For many patients, coping with the psychological and social impact of genital herpes is the most difficult aspect of all, but many become frustrated and feel they don’t receive adequate information and support, even from healthcare providers. Marc Steben, MD, and Évelyne Fleury, both of the Québec National Institute of Public Health, are experts in the counseling and support of genital herpes patients. In this article they offer a primer to guide healthcare professionals in understanding, and proactively responding to, the needs of newly diagnosed herpes patients.

Genital herpes (GH) is one of the most important sexually transmitted infections. While the recurrent nature of the infection is important to theclinician’s eye and the late complications of GH such as heightened HIV acquisition and transmission is important in the realm of public health, the psychosexual aspects of the infection may represent the highest burden for the affected persons.

Psychosexual issues may be greater near the time of acquisition and the time of recurrences, but too many people will live them all their lives. Most frequent initial reactions are shock, denial, confusion, psychological distress, stress, guilt, or anger towards self or partner. If these first feelings are not dealt with quickly, depression, low self-esteem alteration in the body image, and difficulty in dealing with new partner may follow.

Rapid and efficient counseling should be considered of utmost importance. This counseling should go further than the simple transfer of medical information. It should aim at bringing rapid adjustments to the diagnosis of GH. And with these rapid adjustments, prevention of transmission to new sexual partner is less probable.

What then should be the counseling that a person requires after a diagnosis of GH? We have developed the following guidelines for effective counseling of GH patients.

The person needs to feel that she or he is not alone in this.

• Knowing that GH is very common and that most people go through an adaptation phase and eventually live a healthy sexual life is important.
• There are many ways to go through the adaptation phase: support groups, hotlines, psychologists, sex therapists, good reading.
• Rapid follow up by an experienced healthcare giver should be available.
• Involving sexual partners (who most of the times do not know they are infected) can help.

The person needs to understand the natural evolution of the infection.

• Knowing that recurrences are less severe and limited to few lesions that will resolve in few days may alleviate the fear of recurrences.
• Understanding the phenomenon of asymptomatic shedding to prevent the transmission is important. Recurrences and asymptomatic shedding will diminish with time.

The person should be monitored for both physical and emotional aspects of GH.

• Providers should question not only about recurrences but also about the emotional aspects of GH. If a professional broaches the issue, it will normalize it.
• Explain that stress and emotions can influence the recurrence rate and thus worsen the perception of GH.

The person needs to rapidly become empowered.

• While patients can take other steps to stay healthy in general, they should know about antivirals to reduce transmission, control recurrences and lessen the intensity of recurrences.
• Global health is important: learn to relax, sleep well, exercise, eat well.
• Express your emotions and adopt a positive attitude.
• Negotiate preventive activities with your partners and decrease the risk of transmission with condoms and antivirals. Most persons with GH will have a very satisfying and fulfilling sexual life.

Discuss sexual issues.
Discussion with sexual partners should be a priority, as too often the discussion comes later after sexual activities have taken place and transmission has taken place or a significant relationships shatters because the new partner feels betrayed have been not fully informed about the situation.

Many patients feel their healthcare providers are judging them. How can we lessen this?
Too frequently healthcare providers consider sexuality as something happening in the bedrooms of their patients and that what happens there has nothing to do with the practice of medicine. Sexuality far outreaches the sexual activities that may take place in a bedroom. We need to refer to the World Health Organization 2002 definition of sexual health to understand the importance of health- care providers for persons to achieve sexual health. Sexual health is not the mere absence of disease, dysfunction or infirmities. It is also the state of physical, emotional, mental and social wellbeing relative to sexuality. Sexual life, interaction with others and sexual pleasure need to be perceived in a positive and respectful manner. Most persons with GH are having excellent sexual lives and form a family with a spouse that is not affected by GH.