Never Be the Same Again

Never Be The Same Again
Glenn Knight
Protected by the anonymity of the Internet, they reach out to the world trying to find comfort and understanding from those who share their affliction.

"I have to admit I’m not coping very well with the fact that I have this incurable virus and it’s not ever going to go away and I’ll never be the same person again."

The incurable virus referred to by this anonymous poster in an Internet forum is the herpes simplex virus (HSV). Often the victim of misinformation and ignorance, estimates currently put the number of people infected with genital herpes at more than one in five worldwide.
Dr Angela Cooney, Medical Director for Family Planning WA Sexual Health Services endeavours to put this number into perspective.

"There is a lot of ignorance about HSV and ignorance equates to fear. The majority of those who carry HSV 2 have no idea that they do! So ‘how to relate to those who have it’ is awkward when no one knows who has it!" she says.

The herpes simplex virus can exhibit itself in two ways. HSV-1 most commonly exhibits itself around a person’s lips as cold sores. HSV-2 is usually found around the genital area.

However, the virus isn’t mutually exclusive to those areas, with it possible for HSV-1 to occur in the genital region and HSV-2 to exhibit around the oral area. Herpes infections are primarily exhibited by the presence of sores or lesions around the aforementioned regions.

Once the virus has infected a person, the virus travels through the bodies’ nervous system until it settles in the base of the spine where it can lay dormant until another outbreak occurs. There is currently no known cure for the virus and the frequency of outbreaks (exhibiting symptoms) varies from person to person.

A recent study completed by the University of Otago followed 884 participants from an original 1000 sample, born in 1972 or 1973 in Dunedin, New Zealand. The 35-year longitudinal study has found that men aged 26 to 32 have twice the risk of woman the same age of contracting the virus.

The study published in the Sexually Transmitted Infections international journal, attributes these findings in part due too, as we age there is a higher likelihood of coming into contact with an existing sufferer of the virus. According to statements made by one of the study’s authors, Dr Nigel Dickson;

"The most likely reason for the risk to increase with age is that, as a person gets older, there is a tendency for their new sexual partners also to be older and hence more likely to harbour HSV-2. Also, as relationships tend to last longer as people get older, this is also likely to increase the risk of transmission," he says.

The researchers feel that the studies findings are illustrative of the need of a greater global community focus on re-educating the adult demographic about safer sexual practices.

"The study has significant implications for public health policy. Prevention in relation to sexually-transmitted infections has tended to focus on young people. Yet, to control the spread in populations where a high prevalence of infection is driving a large number of new cases, it is important to address all factors which contribute to this at any age" said Dr Dickson.

It was also found that while the highest rate of infection was among those with 10 or more partners aged 26 to 32, there was still high enough risk amongst those with fewer partners.

"This is also an important finding. Two-thirds of new infections in women actually occurred among those having four or fewer partners in that time, compared to less than 20 per cent for women up to age 26. A similar pattern was seen for men," co-author of the Otago study, Professor Charlotte Paul says.

Dr Jenny McCloskey, Head of Sexual Health Services Royal Perth Hospital and Fellow of the Chapter of Sexual Health Physicians, RACP, attributes the increase in herpes simplex virus and other sexually transmitted infections, to the change in our sociological behaviour.

"More relationships are breaking down and people are meeting new partners when they are older. In addition there is a lack of community awareness about STD’s and the older generations seem not be so familiar with using condoms", says Dr McCloskey.

Also of increasing concern amongst health professionals is the link between the herpes simplex virus and the transmission of HIV.

"What's more, transmission of HIV is enhanced by HSV-2 infection, so controlling the current spread of HSV-2 is likely to reduce the spread of HIV though the population in the future," says Dr Dickson.

According to Dr McCloskey, genital herpes is now regarded as the single biggest contributor to the spread of HIV worldwide. This factor also increases the societal impact of the HSV virus.

"The more people infected with HIV, the more the financial burden of care for the government," she says.

Fortunately for countries like Australia with a comparatively low rate of HIV infection the data can be put into perspective says Dr Angela Cooney, Medical Director for Family Planning WA Sexual Health Services.

"I actually think, along with some other sexual health workers, that HSV is not that vital an issue in a country which doesn’t have a high risk of HIV, "says Dr Cooney.

Whilst there is an apparent lack of knowledge amongst the wider community about the affects and nature of herpes, the matter appears to be further compounded by a lack of recognition and knowledge by the medical fraternity.

The International Herpes Management Forum advises that medical practitioners see the educational and emotional needs of genital herpes patients as the same as any other lifelong condition.

However, too often the medical fraternity and government bodies overlook the virus.

According to Dr McCloskey, many Doctors don’t see genital herpes as a serious infection and as such don’t provide a level of adequate patient treatment to the diagnosed.

"Three weeks ago I had a young woman come in with her mother, having been given a diagnosis of genital herpes by another GP, but no treatment or information. I took swabs, provided treatment and information, and asked her to return in five days. By that time her swab had come back showing type one as expected, but her boyfriend had been to a doctor who had taken a blood test and told him that he couldn’t be the source of the infection, as he didn’t have the ‘serious’ one, only the ‘mild’ one!"

Unfortunately it appears that stories such as this are told often by sexual health practitioners and sufferers alike.

"I frequently pick up the pieces from some doctors’ less than ideal management. But it is just like in the general population, unless you are interested you won’t seek out information on how to do it better," says Dr Cooney.

Whilst the physical impact of the virus can be discomforting for many people the social, emotional and psychological impact of the virus is the biggest factor. The psychological morbidity in patients with first episode genital herpes is statistically significantly greater than that occurring in non-herpes patients attending sexually transmitted disease clinics.

"I seem to spend a lot of time reassuring new sufferers that it isn’t the end of the world, and that the majority of people who are actually seropositive for HSV-2 have no, or very few, symptoms," says Dr Cooney.

Overcoming the negative perception of the virus and its lifelong effects often compound the physical aspect of the virus. The hardest thing reportedly for any sufferers, is having too reveal their condition to someone else. Whether it is a family member, friend or a potential partner, the very real fear of infecting someone else is compounded by the fear of being rejected.

"I think we need community education to start reducing this perception of ‘the unclean’. I find that the people who don’t have a lot of distress about an infection are those who haven’t heard a lot of the negative stuff, "says Dr Cooney.

In a 2005 survey published by the International Herpes Management Forum of genital herpes sufferers from 78 countries identified the main concern was, "is this end of my love/ sex life?"

"There are some people who have had a diagnosis of genital herpes, and they are often in a terrible position when trying to discuss the issue with a new partner, who is likely to run away screaming because of the fear/shame factor. So even those who know they carry the virus are reluctant to talk about it for fear of rejection," says Dr Cooney.

For sufferers perhaps they should take comfort in the knowledge that they are not alone. As stated one in five people are living with the virus. Though it may be a discomforting and lifelong condition, it should not be what defines a person’s life and character.