Q.I want to ask you about a very sensitive subject. I get cold sores -- or herpes simplex -- on my mouth about five to 10 times a year, usually when I get chapped lips.
I go crazy when I have them, washing everything that touches my lips immediately. I won't let my husband kiss me, although he has never gotten a blister from me. All the books and articles I read say that cold sores and genital herpes are related, but they never say what I should do to keep from getting genital herpes, or even if it's possible. I'm too embarrassed to ask my doctor.
I also worry that I could give my herpes simplex to my son or the kids I babysit by kissing them. My son is 6 months old and I have trouble keeping either his hands or face away from the sores. I had a cold sore on my face the day he was born and I just cried.
Are the cold sores I get necessarily herpes simplex? And can I give them to my husband, or can he give me genital herpes from intimate contact just before, during or just after I've had a cold sore?
A.Herpes has given cold sores a bad name.
Actually there are five kinds of herpes and almost everyone has at least one of the viruses in their body.
One kind can cause chickenpox and shingles; another causes mononucleosis; a third kind can cause birth defects and then there's herpes simplex type 1 -- oral herpes -- which accounts for most recurring cold sores on the face and in the mouth. The one you're afraid of -- the notorious one -- is herpes simplex type 2, which causes a genital rash, pain, malaise and depression in varying degrees and a lot of basically tasteless jokes, which are hardly funny to the 9 million people who have the problem.
Both types 1 and 2 can be spread only by person-to-person contact when there are sores, and the fresher they are, the more contagious the virus. There also can be a low level of contagion with either type, since viruses can be shed in the mucous of the mouth, the eyes or the genitals, whether there are symptoms or not. But these cases are very rare.
Herpes simplex type 1 is bothersome and the jokes have made it embarrassing, but it's a fairly minor medical problem, shared by 30 million Americans. Although it can't be cured yet, it can be abated, with a doctor's care.
Since you don't want to go to a doctor in your town, call a teaching hospital near you and ask for the name of a virologist. He will type your virus and then test your husband to see if he is immune to your type. If he is, any kind of kissing is all right, any time.
The doctor also will almost surely prescribe an ointment called acyclovir, which can prevent an attack of cold sores, or at least make them less intense and shorten their healing time. This, in turn, often makes the attacks less frequent because the body simply has fewer viruses to worry about.
You'll apply the ointment on the skin when you notice a tingling, burning sensation -- the sign many people have that a sore will erupt there within a few hours or perhaps a day -- and keep using the ointment until the skin clears.
You'll still have to take some precautions when you have active sores.
It's important to keep them clean and dry; to wash your hands whenever you've touched your mouth and to be on the safe side, to use your own towels and drinking glass. Paper cups, or a dishwasher, are also good measures, but that's true in any household with young children.
It's what you must not do that's hard. According to Dr. Henry H. Balfour Jr., a leading University of Minnesota researcher in all types of herpes, you shouldn't kiss your child or any child when you have a cold sore, especially a newborn, for his immunity is low. You also have to keep the children from touching the sores, for they put their hands in their mouths and rub their eyes.
This is why children between 6 months and 4 years get cold sores easily, which can infect their eyes. A chronic herpes eye infection, fortunately rare, can even lead to blindness in one eye.
You don't have to be so careful with your husband, even if he isn't immune. You shouldn't kiss him if you have an active sore, however, and you shouldn't have oral sex then either: Type 1 can be transmitted to the genitals, just as type 2 can be transmitted to the face. In either case, however, the virus would remain true to its type.
For those readers who do have genital herpes, take heart. Acyclovir, in capsules, has been approved by the FDA for type 2 treatment and the medicine has just hit the market. In his research, Dr. Balfour found that the capsules, when taken from the beginning of an outbreak to the end, usually suppress the type 2 symptoms and also control cold sores.
The simplex viruses, which lie dormant most of the time, are often activated because the body, the mind or the psyche is under stress. This may happen after the body is stimulated by a fever, menstruation, birth-control pills, sex, masturbation, poor nutrition, lack of sleep, a low immune system, sunshine, wind and especially worry.
Now that you know about oral herpes, you at least can get rid of that worry.
To learn more about all kinds of herpes, read Herpes Diseases and Your Health, which Dr. Balfour wrote with Ralph C. Heussner (available by sending $14.95 to University of Minnesota Press, 2037 University Ave. SE, Minneapolis, Minn. 55414).