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? From the Cradle to the Grave | Main | Many forms, one Thomas ?

Skin deep

By Will Alexander

The woman told me that she had not expected anything unusual to come up on her yearly gynecological exam. She was in good health, did not have a boyfriend and had never had a problem on prior visits. Her voice started to break as she relayed what the doctor had told her: the irritation she thought was a yeast infection was really the sexually transmitted infection called genital herpes.

In the three years that I worked on the National Sexually Transmitted Disease and AIDS hotlines (1-800-227-8922 and 1-800-342-AIDS), I talked to hundreds of men and women newly diagnosed with sexually transmitted diseases. While the people diagnosed with herpes were some of the safest from a medical perspective, they were also some of the most distraught callers.

Genital herpes is the nation?s most common sexually transmitted disease. According to the American Social Health Association, a nonprofit advocacy group that staffs NSTDAH, one out of every five adults in the U.S. has genital herpes, and every year one million people are infected with the virus that causes the illness. Up to 90 percent of people with genital herpes do not know they have it, experts estimate.

Biologically speaking, herpes simplex type 2, the virus that usually causes genital herpes, is similar to a well-known, less maligned virus?herpes simplex type 1, the virus that usually causes cold sores. Either virus can cause both oral and genital infections. The name of the disease comes from its location, not the responsible virus.

Whatever the location, herpes defies the popular black-and-white, win-or-lose notion of disease. Many people know the bad news: while treatments for symptoms exist, herpes is incurable. Especially during early infection, genital herpes can be exceedingly, even incapacitatingly, painful. I?ve talked to men who woke up to find their genitals, thighs and buttocks covered in blisters and women who resorted to urinating in bathtubs to reduce their pain.

However unforgettable these experiences must have been, they are not representative of typical herpes infections. Outbreaks do go away, after anywhere from a few days to a few weeks. Many people feel only mild discomfort or do not even notice their first outbreak.

Even without treatment, herpes generally gets better. Although the immune system lacks a mechanism to rid the body of the virus, it learns to recognize and destroy active virus, reducing the number and duration of outbreaks. Transmission, primarily linked with outbreaks, also becomes less likely the longer a person has herpes.

Herpes is not a malevolent entity with plans on murdering its host. Herpes does not shorten the lifespan or do permanent damage to a healthy adult. It is a skin virus that exists to reproduce itself. Herpes?s evolutionary success owes much to the fact that the virus is so mild; it is in the virus? best interest if more people are alive and sexually active to spread it.

Other conditions are defined by symptoms, not the presence of an infectious agent. The virus that causes chicken pox never truly goes away?recurrences among the elderly and the immune deficient are known as shingles?but when we refer to people with chicken pox we generally mean active disease. Specific viruses cause warts, yet no one talks about being ?diseased? when he or she wakes up with a bump on his or her hand.

The fact that so many people have herpes without knowing it inspires a rewording of the popular Zen question: if a person has herpes, doesn?t have any sexual partners to spread it to and doesn?t have any noticeable symptoms, does he or she have a disease?

Unfortunately, most people I talked to on the hotlines seemed to believe the answer was a resounding ?yes.? Even the mildest herpes case can come as a tremendous mental blow. Perhaps because of the virus? ?incurable? nature, herpes seemed to carry a stigma stronger than even that of other sexually transmitted diseases. I talked with newly diagnosed people who described themselves as ugly, disgusting, tainted and unlovable.

Although televised jokes about people getting AIDS would rightly draw national outrage, it is still socially acceptable for Jay Leno to joke about contestants getting herpes on a Fox reality show.

Despite their often-difficult nature, I found that some of my most inspiring calls came from people with herpes. People with herpes may not have finished crying by the end of the call, but many of them hung up determined to get on with their lives. Sometimes the hardest decision, in the absence of an easy answer or the possibility of praise, is simply to soldier on.

Will Alexander is a graduate student of medical journalism in the School of Journalism and Mass Communication.

