What to tell a patient who tests positive for Herpes Simplex Virus (HSV) type 2?

From the Guidelines

I would tell the patient that they have genital herpes, a common sexually transmitted infection caused by Herpes Simplex Virus Type 2 (HSV-2), and reassure them that while it is not curable, it is manageable with antiviral medications and lifestyle modifications. When discussing this diagnosis with a patient, I would explain that HSV-2 typically causes recurrent genital sores or blisters, and that the virus remains dormant in nerve cells between outbreaks, which explains why symptoms can recur periodically throughout life 1.

Key Points to Discuss with the Patient

• HSV-2 is a prevalent sexually transmitted infection, with 12.1% of the US population aged 14–49 years seropositive for HSV-2 in 2015–2016 1
• Genital herpes can be managed either by episodic antiviral therapy or suppressive antiviral therapy, and the patient should be informed about the options for treatment 1
• The patient should be advised to keep the affected area clean and dry, wear loose clothing, and take over-the-counter pain relievers for symptom management during outbreaks 1
• It is essential to emphasize the importance of abstaining from sexual activity during outbreaks and discussing their diagnosis with sexual partners to prevent transmission 1
• The patient should be informed that HSV-2 is transmitted through skin-to-skin contact, and that the virus may be present in the genital tract without symptoms, leading to transmission to sex partners or neonates 1

Treatment and Prevention

• Antiviral medications like acyclovir (400mg three times daily for 7-10 days for initial outbreaks, or 400mg twice daily for suppressive therapy) can help manage the symptoms and reduce the risk of transmission 1
• Consistent use of latex condoms can reduce the risk of transmission of HSV-2 and other sexually transmitted pathogens 1
• The patient should be advised to avoid sexual contact when their partners have overt (genital or orolabial) herpetic lesions, and to discuss their diagnosis with sexual partners to prevent transmission 1

From the FDA Drug Label

Patients should be informed that VALTREX is not a cure for genital herpes Because genital herpes is a sexually transmitted disease, patients should avoid contact with lesions or intercourse when lesions and/or symptoms are present to avoid infecting partners. Genital herpes is frequently transmitted in the absence of symptoms through asymptomatic viral shedding Therefore, patients should be counseled to use safer sex practices in combination with suppressive therapy with VALTREX.

Sex partners of infected persons should be advised that they might be infected even if they have no symptoms. Type‑specific serologic testing of asymptomatic partners of persons with genital herpes can determine whether risk for HSV‑2 acquisition exists

• Key Points to Discuss with the Patient:
  • Genital herpes is a sexually transmitted disease
  • The patient should avoid contact with lesions or intercourse when lesions and/or symptoms are present
  • The patient should use safer sex practices in combination with suppressive therapy
  • The patient's sex partners might be infected even if they have no symptoms
  • Type-specific serologic testing can determine the risk for HSV-2 acquisition in asymptomatic partners 2

From the Research

Information to Share with the Patient

• A diagnosis of Herpes Simplex Virus (HSV) type 2 is a lifelong infection, but there are treatments available to manage symptoms and reduce the frequency of outbreaks 3, 4.
• The patient should be informed that HSV-2 can cause genital herpes and can be transmitted to others through skin-to-skin contact 5, 6.
• It is essential to discuss the importance of safe sex practices and the use of condoms to reduce the risk of transmission to partners 6.
• The patient should be aware that there are antiviral medications available, such as acyclovir, to treat and manage symptoms 3, 4.
• In some cases, patients may experience resistance to certain medications, and alternative treatments may be necessary 7.

Treatment Options

• Antiviral medications, such as acyclovir, can help manage symptoms and reduce the frequency of outbreaks 3, 4.
• Topical imiquimod has been shown to be effective in treating ACV-resistant HSV-2 infections 7.
• The patient should be informed that there are various treatment options available, and the healthcare provider will work with them to determine the best course of treatment.

Emotional Support

• A diagnosis of HSV-2 can be emotionally challenging, and the patient may experience distress and anxiety related to their diagnosis 6.
• It is essential to provide emotional support and reassure the patient that they are not alone in their diagnosis.
• The patient should be encouraged to ask questions and discuss their concerns with their healthcare provider.