Getting a handle on herpes

by Elaine Gottlieb

The seriousness of the herpes virus has been overshadowed by the HIV virus. But 500,000 Americans contract herpes every year, and many of them don't even know it.

In 1982, Time Magazine splashed herpes across its cover, calling it the "scarlet H." But herpes was soon overshadowed by another, far more serious sexually transmitted disease (STD) AIDS. Nevertheless, about half a million Americans contract herpes every year, adding to the estimated 40 million Americans who already have it.

Many people who contract herpes don't even know it. Contrary to popular belief, herpes doesn't always cause major symptoms, according to Marshall Glover, director of the National STD Hotline at the American Social Health Association (ASHA). "People think that if you have herpes you are broken out all the time. In reality, the body's immune system does a good job at handling the infection," Glover asserts.

Herpes is caused by the herpes simplex virus (HSV). The first symptom that people with herpes are likely to notice is a cold sore-like lesion. If the lesion is on the mouth, lips, or face, the culprit is herpes simplex Type 1 (HSV-1). If the lesions are in the genital or anal area, the culprit is herpes simplex Type 2 (HSV-2). While there is some cross-over between HSV-1 and HSV-2 due to oral-genital sex, HSV-2 is the more recalcitrant and painful of the two viruses.

The virus lives in nerve cells and "creeps" along the course of the nerves to reach the skin surface, once in a while causing the characteristic sores and blisters. In fact, the word herpes is derived from the Greek word for "creeping." The main difference between HSV and many other common viruses is that HSV establishes a permanent presence in the body. This means that the virus can cause symptoms even if it remains dormant for long periods of time. Recurrent attacks may either be rare, occurring only once a year, or so frequent that they seem continuous. Recurrence can be triggered by many things, including irritation, menstruation, fatigue, and sunburn, and are usually milder and of shorter duration in men.

Laboratory tests can determine whether an infection is indeed herpes: a skin culture taken from an active sore or, alternatively, a blood test can detect the presence of HSV-2. Like other viruses, there is no cure. However, there are medications to ease the symptoms, and a herpes vaccine may be available by 2005.

The first symptom of HSV-2 infection is a tingling or itching sensation in the genital area (called the prodromal phase), which can then be followed by sores red bumps that turn into blisters. In women, the sores usually occur on the vulva or around the anus, and in men on the head and shaft of the penis. Without treatment, the sores form scabs and heal in a few days.

There are medications for treating herpes that alleviate symptoms and keep the virus under control. Acyclovir (Zovirax), which has been available since 1982, can be taken orally or topically, and has virtually no side effects. Two additional drugs valacyclovir (Valtrex) and famciclovir (Famvir) are expected to provide the same relief but with lower doses because they are better absorbed.

There have been reports that the amino acid, lysine, helps reduce early herpes symptoms. Lysine counteracts the effects of arginine, an amino acid found in foods such as nuts (especially peanuts), chocolate, and cola, which may stimulate herpes. It is wise to avoid arginine-rich foods during herpes episodes.

The sores heal best when kept dry and exposed to air; using any creams particularly oil-based ones will aggravate the virus. You can alleviate itching with compresses made of black tea and baking soda baths.

In general, the best defense against herpes outbreaks is a strong immune system. You can keep your immune system healthy by eating a balanced diet and getting enough rest. Vitamin C, zinc and the herb echinacea are thought to also strengthen the immune system.

Herpes is spread by direct skin-to-skin contact during vaginal, anal, or oral sex. If you have a cold sore on your mouth and have oral sex, you can give your partner genital herpes.

Herpes is most contagious during outbreaks, so you should abstain from sex when symptoms are present. The virus can also be transmitted when symptoms are not present, so it is advisable to use condoms between episodes. However, condoms don't provide 100% protection since they may not cover all lesions and occasionally they break. Using spermicides, which have been shown to neutralize HSV, with a condom provides added protection.

Some people contract herpes from partners whose symptoms are so mild they don't know they have it. Others catch it from people who don't tell them of their condition. As with any STD, the best prevention is getting to know and trust your partner before having sex so that you can comfortably communicate about STDs.

"You practically have to fill out a questionnaire on the first date. But taking precautions can save your life," says Boston sex therapist Alexandra Myles. While this may limit spontaneity, sex is usually most rewarding in a caring relationship without the risk of STDs. This becomes particularly important if you do contract herpes.

It is important to note that not everyone with a herpes-infected partner catches the virus – some people in long-term relationships never do.

For many people, the hardest part of getting herpes is dealing with the social stigma. "People aren't traumatized by having a cold sore on their mouths, but society views genital herpes very differently," says Glover. According to an ASHA survey, many readers of the organization's newsletter, The Helper, report experiencing a loss of self-esteem and fear of revealing their condition to a partner, particularly in the first year following diagnosis. Herpes support groups have been established nationwide to help people share their emotions and feel less alone.

Over time, most herpes sufferers are able to have a normal sex life. "I've found that my clients have been able to maintain relationships. The positive side has been that they become more discriminating and don't just jump into bed," says Myles. As Brett, an ASHA reader, said in a recent article in The Helper, "I've been lucky in that I've never been rejected because of herpes. To the contrary I have a normal fulfilling life in every way."

Herpes can also be an issue when a woman becomes pregnant. While less than 0.1% of babies contract HSV and most herpes-infected mothers have normal deliveries, it is important to take precautions. You should inform your health care provider. If your partner has herpes, you should use a condom during the last six weeks of pregnancy.

If a mother gets infected in late pregnancy, babies can contract neonatal herpes, a rare but life-threatening disease. Mothers with herpes who have an outbreak at the time of delivery generally have Cesarean sections.

The facts about herpes dispel the "scarlet H" image. While herpes isn't fatal, it is uncomfortable and puts great stress on personal relationships. This is an example of a condition in which knowledge is your best treatment - the more you know the better you fare.