It does get better with time!

Historically, the natural course of the herpes virus seems to be one of getting better with time. This most likely occurs due to decreased stress in general as years go by. When placed in black and white, it would seem more understandable as to why this occurs. As people get older there is a greater satisfaction with life.  You’re not placed under nearly as much stress as say a young parent with a new mortgage, a car payment, an unstable job and all the stress daily living brings with it. This marked decrease in stress seems to decrease the stimulation to whatever it is that may be enticing recurring outbreaks.

What Could be Triggering Recurring Outbreaks?

Recurring outbreaks are most often triggered by emotional stress. Stress tends to activate the autonomic nervous system, and perhaps increase your body’s production of adrenalin or other neurotransmitters that can play a key role in recurring outbreaks. It should also be considered that stress can and does affect the bodies natural immune system, such as T-cells or antibody levels. Many people living with herpes have reported outbreaks occurring most often when their immune system is challenged by cold, flu’s or other common sicknesses.

Based on the stories of those living with herpes and not the scientific evidence or lack thereof, it is almost certain that reducing the stress in your everyday life can have a dramatic and positive affect on the individual with genital herpes.

Other triggers will be mentioned below in the herpes diet section.

How does one go about living with herpes?

It is known that patients benefit from a "whole life" approach to managing genital herpes. This begins with understanding the virus and its complexity, what is known recurring outbreaks and finding what causes your own outbreaks and incorporating these factors into managing herpes.

Positive living with herpes begins with the person learning to closely watch and monitor symptoms and to treat them promptly.  It may take a bit of experimenting to find a regimen that works for you, but it can be done. Studies have shown that as many as 80% to 90% of people that are infected with HSV do not have outbreaks or any “recognizable” symptoms for that matter. However, it has also been shown that 60% of these people without obvious outbreaks do have some symptoms; they are just not as clear-cut as most textbook symptoms.

Common sense should tell anyone living with herpes to shower at least daily, maybe twice daily when symptoms are present, and to wear clean clothing that is changed regularly, especially when symptoms are present.

Use a clean washcloth each time with warm soapy water. Once the washcloth has been used on the infected area, it should not be used on any other part of the body and should be placed in the laundry for washing with a hot water and detergent. So during the shower, it would be wise to wash the area of the outbreak last.

Once blisters are broken, they should be cleaned with soap and water.  This will help kill some of the active viral fluid that may be seeping from the lesions and help promote healing.

Many who live with herpes have suggested keeping the area as dry as possible.  Wear lose clothing that may allow air to reach the lesions.  Some have also suggested using products such as cornstarch to increase dryness.

The herpes virus cannot live off the human body for more than a few seconds.  So transmitting the virus via inanimate objects such as toilet seats or sharing a bed is not likely.

Prescription Medications

Studies have shown and those living with genital herpes have claimed that genital herpes is very well controlled in by using anti-viral medications. Three medications are available: Acyclovir, Valtrex and Famvir. Other prescription medications can be used in patients with viruses that are resistant to those drugs above, though viral resistance to acyclovir is exceedingly uncommon.

New evidence has shown that the use of Valtrex, and possibly other anti-virals such as acyclovir, not only dramatically diminish viral shedding and is likely to prevent, or decrease, transmission of herpes to partners.

People with genital HSV might want to consider suppressive therapy with antiviral medication if they are in intimate relationships, especially with partners who don’t have herpes.

Just Plain Tired!

When people get tired, their bodies have to work harder to keep going. Fatigue makes the nervous system work harder. In genital herpes, the herpes virus lives in a little part of the nervous system down at the bottom of the spinal cord called the "sacral ganglia". Since the virus is part of the nervous system, the activity of the cells containing the virus is increased. This is most likely the reasons that exhaustion can increase outbreaks.

For those who believe that fatigue is linked to recurring outbreaks, it’s suggested that proper sleep habits be established.  There have been several studies that have proven that the vast majority of humans require about eight hours of restful, non-modified sleep (no sleep aids), including REM sleep.

What Stress?

