Herpes; drug eases symptoms, but still no cure - acyclovir

FDA Consumer, April, 1985 by Bill Rados

When genital herpes began to grab the attention of the American public in the early 1980s, the fear and loathing this venereal disease evoked were mainly due to its incurable, and even untreatable, nature. Now, after being discussed on virtually every talk show and written about in thousands of magazines and newspapers across the country, the uproar over this "epidemic of the '80s" has dminished somewhat. But the fear and loathing remain, as does the search for a cure.

Progress has been made, however, in finding effective treatments for this disease, which afflicts millions of Americans, with some 300,000 new cases every year. This past January, the Fodd and Drug Administration approved an oral form of the anti-virus drug acyclovir, which had previously been available as an intravenous solution for hospital use and as an ointment. The oral medication is approved not only for the treatment of initial genital herpes infections, as are the intravenous and ointment forms, but also for treating and suppressing recurrent genital infections.

Genital herpes is the third most common form of venereal disease in the United States today, behind chlamydial infections and gonorrhea. Unike chlamydial infections, gonorrhea or syphilis, genital herpes cannot be cured by antibiotics, because it is caused not by bacteria but by a virus. In most cases, the culprit is herpes simplex virus Type II, although about 15 percent of the cases are caused by herpes simplex virus Type I, which more commonly is the cause of oral herpes--not a venereal disease. Herpes simplex Type I is extremely prevalent throughout the population. Blood tests to detect the presence of herpes-fighting antibodies show that most people have been infected with Type I virus by age 50, with some 30 million Americans suffering from the resulting cold sores, fever blisters, eye infections, or other symptoms.

Both types of herpes simplex viruses are members of a larger family of herpes-viruses that cause several diseases in men and women, young and old, even children. To date, five human herpesviruses have been identified. Besides the two herpes simplex viruses, they are: varicella zoster virus, which causes chicken pox in children and shingles in adults; Epstein-Barr virus, which causes infectious mononucleosis and some other less common syndromes; and cytomegalovirus, which can cause birth defects and potentially life-threatening problems in organ and bone Marrow transplant patients.

Genital herpes is a lifelong, sexually transmitted disease that has a tendency to recur again and again. It is characterized by blistery, fluid-filled sores around the genital organs. Once the virus enters the body, an active infection may develop. These first cases of herpes are generally the most severe. After the initial episode, the virus becomes latent, retreating to nerve cells near the spine. The virus may emerge at any time and cause renewed outbreaks, usually at the original site of the infection.

During the initial infection the symptoms usually appear a few days to three weeks after sexual contact. However, some infections can occur without symptoms, or the symptoms may be so mild that they are not noticed. Typically, the first signs include itching or numbness in the genital area, a burning sensation during urination, and a discharge from the vagina or penis. These are followed by headache, fever, muscle ache, and swollen glands in the groin. About 10 days later the painful blisters appear, and it may take two to six weeks for them to crust over, scab and heal.

In recurrent cases, warning signs, such as itching, burning, tingling and numbness, may precede the development of blisters by only a few hours or a few days. Recurrent attacks are generally less severe and last about 10 days. They can, however, be severe enough to mimic the original outbreak in some people. What causes the herpesvirus to move back down the nerve pathway and instigate a new episode of the disease is unknown. But many factors are considered possible triggers, including emotional stress, lack of sleep, poor diet, upper respiratory infection, sexual intercourse, or menstruation. In addition, wearing tight clothing, such as jeans, may provoke a recurrence. In many cases, recurrences appear without any obvious "trigger." Most people who have genital herpes experience one to six of these outbreaks a year, although some may get them at least once a month. A small percentage of people never have recurrences.

Herpes sufferers are most contagious when symptoms are present. Contagion results from "shedding" of viruses, and this typically occurs when the virus is reproducing itself in sufficient quantities to produce sores. Live viruses present in the blisters can be transferred from person to person through direct contact, almost always sexual contact. (Oral sex also can transmit the virus from one location to another.) However, a person can sometimes shed viruses without having sores. This may explain why some people can acquire the disease from those with no evidence of infection.