Dear Anne, My girlfriend and I have been exclusive all summer, and I thought things were going great... until painful red blisters showed up on my penis. The doctor told me it's genital herpes. My girlfriend swears she's clean and hasn't cheated on me, and I don't know what to think. Is she lying? What should I do? Is this ever going to go away?
--John
Few things throw a wrench in relationships quicker than a case of herpes. But before you go and incinerate the contents of your summer love's closet and post her picture on Fugly.com, you'd benefit from a few of the facts behind your penile problem.
First, herpes is incredibly common, and more people have been exposed to this virus than they realize. There are two types of herpes that infect humans: HSV-1 and HSV-2 . The first is pretty much ubiquitous since a great majority of the U.S. population has come in contact with the virus at some point in their lives.According to the 2005 edition of the medical bible, Current Medical Diagnosis and Treatment, 85 percent of adults have antibodies to HSV-1 in their blood. This type of herpes is most often picked up in childhood and is associated with shallow, painful blisters in and around the mouth. Not everyone with exposure is symptomatic, although 20 percent to 40 percent of the folks in this country suffer from recurrent oral HSV-1. The infection stays dormant most of the time but can flare up periodically, often with exposure to stressors such as wind, sunlight, fever, trauma and menstruation (in case women needed something else to cry about while they're PMSing). Interestingly, infection with HSV-1 provides some protection against HSV-2, so perhaps there is a positive spin to those unsightly lip lesions that so many people complain about!
While it classically manifests orally, HSV-1 can also infect the genital areas, most likely as a result of oral sex with an infected partner (and you thought your sex ed teacher was talking nonsense when she told you to use dental dams!). About 20 percent of cases of genital herpes are thought to be acquired this way, though CMDT argues that this number may be approaching 40 percent due to shifts in sexual practice.
Although HSV-1 is increasingly implicated in below-the-belt herpes, HSV-2 is still the culprit in the majority of genital outbreaks. It typically infects sexually active adolescents and adults, and the CMDT reports that more than a quarter of the U.S. population has antibodies to this type of the virus by age 30. What most people don't realize is that only a third of those infected show symptoms. Thus, the majority of individuals harboring the virus are oblivious to their infection.
We once thought that herpes could only be transmitted when lesions were present, but unfortunately for you and your penis that's not the case. Virus can shed from perfectly normal-appearing skin, which means that you can get genital herpes from someone who has never had a outbreak in her life and has no idea that she is infected. In fact, most cases of herpes transmission happen this way. Few people come into a clinic and say, "Yeah, my partner had a raging case of herpes, but I figured what the hell, you only live once!"
Like you, most folks are absolutely floored that they've been exposed. It's not unheard of for someone with a mutually monogamous partner to present with new lesions several months into the relationship. According to the CMDT, about 10 percent of non-infected partners in such a relationship will seroconvert, or develop herpes antibodies, during a one-year period. There are even legends of people who come in with new lesions after decades in a faithful marriage. Though this isn't common, it's certainly possible.
The bottom line is that your current herpes outbreak doesn't necessarily tell us how or when you acquired the infection, which means we can neither prove nor disprove that your girlfriend is lying. What's more, there's no great way to screen people for herpes, because a positive HSV antibody test doesn't guarantee that you'll ever have an outbreak or even pass the virus on asymptomatically. Treatment options are similarly disappointing: There is no cure for herpes. Much like the unfortunate "I *Heart* Pabst" tattoo that you picked up on a rough night in Vegas, herpes will be with you for life. The good news is that first outbreaks are typically worse than subsequent ones, and over time they tend to decrease in frequency.
So why all the flare-ups, and why can't we get rid of herpes? First, it's a virus, so antibiotics, which target bacteria, are totally useless against it. What's more, herpes is a bit like the Taliban of STDs: It has learned to hang out under your defense system's radar.
One of the places herpes evades your immune system is the superficial skin, where it's currently causing those pernicious little blisters on your penis. When you're not having an outbreak, the virus is tucked away in another great hiding place: your nerves. Because it's not under heavy immune surveillance, the nervous system serves as something of a Tora Bora for this sexually-transmitted terrorist. The hidey-hole of choice for HSV-1 is in a nerve in your face called the trigeminal ganglion, while HSV-2 cozies up in the sacral ganglion near your nether regions. The virus can sit here quite happily until you're old and gray, creeping down nerves periodically to cause lesions and remind you that you've still got company. And you thought the Pabst tattoo was bad.
Bleak as this lifetime of viral cohabitation may seem, don't despair. Yes, you've got herpes, and no, you're not going to get rid of it. There is, however, a treatment that can help keep the virus in check. With this first outbreak, your doctor will want to calm down the symptoms with seven to 10 days of an antiviral drug. Because recurrences tend to be much less severe, you won't necessarily need any drugs in the future. If you have extremely frequent or severe outbreaks after this one, you and your doctor may decide that you should take daily antivirals to help keep the virus holed up in your sacral ganglion as much as possible. While condoms don't eliminate the risk of transmitting herpes, they will certainly go far to help decrease it, so don't forget to wrap it up to spare your partners of similar flare-ups!
These protective measures are important because unfortunately, painful penile lesions are child's play when compared to the true pathogenic potential of the virus. If herpes spreads to the eye, it can devastate the ocular tissues, impairing vision. When HSV creeps deeper into the nervous system it can lead to a potentially deadly brain infection called herpes encephalitis. One of the most feared complications of genital herpes is neonatal infection after a baby acquires the virus during delivery. Since babies haven't established much in the way of immune defenses, the virus is no longer confined to sneaking along skin and nerves and can rapidly disseminate, wrecking havoc on multiple organs and potentially killing the newborn. For this reason, any woman in this country with active genital herpes symptoms is automatically given a C-section. As you might imagine, immunocompromised adults such as HIV-positive patients or transplant recipients are similarly susceptible to disseminated disease. Thankfully these complications are rare, but they certainly reinforce the importance of doing your best to control your herpes and avoid transmission to your partners.
Anne Mills is a Cavalier Daily Health & Sexuality Columnist. She can be reached at mills@cavalierdaily.com or through the Sex & Balances submission page at cavalierdaily.com/sex.asp. This column should be used for educational purposes only and is not meant to substitute advice from your doctor.
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