Most people experience frequent recurring outbreaks associated with high levels of stress, the sort of stress that triggers intense emotion. Such emotions include anger and fear. Difficulties in relationships worry about personal finances just to name a few.  These types of stresses can lead to recurring outbreaks and in some cases more frequent recurring outbreaks.

People with herpes infections must learn to control these higher level stresses. It is recommended that if recurrences do take place, the patient should look carefully at the stresses in life to determine if changes need to be made. Whether through counseling, refinancing, eliminating debt or just ignoring the phone, changes need to be made.

Clothing Suggestions

Many people with herpes have found that tight clothing, especially undergarments, can stimulate recurrences. It is reasonable for the person suffering with frequent recurrences to at least make sure that garments in the pelvic area are not constricting.  There’ve been many women say that cotton undergarments are best as is eliminating the wearing of pantyhose.

Sun and UV Exposure

Ultra-violet light exposure is known to re-activate oral herpes infections. Anyone living with herpes should avoid UV light exposure as much as possible, or certainly use a sunscreen of Factor 25 or higher on the face prior to UV exposure, it’s not a guarantee that it will eliminate recurring outbreaks and may take a much stronger sunscreen or lesser time in the sun, but that’s up to the person to find what works best for them.

If someone with frequent genital herpes recurrences happens to be visiting a tanning booth without clothing, it would be recommended to terminate or reduce these tanning visits.

Herpes Diet

Some people living with herpes have reported the benefits from diets with elevated lysine levels and decreased arginine levels. Research in this area does not support this suggestion for all patients suffering with herpes. However, lysine supplements are readily available at any health food store or pharmacy.

Some people have increased outbreaks due to excessive amounts of alcohol and/or caffeine. Progressive withdrawal of either or both might be considered in a patient with frequent recurrences.

Other people living with herpes have found a connection between recurring outbreaks and chocolate, nuts and rice, just to name a few.

It might be worth keeping a journal of your food intake just to rule out the food related possibilities that may be linked to recurring outbreaks.

Without a Prescription

Many herbal products have been shown to have properties that may benefit some people with herpes infections.

Some products are known to have anti-viral effects. These include red marine algae, olive leaf extract, melissa, and garlic.  Others have reported a simple regimen of daily vitamin C has helped in their controlling herpes outbreaks.

Immune system stimulators include Echinacea have been reported as having benefit to many people with herpes, both oral and genital.

Topical Treatments

Some chemicals have been shown to have antiviral qualities. These include rubbing alcohol, various essential oils, and lemon balm.  Of course as a person living with herpes, I’d consider rubbing alcohol to be my absolute last resort.

Recommended Non-Prescription Treatments

Intimate Partners with Herpes

Many combinations of partners with and without herpes exist. Sometimes one partner has frequent oral outbreaks only. Perhaps one partner has frequent genital outbreaks. Sometimes both partners have genital herpes while other cases may be one partner has type 1 herpes in the genital area and another partner has type 2 herpes in the genital area. How are recommendations made in these various settings?

To start, the you must remember that it is apparent that any area of skin that has ever been infected with herpes simplex has the possibility of shedding herpes virus out of that area of the skin even when there are no visible symptoms. So, just because a man who has had genital herpes has no obvious symptoms, he may still be shedding virus from the penis. Semen does not carry the herpes simplex virus.

The same consideration holds true for a female that has genital herpes but does not currently have symptoms. She may be shedding virus once in awhile or frequently. It is impossible to know when someone is having this "asymptomatic shedding.”

One of the most common issues of concern is that of performing oral sex when one or both partners having genital herpes. It is a fact that a person who performs oral sex on another person with genital herpes can catch the infection on the mouth. On the other hand, more than 80% of Americans have oral herpes infections, almost always type 1 herpes simplex, though many of these infections are not obvious due to the absence of outbreaks.

Thus, it is important to understand that no clear signal can ever be given that it is completely "safe" for a person to perform oral sex on a partner with genital herpes. This means that the person performing the oral sex might catch the infection on the mouth.

It is not uncommon for oral herpes infections, usually type 1, to be transmitted to the genitals of the partner. This is a common occurrence and is growing to be more and more common, with the incidence of type 1 herpes in the genital area being quoted as low as a few per cent to as high as thirty per cent or more of new cases of genital herpes. So, someone who has oral herpes infections should use caution regarding performing oral sex upon an intimate partner.

