • a prodrome: a burning, itching, or tingling sensation in the lower back, buttocks, thighs, or knees;
  • few hours later, sores may appear, usually without fever or swelling in the genital area.

The sores heal more quickly, within 3-7 days in most cases. Also, recurrent outbreaks usually are less painful.

What can trigger herpes outbreaks?

Although it is not always clear why or when the herpes virus will reactivate, certain factors are known to trigger herpes outbreaks. The most common are:

  • Stress: either physical (fatigue) or emotional (depression, anxiety).
  • Weak immune system: caused by sickness, infections, certain medications, etc.
  • Trauma or irritation of the genital area: due to vigorous sex, intense sweating, tight clothes, etc.
  • Exposure to sunlight or ultraviolet light.
  • Hormone fluctuations: some women may notice that outbreaks are more common right before their period, or during pregnancy.
  • Excessive alcohol consumption.
  • Certain foods: some studies (here and here) have found L-arginine, an amino acid present in food can aggravate or cause more frequent herpes outbreaks. Foods high in arginine include: nuts (almonds, walnuts, cashews, peanuts), grains (whole wheat, oats, brown rice, flour products), chocolate and caffeinated beverages.

How often will I have symptoms of genital herpes?

  • The frequency and intensity of the outbreaks vary with each person. While some people have frequent, painful outbreaks with many sores, others have only rare and mild symptoms.
  • Outbreaks usually are most frequent in the first year after infection. For many people, the number of outbreaks decreases over time.

Is genital herpes a serious condition?

  • Genital herpes is not life threatening in itself.
  • One of the biggest problems of genital herpes is the emotional burden. The fact that genital herpes causes painful symptoms, imposes certain limitations on sexual activity, and it’s a lifelong condition may lead to frustration, anxiety, anger and depression (read more here). Don’t hesitate to discuss your feelings with your doctor, who can advise you how to cope with them.
  • Having herpes sores makes it easier for HIV (the virus that causes AIDS) to enter the body. Moreover, having both viruses together may make each one worse.
  • A pregnant woman can pass herpes on to her baby (see below). Therefore, it is very important that you inform your doctor if you are pregnant and have herpes.

How can I find out if I have the herpes virus?  

If you think you have genital herpes you should consult a healthcare provider, who can diagnose herpes by performing a physical exam and certain laboratory tests:

  • If sores are present, a sample of fluid taken from a sore can show if you have the virus and what type of HSV it is. The sample may be tested with several techniques, of which cultures and polymerase chain reaction (PCR) are the most utilized.
  • Blood tests can detect the antibodies our body produces to fight the virus; these tests can show the type of HSV as well.

How is genital herpes treated?

  • There is no cure for genital herpes.
  •  However, antiviral medicationsaciclovir, famciclovir and valaciclovir – can reduce the duration of the outbreak and make symptoms less severe. There is some evidence that these drugs also reduce the risk of giving herpes to someone else.
  • When taken on a daily basis, medications can decrease or completely prevent the outbreaks. This is called suppressive therapy and is indicated, among other situations, in persons suffering very frequent outbreaks (usually more than six episodes per year).

How can genital herpes be prevented?

  • Condoms may reduce your risk of passing or getting HSV, but do not provide complete protection: areas of skin that have the virus but are not covered by the condom can spread the infection.
  • Avoid sexual intercourse if you or your partner has visible sores on the genitals; likewise, you shouldn’t receive oral sex from someone who has a sore on the mouth. Also, pay close attention to the prodromic symptoms announcing an outbreak: sexual contact should be avoided from the time you feel the prodrome until a few days after the sores have gone away.  Although less contagious, herpes can be spread even if there are no visible lesions, through a process known as shedding (means that the herpes virus is active on the skin). Unfortunately, there is no way to know when a person is shedding.
  • Wash your hands thoroughly after any possible contact with sores, in order to avoid reinfecting yourself or passing the virus to someone else.
  • In certain cases, suppressive therapy may be proposed to reduce the risk of passing the infection to your partner.
  • Once you got the virus, avoiding known triggers may reduce the frequency and intensity of outbreaks: a good diet, enough rest, stress management may all help.