Posted November 22, 2003 03:00 PM

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    • WilsoInAus
      Welcome @Marlena correct you and your partner would benefit from the type specific version of the HSV test (meaning a separate result for HSV-1 and HSV-2). I had no idea the Euroimmun or equivalent actually had a combined version, it is pretty useless given the high incidence of HSV-1. Only one thing to add is that if you are getting frequent symptoms then you can obtain a swab and have this tested for HSV and other things as well.
    • WilsoInAus
      Yeah @FirstTimeUser there is nothing in the pic suggestive of genital herpes. It seems both you and your partner have HSV-1 orally and that's actually pretty cool. It means you won't pass it to each other's genitals owing to immunity. If the two of you are concerned about genital HSV-2 then mutually test for the IgG HSV-2 and HSV-1 antibodies.
    • CHT
      Hi "firstimeuser".... let's see what "WilsoinAus" thinks but, for what's it worth, I don't see anything in your picture (or description) that looks like herpes..... it actually looks more like a scrape or follicle issue.... maybe even a bug bite.  Also, by the way, the odds of having HSV2 with an outbreak on your testicles is very low.... that is not a typical spot for an HSV2 outbreak.    Have your doctor take a look and if you want some peace of mind, get an IgG antibody test for HSV2 in about 12 weeks (takes that long for antibodies to develop).... but, again, I don't think you have anything to worry about here.... just not seeing anything herpes-related here.    take care....best of luck.
    • CHT
      Hi Marlena..... since you stated you've had "herpes on the lips" then you likely have oral HSV1, which the majority of adults worldwide have... the fact your results for HSV1/2 are positive (at least I believe that's what your results show - I don't speak Polish but, I think I'm seeing your results are positive based on the attachment you included) may simply be reading the fact that you have HSV1.... the question is whether you've contracted HSV2 in your genital area. Your description of symptoms could possibly be related to HSV but, it's difficult to verify with certainty based on your description. You may also have contracted a different type of sexually transmitted infection (STI) or a simple fungal infection.   Your doctor does not believe what he/she is seeing is HSV but, unless your doctor has experience with HSV, they could easily misdiagnose your condition.  You need full STI testing. Do you have the option to travel to a larger city in Poland where you could get an appointment to be seen by a doctor with more experience with STIs?  You really need to have an experienced doctor take a look and run tests to check specifically for HSV2 as well as other STIs.  If they can rule out HSV2 or other STIs then hopefully they can then determine what is causing the redness, itching, and swollen condition.... again, it may not be HSV2 but, you need proper testing to verify.  Have you talked to your boyfriend about all this?  Has he had any symptoms on his genitals that are suspect?  Has he taken any tests to check for STIs?   I hope you can get more definitive testing so you know what you are dealing with and how best to treat it.  If you have any other questions/concerns, please come back and let us know.... I hope this helps a little.... best of luck.... take care.
    • CHT
      Hey Jeremy.... I know only too well that emotional pain you are feeling.... I really do.... and many of us on this site also know that pain.  It's not so much the physical side of having HSV that hurts, it's the stigma and risk of rejection that stings like hell!  You have to do what you think is right as it relates to when you disclose your HSV status when getting to know someone romantically.... I just think it's best to do it relatively early, and certainly before any sexual activity.   Have you looked into dating sites that cater to those with HSV?  I know others have had some luck with meeting partners on these sites.... you don't have to worry about the "disclosure" talk nor would you obviously have to worry about passing along a virus the other person already has.... take a few minutes and search around and see if it's an option you like. By the way, by taking your daily antiviral med and using a condom, your risk of passing along the virus is down around 1.9%.... pretty good odds that if you stick to your regimen you are very unlikely to transmit the virus....keep that in mind when you meet your next girlfriend and need to have "the talk."  That statistic might help calm any concerns about contracting the virus from you. I hope you don't give up.... as tough as it can be to find the right partner, it's still worth trying.... try to stay optimistic and look into some alternate options and see what happens.... all the best.... take care.
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