National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
Division of Sexually Transmitted Diseases
Program and Training Branch
Patient Counseling and Education
Counseling has two main goals:
To help patients cope with the infection; and
To prevent sexual and perinatal transmission.
Although initial counseling can be provided at first visit,
many patients benefit from learning about the chronic
aspects of the disease after the acute illness subsides.
Numerous resources are available to assist patients and
clinicians in counseling (see the Resources list at the end
of this module for more information).
HSV-infected persons may express anxiety about genital
herpes that does not reflect the actual clinical severity of
their disease. The misconception that HSV causes cancer
should be dispelled, because HSV-2 is not a primary
etiologic agent in cervical cancer.
Common concerns about genital herpes include the severity of initial clinical manifestations, recurrent episodes, sexual relationships and transmission to sex partners, and ability to bear healthy children.
Patient counseling and education should cover the natural
of the disease, treatment options, transmission and
prevention issues, and neonatal HSV prevention issues.
Natural History of the Infection
Discussion of the natural history of HSV should emphasize the potential for recurrent episodes, asymptomatic viral shedding, and sexual transmission.
Recurrent episodes are likely following a symptomatic first episode
HSV-2 infections have more frequent recurrences than
The frequency of outbreaks generally decreases over time
Asymptomatic viral shedding occurs, and HSV can be
transmitted to a sex partner during asymptomatic periods
Asymptomatic shedding is more frequent in genital HSV-2 infection than genital HSV-1 infection.
Asymptomatic shedding is most frequent during the first 12 months after acquiring HSV-2.