Will herpes affect my pregnancy or my baby?

  • If you are pregnant and infected with HSV you may pass it to your baby, who may eventually develop a severe infection called neonatal herpes.
  • Although the virus may rarely spread through the placenta, most babies get infected during a vaginal birth, with the passage through the infected birth canal (vagina).
  • This is most likely to occur if you first become infected with HSV during pregnancy and if you have your first outbreak late in pregnancy. It is possible to transmit the virus even if you were infected before pregnancy and you have a recurrent outbreak near delivery, but the risk is much lower.
  •  In certain cases, you may be offered herpes medicine towards the end of your pregnancy to reduce the risk of having any symptoms and passing the virus to your baby.
  • If you have sores or warning signs of an outbreak at the time of delivery, you may need to have a cesarean section to reduce the odds of infecting your baby.

Can I breastfeed my baby if I have the herpes virus?

  • In most cases you will be able to breastfeed; in fact, herpes virus is not transmitted through breast milk.
  • Whether you breastfeed or not, the baby may get infected by touching a sore on your body. To avoid spreading the virus, cover your sores and thoroughly wash your hands before holding your baby. If you have a herpes blister on your breast don’t nurse from that side until the area has completely cleared up.

 

References

Centers for Disease Control and Infections: Genital Herpes: CDC Fact Sheet (USA)

The American College of Obstetricians and Gynecologists: Genital Herpes (USA)

MY NATURAL HOSPITAL BIRTH STORY

Wonderful. Empowering. Overwhelming. It is difficult to find a word to describe the experience of a vaginal birth. As a mother -who went through this experience-  and obstetrician, even after having delivered thousands of babies, I can’t help but admire every single time the beauty of a vaginal birth, it always feels to me like a perfectly designed choreography…

But the fact that something is natural doesn’t mean that is devoid of risks or complications. Thus, a hospital natural birth allows a woman to deliver with minimum intervention, while assuring peace of mind in case something goes wrong. And believe me, sometimes things DO go wrong, and then we may have just a few minutes to save the mother or the baby… 
True, hospitals can sometimes interfere with the process of a natural birth: measures such as fetal monitoring or the IV line are usually non-negotiable requirements for a hospital birth, but they can be invaluable, even life-saving in case an emergency ensues.
A natural, unmedicated hospital birth IS possible, it’s just a matter of having a motivated mom and a supportive team…
Here, KM shares her experience of a natural birth at a hospital and provides some tips to overcome the obstacles that may present in the process…

Natural Birth KM 2 resized

My Natural Hospital Birth: Overcoming obstacles to get to the birth I had

“I gave birth without pain relief and I consider my fifteen hours of labour as some of my best. My husband turned ace birth partner – a nice surprise, and a lucky one considering we opted not to hire a midwife or doula. We swayed to Don Carlos’s Rivers of Babylon and Simon and Garfunkel’s I am a Rock, among other soothing tunes in our Labour Chill Mix; moo-ed like cows; and got tennis balls rolling on my back. The first ten hours at home and en route to the hospital felt like a date: laughter, teamwork, watermelon juice (it was August, we live in Greece)… and some manageable pain thrown in to rally against together.

Natural Birth KM 1 resizedWhat I found least pleasant about my birth experience wasn’t the pain. It was the hospital admittance process keeping my husband and me apart and waiting. The hospitals I know prioritise hospital practicalities and legal self-protection over emotional wellbeing. Routine procedures like the IV are designed to allow quick and easy access to medical intervention, not for soothing pregnant women to “open up and let the baby out”. We didn’t expect the hospital setting to encourage natural birth, so we worked with my obstetrician ahead of time to overcome the obstacles we could predict.

