Since I started working in reproductive health, many of my visits are not happy ones. People seek out care with us because they are having a problem. They might have a new partner. They might have a partner that they recently found out is not being faithful. They may come to me and learn that their partner, is in fact, not being faithful.
One of the most common things a medical assistant will say to me when someone is coming in with their first herpes outbreak is, “He/she says she has painful bumps on his/her labia or on his/her penis.” Nine times out of 10, I know that I will be walking into the room and talking about a new herpes diagnosis.
Like many sexually transmitted infections, there is a stark breakdown in race and gender or those affected. According to this medscape article, the prevalence among white women is 20%, white men around 15%, black women’s prevalence is 55% and 35% among black men.
Herpes infection is incredibly common, and, unfortunately, highly stigmatized. I have had four patients in the past three weeks present for during their primary outbreaks, each one of them breaking down into tears in the exam room after I tell them what I’m seeing.
For many, they had been using condoms, they had done everything right. One had a partner with oral herpes that passed it to her because of performing oral sex. Another looked at me and said, “But we even used condoms! This is so unfair!” And its true. It is unfair. Condom use can decrease transmission, but only by 50%.
This diagnosis is so difficult to handle that I had one woman, through sobs, ask me, “so…I can never have sex again….like, normally?”
How does a health care provider talk to women (and men) about herpes? Most of the time in my training I saw women who were pregnant, hadn’t had an outbreak in years, and were on suppressive therapy to prevent an outbreak in the final weeks of pregnancy to avoid a c-section.*
By the time I had seen these women, they had adjusted to having a life-long condition, many were not affected in their daily lives, and they simply took one pill in the morning and one pill at night to prevent outbreaks.
But what I see in clinic is different. I see the woman who is in shock. I see the woman who has a partner who didn’t disclose his HSV status. I see the woman who cannot tell her partner she is having symptoms because she doesn’t feel safe to.
How do we move from the space of initial shock to one of understanding? What is the health care provider’s role is helping women make that transition?
I certainly don’t have all the answers. In an effort to console a woman, I told her that herpes is incredibly common. That she wasn’t alone. Dejected, she looked back at me and said, “I don’t care if it’s common. I don’t want herpes!” Totally fair, is what I thought. She wasn’t ready to hear anything else, and what I needed to do was let her have that moment of anger and disbelief.
I am still figuring out how to talk to those who are newly diagnosed with life-long STIs, or even ones that we can cure easily with antibiotics. Maybe I should adopt an “information only” policy, and the understanding of anger and shock. There is always more time for them to come back once the initial shock has worn off.
Fellow providers, how would you talk to someone, and if you don’t provide direct medical care, how would you want someone to talk with you?
*We give all pregnant women suppressive therapy starting at 36 weeks to decrease the chances of an outbreak, and, a c-section to prevent neonatal herpes.