People hear two things and they panic:
First, that it's a venereal disease.
Second, that it's incurable.
It has driven men and women of all ages to the edges of sanity, to compulsive celibacy, even to suicide. Its existence has destroyed relationships and marriages.
It is Herpes, a sexually-transmitted disease believed to be of epidemic proportions in the U.S. today. Estimates range from 20 to 70 million victims.
In the Washington area alone, there are an estimated 100,000 new herpes victims each year.
Nobody really knows the number for sure because herpes--unlike syphillis and gonorrhea--need not be reported since it is not terminal. For a lot of people, especially men, it is little more than a nuisance.
However, for victims like William Hibbs, "You cannot imagine, how emotionally devastating it can be to hear you have herpes . . . "
Bill Hibbs, 31, is executive director of the Washington area chapter of HELP, outgrowth of a national Herpes research and support organization affiliated with the American Social Health Association. Many of the 45 local HELP groups were founded by victims out of their own despair and frustration that something as ubiquitous and persistent should be treated offhandedly by physicians and researchers.
Indeed, representatives of ASHA express concern not merely with the lack of attention being paid to herpes, but to venereal diseases in general. Wendy Wertheimer, ASHA's Washington representative, notes that syphillis is up 24 percent in women and 58 percent in babies. Penicillin-resistant gonorrhea has increased 400 percent in the last three years.
The federal VD-prevention program, she says, is headed for an $8 million cut. There is only $2 million allocated for research on all sexually transmitted diseases at the National Institutes of Health and only about $9 million altogether. With rare exceptions, medical schools pay VD little heed and research physicians have little incentive to compete for the few grants there are.
The herpes simplex virus is a cousin to the virus that causes chicken pox and shingles, one of those viruses that lurks deep in the cells of nerves where most of the body's defenses cannot reach. There can be long periods between recurrences of herpes. Some people have no recurrences at all. Others have them monthly or more often. Four or five outbreaks a year are considered average.
There are actually two herpes simplex viruses. One, which has traditionally caused cold sores, has afflicted mankind for as long as it has existed. The second virus--the one that has been associated primarily with sexual transmission--causes sores in or around the genital area. However, most recently, the cold-sore variety has shown up in the genital area, and vice versa.
Sexually-transmitted herpes has been around a long time too, but it is only since the mid-'70s, with the wholesale loosening of sexual strictures, that it has exploded into an epidemic.
Herpes manifests itself in sores, sometimes excruciatingly painful, in the area where the virus first entered the body. When the sores are present, and just before, the person is "shedding virus," which means he or she is very contagious. When there is no outbreak, there is no contagion.
Even during an outbreak, because the virus can live only on a human host, it is virtually impossible to transmit herpes any way other than by direct contact. Herpes can be transmitted by sexual contact, by kissing, by hand. Virus from a cold sore can be transmitted to an eye where it can blind the victim, or to a baby where damage can be even more devastating.
Pregnant women with active herpes can transmit it to infants as they are being born. In infants the virus is virulent and systemic. Half the time the baby will not survive much longer than a week. Survivors are often brain damaged or otherwise handicapped.
If an outbreak of herpes occurs within a month of a woman's due date, a cesarean section is the only safe alternative. Even then, because some women show no symptoms and may not know they have herpes, an infant may be infected. According to Hibbs, 3,000 infant deaths last year were attributable to congenital herpes infections.
Herpes thrives when a person's immune system is weakened through such illnesses as hepatitis, or when suppressed by chemotherapy for cancer or to prevent rejection of a transplanted organ.
Women who have had herpes blisters on the cervix are at greater risk of eventual cervical cancer (and should have Pap smears every six months). And for some victims the outbreaks themselves are so painful that hospitalization may be required.
Don't believe the ads. There is nothing around yet that is going to clear up a herpes outbreak or kill the virus. Some purported cures can be self-destructive. For example, anything in an oil base (such as Vitamin E ointments) can spread the painful blisters and exacerbate the attack and recurrences.
On the other hand, herpes (the outbreaks of which can be stress-related) is notoriously susceptible to placebos. If a person thinks a nostrum will clear up his outbreak, it just may, although what works for one may not work for the next.
However, there are promising products, among them:
Acyclovir--May be on the verge of FDA approval in a topical form. Acyclovir administered intravenously has been shown to prevent herpes in immune-supressed cancer patients; scientific studies on the topical product suggest it will be effective as a control, although not a cure.
2-Deoxy-d-glucose--In experimental use at a Philadelphia eye clinic. Preliminary trials suggest that if a person is treated during the first three days of the first outbreak, the chance of recurrence is greatly reduced, or at least lessened in duration and severity. (The Washington area HELP organization can refer some people to the Philadelphia clinic.)
Interferon--The best hope for a real cure. The still-scarce and fearsomely expensive natural substance enhances a person's own immune system. So far most interferon studies involve cancer, but a Houston researcher reported this week that because interferon blocks a gene of the herpes virus it could prevent it from becoming chronic.
Some things that may help alleviate pain and suffering in the short haul (but won't lessen contagion and only sometimes promote temporary healing):
* Meticulous personal hygiene.
* Loose-fitting, cotton underwear.
* Use of a hair dryer to dry open lesions.
Herpes victims realize quickly that harboring the virus is, obviously, a hindrance in intimate relationships. But, Hibbs maintains, it can be "a sexually maturing experience. I know I will put myself at a disadvantage by telling someone about it. I would rather develop a relationship--date and court somebody--and then tell them and hope to get a positive response."
But, he says, "I feel there is a moral obligation to tell someone you care about that you have it, that you will do everything you can to protect the partner, but that there can be no guarantees. (Sometimes there is a pre-outbreak tingling in the area the blisters will appear.)
"The main thing is," says Hibbs, "if you see a lesion on yourself--abstain. On the other hand, if you see a lesion on your partner--get a headache." illustration: "Herbie" (Reprinted with permission of the Philadelphia HELP chapter)