Dealing with herpes, Nutrition Nerd-style (Part one)

While there are worse viruses a person can acquire, few have the stigma of herpes. Because this sexually transmitted disease isn’t generally life threatening like HIV/AIDS, it gets viewed more as an embarrassment. Yet, because it can’t be cleared up with antibiotics the way chlamydia and other bacteria-based STDs can, it’s also a life-long burden that can lead to seemingly random bouts of embarrassing discomfort. It can also make dating somewhat of a challenge.

While I can’t give you relationship advice (Actually I can, but that’s a topic for a different blog), I can explain exactly what herpes is, how it’s treated, and how you might best manage it.

Before we start, in case you’re wondering why I decided to write a two-part blog on this slightly left field topic, there are two reasons. The main reason is because I feel like it. To paraphrase Lesley Gore, it’s my party and I’ll write about communicable diseases if I want to. The second reason is that I have HSV-1—the oral “embarrassing cold sore” kind. But I haven’t had an outbreak in years—without pharmaceuticals—thanks, in part, to the knowledge I’m about to throw down here.

What, exactly, is herpes?

Just so we’re all on the same page, herpes is best described as recurrent viral infection of the skin or mucous membranes characterized by pus-filled little blisters frequently occurring about the mouth, lips, genitals, and conjunctiva and cornea that  burst into a crusty scab that take, like, forever to go away. (Technically, it has an incubation period of 2 to 12 days, average being 6 or 7 days.) The blisters are typically preceded by a tingling sensation for a day or two.

Other symptoms include swollen lymph nodes in the proximity of the affected area, given these little immune system HQs are hard at work trying to deal with the attack.

Long story short, there’s no cure for herpes. Like all viruses, herpes doesn’t have cells. It’s typically just a strand of DNA or RNA coated with a protein shell. It reproduces by invading living cells and using their “cell machinery.” When it’s not doing this, it’s simply an inactive chemical structure, most likely hanging out in your sensory or autonomic ganglia (nerve cell clusters), waiting to be triggered into action. As we’ve learned from The Walking Dead, it’s a challenge to kill something that’s not alive, so while there are some anti-viral drugs out there, viruses are a much tougher target than bacteria, which has all their own cells, allowing them to be killed using antibiotics.

How you probably got herpes.

While there are over 70 viruses in the Herpes viradae family, let's focus on the herpes simplex virus (HSV), of which there are two types:  HSV-1 and HSV-2. HSV-1 is spread via saliva. Kissing, sharing utensils and cups, even sharing a razor can spread it. I’m guessing I got mine from a shared can of Coke—yet another reason soda is bad for you.

HSV-2 is contracted through sexual contact, be it genital, anal, or oral. In other words, no hole can hide from HSV-2.

Until recently, it was thought that HSV-1 manifested itself only around the mouth while HSV-2 was exclusive to the genitals. Au contraire! We now know that either virus can go to either place. So, for example, if you have an HSV-1 cold sore and you go downtown on your domestique,you may make them smile in the short term, but ultimately they could end upwith crotch blisters.

And just because you can’t see it doesn’t mean it’s not there. While contact with an active outbreak certainly increases your chances of getting HSV, it can also be acquired from someone without visible sores.  In fact, many people with either HSV-1 or HSV-2 are asymptomatic, meaning they don’t experience outbreaks--yet they’re still able to transmit it to others. (Apparently, being single in the 21^st century wasn’t stressful enough as is, so nature had to throw this angst-inducing curveball into the mix.)

As is the case with many other sexually transmitted diseases, rubbers help prevent transmission of HSV by up to as much as 50%--but you single fellas out there were already wrapping your rascals. Right? RIGHT?

All kinds of things can trigger an outbreak, including sun exposure, sexual activity, menses, stress, food allergies and other trigger foods, or drugs. Chronic outbreaks are often linked with a suppressed immune system, so when your body is busy dealing with stress or illness, it makes it easier for the virus to slide into the party past your T-cell (a kind of white blood cell that’s your body’s primary soldier in the war against viruses, including HSV).  That’s why they call them “cold sores.”

How your doctor will probably help with your herpes.

There are a few ways a medical practitioner can diagnose HSV. During an active outbreak, direct “virologic” tests from scrapings can determine what type of herpes you have and whether it’s a new infection or you’ve had it for a while and just didn’t know it. (This can be useful in determining who to send a rage-filled text message to after leaving the doctor’s office.) Blood tests are also available, but particularly when testing for HSV-2, false positives are common.

If you do have HSV, your doctor will probably to talk to you about avoiding contact when you’re having an outbreak and about how it’s your responsibility to notify potential sexual partners. He’ll also probably prescribe an anti-viral medication. With oral medication, you can take them daily, hoping to decrease frequency of outbreaks. This is called suppressive therapy. It slows the activity of the virus so the body can better combat it. The other option is to start popping pills at the onset of an outbreak in order to shorten the duration. This is called episodic therapy. Some better known oral antivirals include acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex).

Topical ointments can be used for oral herpes as well, including penciclovir (Denavir) and docosanol (Abreva), which is over-the-counter. The CDC doesn’t recommend topical ointments for genital herpes. I’m not sure why, although putting Vaseline down your pants is rarely comfortable, so maybe that’s a good thing.

Should you use all these medications? That’s your call, man. On one hand, the results you’ll get from antivirals are mixed. On the other hand, while they can have side effects, they seem to be relatively minor, with exception of people with a compromised immune system, such HIV patients, who can build a resistance to antiviral medication. In other words, in most instances, if your doctor prescribes them, I don’t think you have much to lose by using them.

(In part two of Dealing with herpes, Nutrition Nerd-style, we'll discuss what you can do to manage HSV.)