Understanding and preventing genital herpes: Avoiding embarrassing topics

Genital herpes

How to avoid an embarrassing topic

Viruses are not necessarily fatal, disabling, or even extremely painful; genital herpes is one example.

Most people are unaware that the genital herpes virus resides in their bodies, and only a small percentage experience occasional, brief pain. Nevertheless, because the disease is sexually transmitted, can recur, and can cause public outcry, it places a significant psychological burden on patients.

Ted Grossbart, a Harvard Medical School psychology professor, co-author of *Deep in the Skin: A Mental and Physical Solution for Healthy Skin*, and a PhD, says that while many people can calmly deal with herpes-after all, there are so many other terrible germs to worry about these days-its psychological impact can manifest in various ways, including social withdrawal and depression. "The effect it has on self-esteem-a harmful feeling of being hurt and unloved-is quite serious," he says. "Some people choose to avoid social interaction."

A very common virus

Everyone knows herpes isn't uncommon, but you might not believe how widespread it is: experts estimate that 40% of American adults are infected with the virus. Even more surprisingly, three out of four people carrying the virus may be completely unaware of it. Dr. Lawrence Stanberry, chief of the Infectious Diseases Department at the University of Cincinnati Children's Hospital, says that even the most severe initial infection often presents with no symptoms.

The virus that causes genital herpes is the same virus that causes cold rash-herpes simplex virus. It is transmitted through direct contact-from one person's genitals to another's-but it is not a highly contagious disease: a man who has been living with a woman with herpes for a year has less than a 5% chance of contracting the disease.

Genital herpes is particularly bothersome in its early stages: it begins with stinging and itching, followed by the appearance of numerous blisters that eventually ulcerate. It typically takes 3-4 weeks for the ulcers to scab over and heal. Patients may also experience fever.

However, the disappearance of herpes does not mean everything is fine: the virus is not dead, but lies dormant in nearby nerve cells, and it can re-emerge from there at any time, causing a herpes recurrence (usually with less pain and shorter duration than the previous one).

Nearly one-third of people infected with herpes do not actually experience recurrences, the reason for which is currently unclear; another third experience very few recurrences-about three times a year; and the remainder experience more frequent recurrences. Dr. Stanberg says this may be due to differences in the type of virus and the amount of virus you are exposed to. Other factors include the differences in each person's naturally developed immune system.

The basis of self-protection

Since there is no cure for herpes-once the virus enters your body, it is very difficult to leave-it is best to avoid getting it in the first place.

With the use of condoms, people once thought that herpes was only contagious when the virus emerged from its hiding place and caused visible symptoms, or in the days before or after that. However, it is clear that many people can transmit the virus even without showing any symptoms. One study showed that in 75% of cases, herpes is transmitted without any actual symptoms.

"The chances of infection are greatest when there are obvious signs of organ damage," said Dr. Grigori Merz, chief of the Department of Infectious Diseases at New Mexico State University in Albuquerque. "It is very important to avoid skin-to-skin contact at this time; while the risk of cumulative infection through repeated contact is even greater during the asymptomatic period."

Therefore, the Centers for Disease Control and Prevention believes this clearly demonstrates that condoms must be used during sexual intercourse because viruses cannot penetrate condoms.

If you know your sexual partner has had herpes, Dr. Merz points out that to prevent infection during the asymptomatic period, you should use a condom during every sexual encounter-not just when herpes recurs. However, condoms are not 100% safe; they only protect the part they cover-the penis. If the herpes virus comes into contact with other parts of your body, you can still become infected through those areas.

The Centers for Disease Control and Prevention's general recommendation for reducing all sexually transmitted infections (STIs) is to be selective about your sexual partners. The more sexual partners you have, the greater your risk of infection.

Beware of oral sex. Dr. Merz points out: "Herpes can also be transmitted to the genitals through the mouth." Oral sex can quickly turn your girlfriend's cold rash into your genital herpes.