A man could wear a latex condom which should, if it remains unbroken, prevent transmission of oral herpes infections to the penis or genital herpes to the mouth. A woman has other options. The woman could place Saran Wrap over the vaginal/clitoral area to prevent either transmitting virus to the mouth of the partner if she has genital herpes or to the vaginal area if the partner has oral herpes.

One quick word about types of condoms is important here. The condom should be latex, not a natural membrane such as "lambskin", which is porous which allows the virus to pass through. Also, the condom should be lubricated, so that friction is diminished. Friction is another common cause of recurring herpes outbreaks.  Spermacidal lubrication should be avoided since it can possibly cause irritation of the skin.

A device known as a "dental dam", is available for females with genital herpes to wear while oral sex is performed upon them. This is a square piece of latex that covers the vaginal area and provides a barrier to transmission to the mouth of the intimate partner. As long as the barrier remains unbroken and as long as the outside of the dental dam does not get wet with vaginal secretions, the dental dam should be a useful tool to decrease the risk of transferring genital herpes to the mouth of the intimate partner. The dental dam might also offer some protection to the genitalia of an uninfected female from oral sex performed by someone with oral herpes infection. If a dental dam is not available, a latex condom can be cut lengthwise and used to cover the vagina and clitoral area.

If one partner has genital herpes and the other does not, latex condoms offer the highest degree of protection, though nothing should be considered 100% effective. However, the condom must remain unbroken, must remain in place, and it must cover all areas of the penis that might touch the vagina. Obviously the condom would not protect the scrotum, fingers, or other areas of the male partner’s body if the female is the infected partner.

In many couples both partners have genital herpes.  If both partners have been properly tested for herpes and are fully aware of their type, there’s little risk of re-infecting, if at all.  There has been some speculation that a person with type 1 can contract type 2 while on the other hand a type 2 infection is believed to offer resistance to a type 1 infection.

Herpes infections occur when the virus is transmitted through a broken area of the skin. Recurrences occur in the same place where the virus first broke through the skin or in other areas served by the same nerve cell. It is possible that when both partners have genital herpes that one partner might insert the infection into additional areas on the partner’s genitalia, causing other areas where recurrences can occur. However, the true risk of this is unknown at this time.

So, it is reasonable that in intimate partners where both have genital herpes, consideration should be taken to avoiding very aggressive intercourse, to consider using latex condoms, and to certainly avoid having sexual intercourse when any partner is having symptoms. As mentioned above, consideration should also be given to the partners being on medication to help prevent or reduce virus transmission.

Where do I go from here?

It has been shown previously that most people with genital herpes shed virus from time to time, sometimes very frequently and sometimes not. Anna Wald of Washington State Herpes Research demonstrated several years ago that acyclovir decreases viral shedding by over 80%. This should imply that the drug, when taken faithfully, may make the partner with genital herpes less contagious. The fairly recent study completed by GlaxoSmithKline on the antiviral drug Valtrex has shown an approximate 73% reduction in risk of transmission of the virus from the infected partner to the non-infected partner.

The author does know several couples personally where one has herpes and the other does not or where each have a different type.  In each case, the virus has NOT been transmitted to the uninfected partner.  It is a common belief in the herpes community and among those couples where one has it and the other does not, that communication is the key ingredient in minimizing the risk.

Each couple discussed above is married and have chosen not to use suppressive therapy or condoms.  Why and how this is preventing the transmission is unknown, but it obviously works.  Many have stated just taking the time to know their own body, know their symptoms and their triggers is enough to protect their partner.

Perhaps, in the near future, new scientific and formal recommendations regarding partners and intimacy will be forthcoming in the setting of one or both members having genital and/or oral herpes.

Current studies on possible vaccines are being conducted.  It’s realistic to think that a vaccine may one day be available to prevent uninfected partners from catching an infection. Perhaps, too, vaccines will even help people to be able to decrease or eliminate recurrences of the infections.  We can only hope.