Having read Birthing from Within and Ina May’s Guide to Childbirth (one of these suggests moo-ing like a cow to relax and open the cervix), attended birthing classes at Eutokia and Babycenter’s online birthing course, we were convinced that the less unnecessary medical intervention the better for both mom and baby. Avoiding unnecessary intervention seems like common sense, but as my obstetrician reminded us: common sense is not so common. We prepared for birth in the country with the highest rate (at 70%) of caesarean births in the world, a Human Rights in Childbirth case study.

Here is what was at stake at the hospital and how we managed each concern:

A. My rights over my body – My obstetrician kept me informed of my choices throughout. Her track record in vaginal births, willingness to explain our options, welcoming attitude to our attempts to be informed all set the stage for mutual respect. When she suggested interventions, we agreed. I had a membrane sweep a day before my due date and had my waters broken when I was about 8cm dilated.

B. My responsibility towards my baby – Protecting my birth experience felt like a first success at parenting. The memory still provides a deep well of confidence that we draw from in the endurance sport of parenting.

C. Recovery time – I was able to walk to the toilet by myself after the birth, and to walk to the nurse’s desk to ask for my baby back.

D. Breastfeeding success – I chose to room in with my baby and I enforced this choice by asking for my baby back. Even though we were “rooming-in”, our baby spent a lot of time out of our sight. My obstetrician informed the hospital staff that I was interested in exclusive breastfeeding and asked that they not to offer formula or water. Leaving the hospital after 24 hours ensured that any accidental feeds during the baby’s long absences from rooming in didn’t sabotage my breastfeeding goals.

E. The opportunity to bond with baby – My obstetrician did her best to remove unnecessary separations between us and our new baby. She arranged some alone time for the three of us before the hospital’s priorities took over again after the birth. She also signed off on our “early” release at 24 hours.

Natural Birth KM 5 resizedEight tips to having a natural birth in hospital: 

  1. Learn about what you can expect. We had read about the “I don’t think I can do this” moment getting through the last couple of centimetres. Knowing about this ahead of time kept us calm and later we laughed in recognition of the predictability of it. Just because childbirth (and breastfeeding, for that matter) is natural, it doesn’t mean that it comes easily or without need for knowledge.
  2. Be vigilant about what you want and get your birthing team on the same page. My husband and I wrote our birth wishes down (see below) and talked them over with each other, our obstetrician and the hospital staff until we reached a version that was more realistic. The process of writing this one pager was invaluable – it helped us become more informed and helped us mentally prepare for what success could look like.
  3. Arrive at the hospital late. On our obstetrician’s advice, we didn’t leave our home until after my contractions were about three minutes apart, ten hours into labour. I credit my obstetrician with sharing this advice, but I imagine that the advice she is able to give varies based on how informed a couple is.
  4. Make yourself at home in the hospital. We dimmed the lights, brought music and admittedly a small suitcase full of other personal touches we didn’t end up using. It turned out that I was focused inward much of the time in the later stages of labour at the hospital and my husband and music were all I needed to feel relaxed. I still claim that having the little suitcase of other supplies was comforting.
  5. Have at least one champion who will be vocal about what you want. There came a time when I was in another zone and talking was difficult. I was lucky to have both my husband and obstetrician fend off well-meaning nurses offering an epidural too late into my labour,  when it was tempting but would have been counter productive. I later roomed with a mom who was given such a late epidural, essentially sabotaging her natural birth efforts after having done most of the hard work.
  6. Rooming in – ask for your baby back! In my experience “rooming in” babies seem to spend a surprising amount of time in some auditorium that parents aren’t allowed even to look into. They are not returned after their individual checks are done but when they are all done, unless you ask.Natural Birth KM 4 resized
  7. Ask for the advice you need to care for your baby yourself – how to change a nappy, how to hold the baby to wash away poop, how to help baby latch onto nipple, how to breastfeed lying down. Many of these are much easier to learn with guided practice rather than through books. I noticed that hospital staff are used to parents who are content to let them handle the baby, but who miss out on learning while in the hospital.
  8. Get out as soon as possible, unless you find the hospital setting a rest from home (my obstetrician suggested I keep an open mind about this since the hospital can be a nice break when there are other children waiting at home). I gave birth at the only Greek hospital at the time that allowed exit after 24 hours, assuming all is well. We fought for our exit and the two couples we roomed with decided to do the same. We were much more relaxed at home and I could stop demanding for my baby back.

