Herpes is an extremely common condition worldwide and appears to be on the increase. It is equally common in all socio-economic and racial groups, and in both developed and developing countries.
Dylan is a very handsome young man who prides himself on his physique. He works out daily and looks like an ad for fitness products. Dylan has worked in the travel industry ever since high school, when he helped out in his parents’ travel agency. He has also been quite sexually active, in a very casual way, since he was sixteen.

When Dylan was 23, shortly before he met his wife, Kathy, he had a little fling—or, to be precise, a one-night stand—with a girl he met at a party. They had both drunk quite a bit and she was on the Pill, so his usual caution was thrown to the wind and no protection was used. About a week later, he felt really under the weather, as though he was coming down with the ’flu. This passed, but then he noticed that he had a weird tingly, burning sensation in his penis. A few days later, blisters appeared on the skin of his penis, all along the shaft, and the light bulb flashed.
Sure enough, the doctor told him he had herpes and gave him a prescription for aciclovir, explaining that the first episode is always the worst and the aciclovir would shorten it and decrease the severity. Even so, the blisters turned to ulcers that sort of ran together, his whole penis felt very raw and the glands in his groin were swollen and sore. He had just begun a new job as a scheduling agent with a major airline and hated to lose any work so soon, but had to take a week off because he couldn’t walk—the pressure of his trousers was agonising!
About three months later, Dylan had a second episode. This one was not half so bad. He had the mild tingling on the penis, but there were only a few blisters and ulcers. His glands didn’t swell at all. This was a relief, because he was away overseas on business and couldn’t afford to lose any time trying to find a doctor in a strange city. Six months later, he felt the tingling, went straight to his own doctor, started the aciclovir and nipped it in the bud.
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It was around this time that he met Kathy. Within a month of starting dating, he realised that this was the woman he wanted to marry. He told her that he’d had a ‘little something’ once, but that it had been treated and wasn’t anything to worry about. They were using condoms religiously and he figured that she was safe.
After a year of serious dating, Kathy and Dylan moved in together. Kathy went on the Pill and they stopped using condoms. Dylan hadn’t had an episode of herpes for so long that he figured he was cured.
After an additional episode-free year, the couple married and settled into a happy newly-wed routine. All went well for another nine months—too well, perhaps, because Dylan received a big promotion in his job and started to work long hours and bring paperwork home. He was losing sleep and wasn’t able to get to the gym every day. One Friday night, as he opened his front door, he suddenly felt that tingling again. Oh no! He sat Kathy down and embarked on a difficult recital—the ‘H’ word hadn’t ever really been mentioned before and now after so long…He could feel the freeze in the air as Kathy took in what he was saying. To make matters worse, it was too late to get to the doctor’s that night so he had no profes¬sional ally to help tell her. He felt lower than a worm’s belly. The worst was still to come, though.
By Sunday, Kathy was running a fever and felt very ill. She couldn’t even keep a bite of ice-cream down. The next day, she experienced a painful burning and tingling at the vaginal opening and knew it had struck. She got in to see her family
doctor the same morning, and received much sympathy, along with a prescription for aciclovir. Dr Seip took the time to explain to her that this was a common affliction and that having it happen now didn’t mean that Dylan had been cheating on her. She told Kathy that the virus, once acquired, resides in the cells beneath the skin and can remain latent for long periods of time and then be activated by stressors—in Dylan’s case, probably the stress of his new position and the resultant fatigue. She also explained that the prescription should decrease the severity of this first attack, since Kathy was receiving it within the first six days.
By Wednesday, though, Kathy was totally inca¬pacitated. Her vulva was covered with blisters and ulcers and the whole area was swollen. She couldn’t do anything but lie in bed because she couldn’t walk —any friction at all against her crotch caused a griping pain. Dylan turned into a proper nurse—in constant attendance, bringing cool compresses, aspirin and a strong drink. He looked like a mourn¬ful dog with the shame of it all. He was also worrying that she’d never have sex with him again.
On Wednesday night they had to throw in the towel and go to Emergency. Kathy couldn’t pee. She was catheterised and admitted for IV fluids and pain medication. Dr Seip suggested, when Kathy was discharged home, that Kathy take aciclovir daily for at least a year to suppress the virus, because Kathy had had such a bad first episode. She also called the couple in to see her a week later and then discussed with them the ramifications of all this for their desire
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to start a family in the near future. She explained that if Kathy had an attack around the time her baby was due, she might have to have a caesarean to avoid the baby developing a serious infection, but that this was a safe procedure and no reason to decide against trying for a pregnancy.
Herpes can destroy relationships, but fortunately Kathy and Dylan had worked hard at talking through problems and had built a relationship based on honesty. Kathy believed Dylan that this was not a new infection and forgave his rather na¨?ve neglect of openness about it. Dr Seip was tremendously helpful to the young couple and helped them to see that this was not the end of the world and that they could still realise all their dreams.
Genital herpes is caused by herpes simplex, type 2. This is a virus and there are other members of the herpes virus family. Type 1 causes the common cold sore and, much less often than type 2, can also cause a genital herpes infection. But here, to all intents and purposes, we are not talking about type 1. Make no mistake about it: genital herpes is a sexually transmitted disease. You will not get it from using your friend’s towel. The virus likes warm, moist areas and can infect the genitals, mouth, throat and anus—in other words, wherever sexual contact may occur. Condoms can protect to a great extent but not completely, and the virus may be passed to a sexual partner even when no symptoms are present.
Within two to 20 days of exposure, you may experi¬ence—as did Dylan—flu-like symptoms, followed by tingling and pain. Dylan experienced this on his penis, but
it can occur anywhere in the lower pelvic area. Then come the blisters, which quickly open out to shallow and very painful ulcers. The active manifestation of the illness is self-limiting and the ulcers and pain clear within two weeks for most people. Each occurrence is usually milder than the last, with the first being the worst. Treatment helps to mod¬erate the severity and length of the outbreak and is most effective in the first episode. As mentioned before, treatment needs to begin during the first six days of symptoms.
It is critical to understand that, although the rash goes away and the outbreaks get milder, the virus resides happily in your cells and you remain infected. Our drugs can suppress it (like caging a wild lion), but will not cure it. Therefore, if you have new sexual partners, you need to be honest with them. If you have an active attack, it is best to abstain from intercourse; otherwise, use condoms at all times. Although we are not sure that these measures are 100 per cent effective, studies of monogamous couples in which one partner has the infection and the other doesn’t indicate about a 15 per cent infectivity over an eighteen-month period.

