Twenty years ago the cover of Time magazine propelled herpes into the national consciousness with an allusion to The Scarlet Letter: the image of a giant red H. Suddenly, the dread disease became all the talk of the town, the fear of the day, and the butt of jokes (remember The Big Chill?)
Pretty soon, however, AIDS bumped herpes out of the spotlight. After all, herpes doesn't kill, and it soon lost some of its sensationalism. Since that initial media frenzy, however, not much has been written that would alter whatever perceptions were formed at the time. Having herpes is still a stigma, largely due to a lack of knowledge.
Many people believe that no one they know has herpes, that it's reserved somehow for some imagined lower class. But the fact is, one in four or five Americans over the age of 12 has genital herpes: That's 45 million people. Each year sees one-and-a-half million new cases. Yet 80 percent of the people with herpes don't know it, either because they don't recognize the symptoms, or because they attribute those symptoms to some other cause (yeast infection, jock itch, ingrown hair, hemorrhoids).
The disease, however, is a biological occurrence, not a moral one. It knows neither social, economic or educational distinctions. Doctors, lawyers, teachers, truck drivers, social workers, teenagers, grandparents and parents -- in short, anyone having sex with someone other than a lifelong, monogamous partner can contract herpes.
Herpes is neither new nor rare: Its symptoms were described in writings from 3000 B.C. But it took 20th-century science to realize that it's caused by a virus and is infectious. And it wasn't until the 1970s that it was recognized as a sexually transmitted ailment.
The term "herpesvirus" refers to a group of viruses that include those that cause such diverse afflictions as mononucleosis, chickenpox, shingles, cold sores (or fever blisters) on the face -- and genital herpes. Unlike bacterial infections, which can usually be controlled with antibiotics, most viral infections can't be treated. The common cold and intestinal viruses are classic examples. There are two closely related types of herpes simplex virus:
HSV 1 generally operates above the waist and causes common facial cold sores;
HSV 2 usually affects the genitals. Both types thrive in the soft, moist skin found in those areas of the body. The thicker skin of arms, legs and hands doesn't generally support transmission. If you've touched an open sore, however, be sure to wash your hands before touching your eyes. What's more, both HSV 1 and 2 can sometimes "cross over" to the other area.
A person with a fever blister on the mouth can transmit the virus via oral sex, and the reverse is also true. Condoms can reduce the risk of transmission, but since the lesions can occur on areas not covered by a condom (such as the scrotum), even prophylactics don't provide absolute security. To avoid transmitting the disease, it is essential to abstain from sex not just during an active outbreak, but also during the "prodrome" or warning period preceding an outbreak, and for some time afterward.
First episodes are likely to be the most troublesome and uncomfortable. Later, the body's immune system learns to recognize the intruder and is able to fight back. Even after healing, however, the virus remains in a latent state in a bundle of nerves at the base of the spine. Various often unpredictable biological triggers -- such as stress, sunburn, vigorous exercise, the friction of sex, or certain foods -- may cause it to become active again. The number and severity of outbreaks varies with each individual, but the disease will remain in the body.
Sometimes equal to, or even exceeding, the medical debilitation caused by herpes is the emotional trauma experienced by the victim. Even the most confident and well-adjusted individual is likely to be shaken up by a herpes diagnosis. Some people with low self-esteem are even led to consider suicide, believing that their sex life is over and no one will ever desire them again.
Doctors' attitudes can be unhelpful, too, since many professionals regard the virus as inconsequential compared to AIDS, hepatitis or other life-threatening illnesses. Getting accurate information; talking to a medical professional, counselor or trusted friend; and having time to adjust to the idea can all be helpful. Telling a potential partner and answering their questions supports informed choices and mutual decisions about how to prevent transmission.
Misinformation abounds on the subject, especially on the Internet. One should be particularly skeptical of sales pitches for products that claim to cure herpes. Reliable information sources include www.ashastd.org, the Web site for the American Social Health Association (a private, non-profit organization dedicated to education about and prevention of sexually transmitted diseases). The National Herpes Hotline ( 919-361-8488) is another valuable resource. Attending a local support group can be an excellent way to talk with others in a safe and understanding environment where you can share your concerns.
Asheville's local support group Mountain HELP meets the first Tuesday of each month. Contact: firstname.lastname@example.org or call 669-5118.