Avoid sun exposure. The only known cause of herpes recurrence is exposure of the affected area to ultraviolet light, a problem more common with oral herpes. If you're a hardcore nudist, you should take note.

Reducing stress: Many people insist that stress can trigger herpes recurrence, but relevant data does not support this view. However, no one has said that reducing stress is harmful to your body.

Dr. Stanberry notes that while some people rely on taurine (an amino acid) and other nutrients, there is no reliable data to suggest they reduce herpes recurrence or accelerate healing. However, generally speaking, "people with good nutrition do heal faster."

Correct medication

Although it is currently known that once the herpes virus enters the human body, it cannot be eliminated, scientists have discovered a fallback option-a drug that can shorten the duration of the illness and almost completely prevent recurrence. This drug, called acyclovir (Zovirax), apparently inhibits viral replication. If you start taking it immediately, the discomfort caused by herpes in its early stages can be significantly reduced, and ulcers can heal faster. Taking it when signs of an impending recurrence appear (usually itching and stinging at the affected area) can also shorten the duration of the illness.

This medication is even more effective for patients suffering from frequent herpes recurrences, as it can stop viral flare-ups. A study conducted at Baylor College of Medicine in Houston followed a group of patients who had suffered from genital herpes for up to nine years. At the start of the study, their herpes was recurring frequently-an average of 12 times a year.

After 5 years of acyclovir treatment, the number of herpes recurrences among the participants decreased to less than 2 times per year on average, and 20% of them have never had a herpes recurrence since the start of treatment.

In addition, acyclovir has the potential to reduce viral transmission between relapses. A study conducted by Washington State University in Seattle found that patients taking the drug twice a day experienced fewer instances of asymptomatic viral shedding, which could potentially facilitate viral transmission.

Other treatment methods

There are many ways to alleviate the suffering caused by severe herpes flare-ups.

For the first flare-up, take a warm bath or shower 2-3 times a day. Gently pat (but do not rub) the affected area to allow it to air dry. Excessive rubbing can irritate the affected area and spread the infection, says Dr. Steinberg.

Latest Information

• Commonality: It is estimated that 31 million Americans are infected with herpes simplex virus, with 200,000 to 500,000 new infections each year.

• Risk factors: The only way to contract genital herpes is through sexual contact with an infected person. Other factors include social status (the infection rate is twice as high in lower socioeconomic groups as in higher socioeconomic groups) and race (African Americans and Hispanic Americans are more susceptible). The more sexual partners you have, the greater your chances of infection.

• Affected age groups: Since infection can last a lifetime, the older a person is, the greater the risk.

• Gender differences: More common in women. A large proportion of male homosexuals are also infected. Men are one-third as likely to contract herpes virus from women as women are from men.

• Who to seek help from: Internists or family doctors can usually treat herpes. If abnormal symptoms occur or recurrences are frequent, you should see a dermatologist or specialist.

Keep the area dry and apply a drying agent directly to the ulcerated area, such as zinc oxide or calamine lotion.

Applying heat or cooling to the affected area with ice packs, infrared heating lamps, or a hairdryer set to cool or warm air can relieve pain. However, do not overdo it; stop immediately if you feel even a slight irritation.

Wear loose clothing, especially loose-fitting underwear, as air circulation helps prevent irritation to the affected area and can speed up wound healing.

Avoid using viscous medications and petrolatum-based ointments. Dr. Stanberg says, "They don't keep the affected area dry, thus prolonging healing time and the time it takes for the virus to shed." He says that zinc-containing topical ointments, available without a prescription, may have some antiviral properties, but they haven't been found to be highly effective clinically. Nevertheless, they may provide some benefit and are harmless.

Wash your nails thoroughly with soap after touching the affected area. The virus can survive on the skin for 30 minutes and is easily transmitted through contact between the hands and other parts of the body, especially the face.

If you experience depression, consider seeking help from a mental health professional or participating in group therapy. Dr. Grossbart says, "Sometimes, simply being with or talking to someone who has been suffering from the illness longer but has become accustomed to it can be helpful."