The husband adds:

Natural Birth KM 3 resizedPreparation was key to having an excellent birth experience. To support my wife, it was important to be involved, not just by being present for the labour but at an early stage. Reading the books Katerina mentions, Birthing from Within and Ina May’s Guide to Childbirth, were critical to understanding exactly what was going on – and what to expect — at all of the stages of labour, and how panic can cause the process to go into reverse. Doing my homework beforehand allowed me to remain calm and focused. Being involved also created a sense of shared endeavour with Katerina, an important bond necessary for fostering the feelings of trust and safety between us during the labour.

One more thing: if you’re a birth partner, and you have any feelings of self-consciousness about not behaving “seriously” during the labour, get over them. The books were full of useful tips about what to do in specific situations to help Katerina overcome fears and relieve tensions that commonly crop up. If she was going to open up her whole body to let a human out, mooing like a cow was a small ask for me.

 

BIRTH WISHES

KM & MB

Due date: Sunday, 11 August 2013

Baby details: Our first, a girl, we intend to name her CLLB

Obstetrician: Dr. Liliana Colombero

 

We are open to any intervention that Dr. Colombero judges is necessary for the safety of mom and baby. We ask that, outside of an emergency, we are informed before any procedures and be allowed to ask questions about the pros and cons. We are aware that things can change suddenly. Below is our best case scenario, as we imagine it today, 9 August 2013. Thank you for taking the time to read our birth wishes. 

HOSPITAL ADMISSION & PROCEDURES 

Once I’m admitted, I’d like to: 

Prep

  • Opt out of being shaved, assuming I’ve shaved myself already.
  • Opt out of the enema, assuming my system has emptied out ahead of time on its own.
  • Have a heparin lock instead of routine IV, assuming I’m not going for an epidural or c-section.

Environment

  • Listen to music and limit outside noise.
  • Dim the lights when visibility isn’t important.
  • Drink water, or other clear fluids.

LABORING AND BIRTH

As long as the baby and I are doing fine, I’d like to:

  • Avoid a cesarean.
  • Avoid being induced with pitocin.
  • Try a membrane sweep before induction by pitocin.
  • Progress in labor without time limits.
  • Not be offered an epidural, unless I request it.

When it’s time to push, I’d like to:

  • Try different positions.
  • Try perineal massage or compress.
  • Push instinctively when I have the urge.
  • Get guidance about how to push during crowning to reduce the chances of perineal tearing.
  • Avoid an episiotomy, unless Dr. Colombero feels that tearing will be very extensive.

After birth, I’d like to: 

  • Have the baby placed on my stomach immediately for skin-to-skin contact.
  • Hold off on the cutting of the umbilical cord until it stops throbbing.
  • Try to nurse immediately.
  • Wait for the placenta to be delivered in its own time, as much as possible.
  • Hold off on procedures (labelling, shots, tests) for an hour to allow for nursing and bonding.
  • Stay together during recovery with my husband and baby as long as possible.

IF CESAREAN IS REQUIRED

  • I would like to be conscious and have skin-to-skin contact with the baby as soon as possible.
  • Please use double-layer sutures to raise my chances of a VBAC in future.
  • I would like to stay together with my baby during recovery, and to breastfeed as soon as possible.

POSTPARTUM 

While recovering, I’d like to: 

  • Choose 24-hour rooming-in with our baby.
  • Have procedures on our baby done in our presence, as much as possible.
  • Breastfeed exclusively.
  • Speak to a lactation consultant as soon as possible.
  • Avoid baby formula, sugar water, or a pacifier being offered to my baby without my consent.
  • Go home as soon as possible, if all is well.”

 

Do you have any experience to share with us? You may help other women! Send us your story to woman2womenblog@gmail.com