The Elephant in the Dorm Room Part 2: Herpes, Chlamydia, and PID

August, 1982

Genital Herpes is one of the better known and more socially stigmatized of STDs, as shown in the August 1982 cover of Time Magazine above. A sexually active male has a one in five chance of being infected in college, while his female counterpart has a one in four chance of being infected. Anatomical differences make genital herpes transmission from male to female almost three times as common as female to male transmission. Hence, more women are positive for genital herpes than men.Those infected often have significant psychosocial problems, especially just after becoming infected.

HSV-1

HSV-1 causes oral Herpes, thought to infect from 50% to 80% of the population, and is known as the cause of “fever blisters” around the mouth, or “canker sores” inside the mouth. In the early 1980’s, a second strain of the Herpes Simplex virus affecting genitalia appeared to be spreading rapidly through sexual transmission. From then on, Herpes Simplex 1 (HSV-1) was accepted as the cause of oral infections, while Herpes Simplex 2 (HSV-2) caused genital herpes. Each strain can cause oral or genital herpes in some people, however. Studies show that those infected with HSV-1 often have a less severe outbreak of lesions when infected with HSV-2; as many as 75-90% of those with with HSV-2 are unaware they are infected. When open sores are present, large numbers of viruses are shed, and the risk of contagion is high. Many are unaware that even if no lesions are present, viruses can still be shed as much as 10% of the time and others can still be infected, though the chances are far higher when lesions are present. Recurrences do tend to decrease in number and severity over time. Herpes Simplex has a cousin known as Varicella Zoster, which is the cause of chickenpox in children. Like Herpes Simplex, once Varicella Zoster infects its host it lies dormant in nerve tracts until it is triggered to migrate to the skin surface and form vesicles, which then rupture, leaving open sores. When varicella recurs later in life when the immune system is weaker, this is a painful condition called shingles.

Symptoms of an initial HSV-2 outbreak vary in severity; flu-like symptoms, headache, low grade fever, and of course painful, inflamed vesicles or open sores on or around the genitals are common. Enlarged inguinal lymph nodes can sometimes be observed in an initial outbreak of genital herpes as well. In any situation where inguinal lymph nodes are swollen or tender, this is reason to seek medical attention without delay, since enlarged inguinal nodes indicate significant pathology occurring in the genital area, with the lymph nodes attempting to “wall off” the infection to prevent spread to the rest of the body. More on this below.

All sexually active college students would do themselves a big favor by asking their doctors to test their herpes status. Let go of the social stigma. Muster the courage by closing your eyes for a few minutes and envisioning being either the recipient or the caller in a “You gave me Herpes!! or “I’m so sorry to have to tell you this but…” Anyone infected can take comfort in knowing that he/she is certainly not alone. Plus, if you know you have herpes, you can treat it. Genital herpes outbreaks can be limited in number, severity, and duration by any one of three drugs presently on the market- Valtrex, Famvir, and Zovirax. Taking these drugs continuously as suppressive therapy reduces risk of transmission by as much as 50-75%. Although genital herpes can seem like a Very Big Deal to a young single person, once in a committed relationship, it loses much of its significance, especially with suppressive drug therapy and care to avoid sex when active lesions are present. There are cases of people married for decades where transmission of HSV-2 does not occur. This would be the case more often when it is the woman infected, for reasons explained above. Read more about HSV and get support here.

There was a highly publicized civil case in Oregon recently in which a woman was infected with HSV-2 by a man she had met on an online dating site. The woman was awarded almost a million dollars because the man had failed to inform her of his HSV-2 infection before having sex with her. This goes to the core reason behind psychosocial effects of genital herpes or any other communicable STD: If you know you are positive for an STD, you are morally and otherwise obligated to inform any potential partner before having sex. This applies regardless of whether or not you  are on suppressive drug therapy or you intend to use a condom.

Now on to chlamydia, the most common bacterial cause of STDs. The good news is that since chlamydia is caused by a bacteria, it is curable with antibiotic therapy. It is another “silent” STD since those infected, especially women, are often unaware they have it. Left untreated, chlamydia can cause “PID,” or Pelvic Inflammatory Disease, which can lead to irreversible damage to the female reproductive tract and infertility. All sexually active women should be tested for chlamydia at least annually; if infected, all sexual partners must be treated as well, and they should abstain from sex for at least seven days afer treatment is initiated.  If the woman’s partner is not treated or is treated inadequately, she can easily be reinfected. The more infections a woman has, the greater the potential damage to her reproductive tract. It is also believed that chlamydia infections facilitate infection with HIV, the AIDs virus.

Now for a story about PID and inguinal nodes. While in pharmacy school, I went on Spring Break with a big group of college kids. We’d been at the beach for a few days when one of my friends, a very cute, petite girl next door type, asked me to come with her into the bathroom. Once there, she told me that she had not been feeling well, had no appetite, and she showed me “these knots rights here.” She told me that she had had sex when she “probably wasn’t quite ready” and that she thought she “had some little cuts down there.” Any time sex results in small tears in the vagina, the possibility of infection with STDs is enhanced. Non-sexually transmitted bacterial infections are also more likely to occur. As it happened, I had just finished a pathology course, and recognized the knots as swollen inguinal nodes. I knew just enough to tell my friend that this was serious, and that we needed to get her medical attention. I  found a physician who very kindly offered to meet us at his office on that Saturday. Since no nurse was available I held my friend’s hand during what turned out to be a very painful examination. The doctor told us that he was very glad we had called him, because my friend had a severe case of PID. He told us to leave his office immediately and meet him at the hospital in a nearby city. My friend was admitted to the hospital and placed on IV antibiotic therapy. She was in the hospital for almost a week, and her parents flew in to be with her. The doctor later told me that if we had waited even a few hours longer, my friend might have gone into septic shock, and could have died. I never asked what the pathogen was. So, young ladies and gentlemen, have a healthy respect for enlarged inguinal nodes. If present, especially with other symptoms like low grade fever, malaise, and loss of appetite, seek medical attention.

Next Week- Part 3: Gonorrhea, Syphyllis, and (Yikes!) Crabs