Herpes infection doesn’t mean that you are dirty or promiscuous or a social leper. It means that you need to be careful and honest in your sexual relationships. Health care workers can help you explain to partners if any difficulty arises.

As we’ve intimated, the newborn baby is the greatest victim of genital herpes. There is about a 60 per cent mortality rate associated with neonatal herpes infection. So it is important that doctors caring for pregnant women are informed if a woman and/or her partner has ever had genital herpes so that appropriate measures can be taken.

Some fortunate souls never have a recurrence after the initial attack of herpes, while others are plagued with frequent recurrences. The difference has nothing to do with virtue or lack thereof. We quite frankly don’t under¬stand why it acts like this, but need to accept that it does. Recurrences seem to correlate with times of greater stress, be it physical, emotional or a combination, as in Dylan’s case. Stress alters our immune responses, so this makes sense. Other illnesses obviously stress one’s body greatly, and it is not uncommon for an attack of herpes to add to the discomfort of another illness.

This leads us to the association with HIV. While not yet cast in granite, there are clear indications in various studies that people with herpes simplex, type 2 are more susceptible to HIV when they are exposed to it. It is also known that herpes infection complicates HIV. We used to think that herpes posed an increased risk for cervical cancer, but we now know that the association is actually more with human papilloma virus, which we’ll talk about later. The bottom line is that these STDs make good bed¬fellows for each other and, when one is diagnosed, the others should be tested for.

As we’ve mentioned, we can treat herpes infections with antiviral drugs, like aciclovir and valaciclovir, but these do not cure the infection—they only suppress the virus. Other treatments aimed at relieving the pain and discomfort are local cool compresses and oral or, more rarely, IV pain medication. Complementary medicine advocates the use of l-lysine, an amino acid, both to treat and prevent the attacks. It is further advocated that infected people avoid foods high in methionine, like nuts and seeds, because these interfere with lysine. Studies are lacking to confirm or deny the efficacy of this approach, but it is not harmful. Advocates use 500 mg l-lysine three times daily when the virus is active and 500 mg daily otherwise.