An Ob-Gyn on Herpes
An Ob-Gyn on Herpes
When she was diagnosed with genital herpes at age twenty, Sheila Loanzon’s reaction was typical: She felt shame and tried to ignore it. Her book, Yes, I Have Herpes: A Gynecologist’s Perspective In and Out of the Stirrups, is the story of how she came to be frank about her herpes-positive status. As a board-certified ob-gyn, Loanzon uses her personal and clinical experience to help others. She sheds light on the outsize embarrassment around genital herpes and how to live a life with herpes without discomfort. “I think what’s important about my book is that even though the topic is herpes, the tools are helpful for overcoming other things that people find shameful,” she says.
A Q&A with Sheila Loanzon, DO
I’d been working with an executive coach. When I built up enough confidence and strength to share my story, I felt like we needed something very bold. And the title definitely catches your eye. It describes being the person and being the physician. I wanted to write this book for my patients and as a resource for my colleagues. I know that there are people who are struggling with the virus because there’s so much shame wrapped up in it. I wanted to discuss herpes openly and bring it to light.
I was diagnosed when I was twenty, which is when most young people are exploring and discovering their sexual paths. I got it from my first real boyfriend when I was in college. I remember having a lot of pain when I went to the bathroom, so I went to the campus clinic and was told that they were suspicious that I had herpes. They took a culture and gave me medication. In the 2000s, the internet was not as all-encompassing as it is now, so I didn’t quite understand what herpes was, but I did know that it was something that we don’t talk about.
I come from a Filipino Catholic background. I was trying to uphold this level of perfection for my family. As a first-generation daughter of a Filipino family, I embodied my immigrant parents’ hope for a better life. I didn’t want to believe I had an incurable disease. So I dealt with it in my own way. Fast-forward to medical school, when I was learning about viruses. I realized I had this virus and had not understood the gravity of the diagnosis.
I had a disconnect between being a physician and being diagnosed with herpes as a patient and wasn’t processing the implication of what that meant for me. I realized that I had to put these two parts of myself together and embrace the thing that I was ashamed of so that I could achieve what I wanted, which was self-confidence and self-love.
There’s a stigma in general with sexually transmitted infections, and pop culture has not helped the situation by making herpes the butt of the joke. It seems to be easier to laugh at it than to discuss it. When I came out to my friends and colleagues, they said it was incredible because it personalized something that’s very vulnerable.
After my boyfriend and I broke up, I struggled with how to tell my sexual partners openly about my herpes diagnosis. We used condoms, and I avoided intimacy if I had an outbreak. None of my partners said that they developed lesions.
I had to do more internal work than I’d expected. And self-confidence-building. I had to realize that I had value. It was important to process through the discomfort of why I deserve to be loved.
Once I finally felt strong enough, it was okay to be turned down by people I was dating. I realized that it was a judgment of the virus, not of myself. I realized that the virus diagnosis is an amazing filter to be able to find the next partner I’m meant to be with. I realized if my openness about herpes doesn’t work for someone, it’s okay, because the person I want to be with is someone who is open, willing to learn, and willing to communicate and discuss. That’s the person I should be with.
Everyone has a different stance on that. Some people feel most comfortable disclosing on the first date. Either they don’t want to waste time or they want to be up front. And that is one wonderful way to approach it. Any time there’s an inkling that the relationship may turn into a physical one, it’s important to discuss sexual history and to get tested. It’s important that we aren’t surprised when a diagnosis is presented. And it’s important to make sure that you’re mentally prepared for whatever can happen. Because if you are engaging in sexual activity, there is a possibility that you may be exposed to bacteria or viruses that may or may not be treatable.
It’s not always from vaginal penetration. When I was diagnosed, I was a virgin; I’d gotten herpes through oral sex. My boyfriend frequently had cold sores on his mouth, although he didn’t have any at the time. Someone who has a history of cold sores, which are generally caused by HSV-1, can transfer herpes to a partner’s genitals by performing oral sex. That’s often the case for women I diagnose in my office.
Herpes is caused by the HSV-1 and HSV-2 viruses, which are transmitted through skin-to-skin contact. Transmission is through mucus membranes, which make up the skin on the genitals, mouth, and anus. Kissing is one way to transfer herpes, and you can also transmit it through anal sex. And if a hand touched an open sore and then rubbed the eye, that would be an opportunity for transmission.
It’s important to get the sore tested. There can be ulcerations in the genital area that aren’t herpes but could be skin cancer, vaginal infections caused by yeast or bacteria, or an STD like syphilis. A culture test will report the type of strain: HSV-1 or HSV-2. The best time to obtain a culture is when the lesion first occurs.
Disclosing to the partner is the first thing. Protective measures help, but they may not be 100 percent effective at preventing transmission. The second thing is using a protective barrier, whether it’s a female or male condom, that prevents a majority of the skin contact that can transmit herpes. However, even with a condom, there is quite a lot of skin that is still exposed during sexual activity.
Antiviral medication can be used to prevent and treat lesions, and it can help decrease the risk of viral shedding. If someone has an active lesion, they should avoid sexual activity because that is when the virus is shedding.
I think that is a personal choice, a shared decision between the patient and their health care provider. There are people who prefer to treat outbreaks as they occur. They may have outbreaks that are so infrequent that taking something daily does not make sense for them. And you have to factor in the financial aspect that comes with taking medication daily. But it is reasonable to offer daily suppression—meaning taking a medication every day—to someone who has at least six outbreaks a year. And if someone is sexually active, it would be reasonable for them to take an antiviral drug as a preventive to decrease the risk of transmitting the virus to their partners.
The great thing that we’ve discovered is that we do not develop resistance to the antiviral medicines, as happens with antibiotics. And the antiviral medicines are quite safe. We use them in pregnancy. It’s very helpful for people to know that even with herpes, they can have babies vaginally. The drugs are somewhere between 50 and 90 percent effective at preventing outbreaks.
Most people have their worst outbreaks in the early years after infection. As people get older and develop antibodies and can recognize the stressors that may cause an outbreak, they may find the outbreaks are few and far between.
Yes, Janell Marie-Pierre—the executive director of the STI project—is wonderful at sex education and at discussing herpes and being STI-positive.
Sheila Loanzon, DO, is a board-certified obstetrician and gynecologist with more than fifteen years of clinical and personal experience with the diagnosis and treatment of herpes. She studied biochemistry as an undergraduate at Vassar College, attended medical school at the Western University College of Osteopathic Medicine of the Pacific, and completed her residency at Saint Francis Hospital in Evanston, Illinois, graduating as chief resident. She is a diplomate of the American Board of Obstetrics and Gynecology and a fellow of the American Congress of Obstetrics and Gynecology. Loanzon provides surgical and medical care to women from childbearing age through postmenopausal years and is the author of Yes, I Have Herpes: A Gynecologist’s Perspective In and Out of the Stirrups.
This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of goop.
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