Personal Health; Genital herpes thrives on ignorance and secrecy.
By Jane E. Brody
Published: August 12, 1992
THE woman wrote that although she is young, attractive and in love, her life has been destroyed by genital herpes, an incurable venereal infection that she is too ashamed to reveal to anyone, especially the man who loves and wants to marry her. She explained that she had contracted herpes during her one previous relationship with a man. She said the infected man had known that he had herpes but had neither told her nor done anything to protect her from the viral disease.
A decade ago, herpes sent a wave of panic through participants in the so-called sexual revolution. Now, in the wake of publicity about the AIDS epidemic, genital herpes is nearly forgotten but hardly gone. About 30 million Americans -- 16 percent of people between the ages of 15 and 74 -- are believed to harbor this contagious virus, which takes up lifelong residence in the body and emerges from time to time to produce painful blistering sores on and around the genitals.
Each year, many thousands of Americans join the unfortunate ranks of the infected. Most of them, like the young woman, are not promiscuous. The problem with herpes is that some infected people do not realize that they harbor the virus and can transmit it to others through sexual intercourse or oral sex. And the many who know they have herpes often do not realize that they can sometimes spread the virus even when they do not have a noticeable outbreak.
The infection thrives on ignorance and secrecy because those who are infected are understandably reluctant to discuss genital herpes with anyone and because physicians are often ill informed about the problem and insensitive to the despair that can accompany it.
Yet experts say the emotional and physical toll of herpes can be dramatically reduced by information, emotional support, medication and precautionary health practices. The young woman, who anonymously requested help from The New York Times, may have a fulfilling life ahead after all. How It Spreads
Herpes viruses, and there are many different kinds, have a nasty habit of hiding from the body's immune defenses by seeking sanctuary in the nervous system. After the initial infection, the virus can travel along nerves to their roots, where the virus lingers, quiescent, until circumstances encourage it to reappear.
Various factors, including illness, skin irritation, fever and stress, can prompt the virus to travel back along the nerves to the skin, where the characteristic sore develops. As with the herpes virus that causes cold sores around the mouth, the genital herpes virus first causes itching, tingling or pain, which is soon followed by an eruption that usually blisters, crusts and scabs over. Within about two weeks, the scab falls off and the skin once again appears healthy and normal.
The first attack, usually within 10 days of exposure, is often accompanied by local swelling and flu-like symptoms, including fever, headache, muscle aches and fatigue. However, subsequent outbreaks rarely have any symptoms except the genital sores, and those usually become less severe and briefer with time. Recurrences may occur as often as several times a month or as infrequently as once every year or longer.
The virus is spread by skin-to-skin contact only when the infection is active. People who develop the sores can spread the virus from the time that the first tingling is felt until the last scab falls off. However, the active infection is essentially symptomless in some people or produces such minor symptoms as to go unnoticed or undiagnosed. These asymptomatic carriers are, in effect, the Typhoid Marys of genital herpes.
Type 1 herpes usually causes cold sores, and type 2 usually causes genital herpes, but the types overlap, and the genital infection can be acquired through oral sex with a partner who has a herpes outbreak on the mouth.
Experts say that to reduce the risk of spreading genital herpes, people with known active infections should practice abstinence until their sores are completely healed and use protective measures during sexual activity at all other times. The protective measures are the use of latex condoms along with a spermicidal jelly or cream, which can inactivate the herpes virus as well as other organisms that cause venereal disease.
But there are no guarantees. Having intimate contact with someone who has had genital herpes, even if the outbreak occurred years ago and never recurred, always carries some risk of acquiring the infection. But someone who acquires the virus from an infected partner may not develop herpes sores, even though he or she could pass the infection along to someone else. One person in 10 who has a first outbreak never has a recurrence. High Emotional Toll
The young woman who wrote to The Times is hardly alone in her feelings of desperation and social inhibition. A survey conducted last July by the American Social Health Association among 5,000 men and women infected by herpes revealed that even years after the first attack, feelings of isolation and depression are commonplace. More than half of the 62 percent who responded to the survey reported feeling depressed, and an equal number said they feared rejection in social situations.
With time, the impact of herpes on work and school performance and nonsexual social pleasure diminished. But the respondents continued to be distressed about sexual issues. Forty-four percent said they thought that herpes diminished their desirability and 48 percent said it interfered with establishing new relationships.
The survey respondents also gave poor marks to the physicians they had initially consulted about herpes. Sixty-four percent said the doctors had failed to deal appropriately with the emotional issues related to their infection.
While there is no cure for a herpes infection, the severity and duration of an attack can be reduced by an antiviral drug, acyclovir, if it is taken during the initial outbreak for 10 days or at the first signs of a recurrence for five days. The drug is usually taken orally five times a day. Various treatments may also be applied directly to the affected area to relieve discomfort and speed healing.
For those who have frequent or especially severe outbreaks, acyclovir may be given continuously to suppress the virus, with a break in the medication routine every six months to see if it is still needed.
From the first inkling of a herpes outbreak, patients should avoid touching the affected area, since the virus can be transmitted by contaminated fingers. Washing soon after with soap and water can cleanse any body part that may have picked up the virus accidentally. Help for Herpes Sufferers
The American Social Health Association has established a national network of nearly 100 support groups under the auspices of its Herpes Resource Center, the only such service program in this country for people infected with herpes.
The resource center offers both information and referrals to support groups. It distributes educational pamphlets, audiocassettes, videotapes and other publications about herpes, as well as a newsletter called The Helper.
A brochure on herpes can be obtained by sending a stamped, self-addressed envelope to ASHA, P.O. Box 13827-Z, Research Triangle Park, N.C., 27709.
The association also operates the National Herpes Hotline, a telephone service staffed by specialists who can answer a wide range of questions about herpes. The service handles about 15,000 calls a year and can be reached weekdays from 9 A.M. to 7 P.M., Eastern time, by calling (919) 361-8488.
Graph: "A Sexually Transmitted Epidemic" tracks genital herpes simplex virus infections, as measured by intital visits to physicians' offices, 1966-1990. (Sources: National Disease and Therapeutic Index (IMS American, Ltd.), "D.S.T.D./H.I.V. Prevention Annual Report 1991," (C.D.C.))