Genital herpes: a hidden epidemic

FDA Consumer, March-April, 2002 by Linda Bren

Most people diagnosed with HSV-2 affecting the genital area typically have four or rive symptomatic recurrences the first year. After the first year, most people have fewer and milder recurrences, lasting a week or less. Many people get warning signals of a recurrence, known as prodrome. With prodrome, there may be a tingling or itching in the genital area, or pain in the buttocks, down the legs, or in the lower back. Sometimes these symptoms go away and no lesions appear.

Phinney's outbreaks were so frequent that they made him irritable, he says. "I would get an outbreak, and as that outbreak was fading over a week or so, suddenly a new one would crop up. As a result, I was really only `clear' for as little as one week a month."

Researchers don't know why recurrences happen, or why their frequency and severity vary. Some people report that recurrences are triggered by stress, illness, poor nutrition, menstruation, and friction in the genital area, such as that caused by vigorous sex. However, many of these supposed triggers have no scientific basis, says Ashley. "You can't say stress is a trigger. It's like the chicken and the egg. Which came first--the herpes or the stress?" Nevertheless, for many people, trying to avoid their triggers seems to work for them, says Ashley.

Stress is a "huge factor" in triggering outbreaks for Pat Adams of Washington, D.C. Adams has had genital herpes for about 20 years. "Anything I can do to calm myself down during a stressful period and take better care of myself can help," says Adams. She finds that a good diet and exercise help her to keep the virus in check.

Asymptomatic Shedding

In many instances, people with genital herpes know the virus is active because they have symptoms, such as lesions. But this isn't always the case.

The herpes virus can become active without causing symptoms. During these times, small amounts of the virus are present on the skin, often at the place of first infection. This reactivation without symptoms, known as "asymptomatic shedding," may also occur in rectal tissue or in fluids from the penis and vagina.

"Even if you're asymptomatic, you can transmit the virus," says Stanka Kukich, M.D., a medical team leader in the FDA's Center for Drug Evaluation and Research. In fact, studies have shown that most people get HSV from sexual contact during rimes of asymptomatic viral shedding.

Researchers have found that people with HSV-2 genital herpes tend to have more shedding than those with HSV-1. In addition, people with new infections are more likely to shed the virus than those with an infection more than a year old. Those with frequent recurrences may also shed the virus more often, but this is still an area being studied.

Transmission and Prevention

Genital herpes is spread only through direct skin-to-skin contact or mucous membrane contact. It can be transmitted through penile-vaginal intercourse, anal intercourse, oral-genital sex, and other sexual body-to-body contact.

To reduce the risk of transmitting genital herpes, people who have the virus should avoid sexual contact from the time they first feel any symptoms until their lesions are completely healed. During times when there are no symptoms, using latex male condoms for genital-to-genital contact reduces the risk of transmission, according to the American Social Health Association. But condoms are only effective if they cover or prevent contact with the area of the body that has a lesion or active virus.