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In a flurry of tears, a close friend revealed in confidence her panic regarding the herpes diagnosis she had received. Fearful she would never be able to engage in sex again, she began to isolate herself socially. Through education and counseling, however, she faced her demons about the diagnosis and came to realize herpes is a manageable chronic disease and, through safe practices, sexual activity can continue. What she found out is imperative for others to know.

Genital herpes is a sexually transmitted infection that affects about one in five American adults (http://www.ashastd.org). Herpes is a virus of the herpes simplex family that has more than 80 different strains. Eight of those strains are responsible for human herpes infection, with herpes type 2 virus the most frequent culprit. Diagnosis is done through visual inspection or swabbing of the site when lesions are present. Tests are available that can confirm that the herpes 2 virus is present in the blood.

Managing an outbreak

The genital herpes infection follows nerve routes and can invade other areas of the body as well. It is typically contracted through genital mucosa or abraded skin epithelium. It is a silent infection that can lie dormant in the body for a few days or several months to several years after the initial contact. The first outbreak is usually the most severe, with symptoms ranging from fever; swollen glands; leg, buttock, or genital pain; itching or burning on urination; vaginal discharge; or a feeling of pressure below the stomach.Several days after the symptoms disappear, the lesions occur. They appear as a group of bumps or blisters, with a red base in or around the genitalia and rectum. Lesions from the first outbreak may last several weeks, and outbreaks can occur four to five times the first year, with the symptoms and severity decreasing over time as the body generates antibodies. Future attacks usually coincide with stress caused by trauma, fever, generalized body infection, surgery, friction, changes in the immune system, and sun exposure.

Treatment entails keeping the area dry, to allow air circulation to the lesion (cotton clothes are recommended). Avoid topical creams and petroleum-based products that limit air flow. Ice and local anesthetics such as lidocaine help control pain, as do cool showers, salt water baths, and increased fluids. Antiviral drug therapy may also be an option and is available through a physician.

Eating well is important. Avoid foods with arginine amino acid – chocolate, nuts, seeds, caffeine, oatmeal, whole white and wheat flour, coconut, and gelatin. Foods high in lysine (milk products, fish, chicken, beef, vegetables, and brewer's yeast) can help minimize outbreaks and reduce their severity. Vitamin and mineral supplements also help. These include zinc, which helps ward off the virus through stimulation of the immune system; vitamin C, for healing connective tissue; vitamin A, for skin healing; and B vitamins for stress. Bioflavanoids, known as vitamin P, can also assist in warding off infection.

The emotional toll

Feelings of isolation, loss of self-esteem, and concerns regarding loss of sexuality are not uncommon. Open and honest discussion about your condition with your spouse or sexual partner is essential. Once your partner is aware of your infection, be patient. He or she needs time to process the information. There are numerous resources available at sites such as www.mayoclinic.com or www.familydoctor.org that can answer the questions that will undoubtly arise.

Although there is no cure for genital herpes, lifelong management is possible. Through safe sex and other preventive practices, persons affected can lead normal lives.

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Kathleen Caulfield, RN, is a psychiatric nurse at St. Luke's Hospital, New York, N.Y.

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