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Herpes: Complications, Costs and Your Reproductive Health

Find out how this herpes affects your sexual well-being, especially what could go wrong.

The herpes simplex virus (HSV) is a sexually transmitted or orally transmitted infection and presents as HSV-1 and HSV-2. HSV-1, known as oral herpes, is estimated to have been contracted by 50 percent to 80 percent of adults in the United States, according to the National Institutes of Health (NIH). As many as 90 percent of Americans will be exposed to the virus by age 50.

Additionally, it's estimated that about 12 percent of people ages 14 to 49 in the U.S. have HSV-2, more commonly known as genital herpes. The Centers for Disease Control and Prevention (CDC) estimates there are more than 550,000 new infections every year.

There is no cure for the herpes simplex virus (HSV) and most people rarely show symptoms.

If you've received a herpes diagnosis after an outbreak, it's important to know how to have a healthy sex life. While herpes can be transmitted without an active outbreak, it's rare. However, you should be open with potential partners so they can make an educated decision about their respective sexual health.

Using protection—latex or polyurethane condoms—and talking to your doctor to configure the right treatment and antiviral medication are all good strategies. Most importantly, don't have sex, either penetrative or oral, during an active herpes outbreak.

Treatments are available easily and at a low cost

While there may not be a vaccine to prevent herpes or cure the condition, there are treatment options available for people experiencing an active outbreak or who have had outbreaks in the past.

“The best treatment for herpes is antiviral medicine to shorten or prevent outbreaks,” said Monty Swarup, M.D., FACOG, board-certified in OB/GYN in Chandler, Arizona and the founder of HPD Rx. “Antiviral medicine reduces the chance of spreading HSV [as well].”

The three main herpes antivirals are acyclovir, famciclovir and valacyclovir, all of which work for both genital and oral herpes, plus chicken pox and shingles. These medications work by inhibiting DNA synthesis, preventing the virus from replicating in the body.

Antiviral medications are readily available with a prescription from your doctor, but herpes treatment comes with some associated costs.

“The costs for treating herpes include lab testing, medical consultation, antiviral medication and the costs of preventative measures, such as condoms,” Swarup explained.

The good news is herpes antiviral medications are typically covered by most major insurance plans, but coverage varies by location and plan. However, for people without insurance coverage, antivirals can cost anywhere from $23 to $800 for a 30-day supply of pills.

Herpes antiviral drugs decrease outbreak time and increase the time between outbreaks. However, you may experience side effects from the medication. For valacyclovir (brand name Valtrex), a popular oral herpes antiviral, the most common side effects are a feeling of sadness or emptiness, irritability, lack of appetite, tiredness, trouble concentrating and trouble sleeping, among others.

As with any medication, keep an eye on the side effects you're experiencing and see your doctor if things don't feel right. Your healthcare provider can change your medication if there are perceived issues.

Herpes and sexual health

“Millions of people live sexually healthy lives with proper precautions so they don't pass [herpes] on to others,” Swarup said, adding that with antivirals, condoms and proper communication, it's perfectly possible to lead a healthy sex life with herpes.

Since oral herpes can spread to the genitals and vice versa, most sexual interactions run the risk of passing herpes to a partner.

The New Zealand Herpes Foundation offered some conversation tips for telling a partner you have herpes, regardless of the type. First, it recommends being as informed as possible about herpes and how it can impact sexual health. Next, rehearsing what you want to say with a doctor can be helpful to make sure you're covering all of the important parts and it also helps you get comfortable talking about an uncomfortable topic.

The final recommendation is to not wait until right before you're about to have sex to tell your partner. Tell them early on, give them time to process the information and allow them the space to make the best decision for themselves.

No matter how you choose to tell a potential sexual partner, the most important part is to make sure you tell them.

However, this is a personal choice. In the heat of the moment, many people won't tell casual partners if the sexual interaction happens during a dormant period and they plan to use proper protection, such as condoms. You may even statistically believe your potential partner may have already contracted the virus.

However it's imperative to communicate your positive status if you're aware of it, as withholding such information could harm someone else's physical health.

Herpes and fertility

Swarup noted herpes doesn't impact female fertility and does not affect pregnancy or the health of your fetus, unless you have an outbreak shortly before birth. If that happens, you could pass the herpes virus to the baby, which can be life-threatening.

For males, herpes can reduce sperm count, which could hinder the ability to conceive naturally.

Research studies, such as one published in 2011 in Canadian Family Physician, indicate it is safe to take acyclovir or valacyclovir while pregnant to prevent transmitting the herpes virus to the baby during childbirth.

The most risk to a baby comes when the pregnant person experiences their first herpes outbreak close to or during childbirth. If there wasn't an opportunity to get the person on antivirals to prevent an outbreak, the risk of passing the virus to the baby is now greater. If transmission to the baby happens, the baby is given acyclovir for the virus.

Common complications of herpes

Swarup said common complications of HSV-1 include aseptic meningitis when the lining of the brain becomes inflamed which, although rare, can become a serious condition.

For HSV-2, complications include genital ulcers, which are painful in people with suppressed immune systems, as well as aseptic meningitis.

Bladder problems, rectal inflammation and other STIs, such as HIV, can also occur alongside both HSV-1 and HSV-2.

Having herpes can make you more susceptible to contracting HIV. If you engage in sexual activity during an active herpes outbreak, the sores or breaks in the skin, lining of the mouth, vagina or rectum create a pathway for HIV to enter the body, according to the CDC. This can happen without visible sores because herpes increases the number of immune cells in the lining of the genitals and HIV targets those immune cells as it enters the body.

There is overwhelming evidence of untreated herpes virus leading to a strong risk of Alzheimer's disease and dementia, too, especially in carriers of the APOE4 gene, a strong risk factor gene for Alzheimer's.

Complications of herpes are rare and usually occur during the first outbreak, especially with genital herpes because of the sensitive location of the sores. If any complications do arise, make sure you discuss the issues with your primary care physician or OB-GYN to learn the best course of action for the future.

Editor's note: This report is part 3 of a four-piece introduction and continuing update focusing on the herpes simplex virus. Check out the other parts of this series:

  1. Herpes Simplex Is More Complex Than You Might Think
  2. Herpes: Symptoms, Diagnosis and Treatments
  3. Herpes: Complications, Costs and Your Reproductive Health
  4. Herpes: Living, Dating and Thriving

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