August, 2006

Definition of the Problem
There are two separate and distinct contagious viruses that make up the Herpes Simplex Virus. The viruses cause shingles, chicken pox, mononucleosis, oral herpes, and genital herpes. HVS-2 accounts for 90% of genital herpes; HVS-1 causes the other 10%. Herpes is spread from person to person through contact with bodily fluids.

An infected person can also cause it to spread to more than one area of his own body. It can be spread whether or not the infected person has an active outbreak, since the active virus is continually being shed. Since shed virus can live for a time in the air, a person can be also infected by coming into contact with an infected towel or clothing.

A herpes “episode” can have no symptoms, or it can start with flu-like symptoms, including fever and swollen glands. While the virus has no cure, the number of outbreaks tends to decrease over the years.

Scope and Cost of the Problem
At least one in five Americans – about 45 million people -- have herpes, and most are unaware that they are infected (Genital Herpes CDC Fact Sheet, 2004). Since most people with HSV-2 never get lesions or have only mild symptoms, it is easily possible for them not to know they have been infected (Genital Herpes CDC Fact Sheet).

There are approximately 1,000,000 new cases annually (The Surgeon General's Call to Action, 2004). The number of Americans with genital herpes increased 30% between the late 1970s and the early 1990s (Genital Herpes CDC Fact Sheet, 2004).

According to the National Institutes of Health, the annual cost of genital herpes is more than $96 million (Sexually Transmitted Disease Cooperative, 1994).

Medical Treatment
Antiviral therapies can be used during outbreaks or to inhibit or reduce future outbreaks. Antirival medications include acyclovir (Zovirax), famciclovir (Famvir), and valaciclovir (Valtrex). Pain relief can usually be achieved using over-the-counter remedies such as acetaminophen or ibuprofen.

Lifestyle changes (stress reduction, healthy diet, exercise, sleep, limiting sun exposure) can sometimes limit the number or severity of outbreaks.

Mind-Body Approaches
Since stress has been linked to the frequency and severity of outbreaks, stress reduction is always a goal (Cohen, Kemeny, et al, 1999; Cruess, Antoni, et al, 2000; Lutgendort, Antoni, et al, 1997). In one study, patients using a program that included stress reduction, education, and guided imagery were able to limit the number and severity of herpes outbreaks (Longo, Clum, and Yaeger, 1988).

Relaxation has also proven beneficial (Kiecolt-Glaser, Glaser, et al, 1985; Koehn, Burnette, and Stark, 1993), as has hypnosis (Fox, Henderson, et al, 1994; Gould and Tissler, 1984; Pfitzer, Clark, and Revenstorf, 2005; Shenefelt, 2000).

Guided imagery can help to lower stress, improve coping skills, improve compliance with lifestyle changes, and possibly reduce the severity and frequency of outbreaks.

Cohen F, Kemeny ME, Kearney KA, Zegans LS, Neuhaus JM, Conant MA. Persistent stress as a predictor of genital herpes recurrence. Arch Intern Med. 1999 159:2430–6.

Cruess S, Antoni M, Cruess D Fletcher MA, Ironson G, Kumar M, Lutgendorf S, Hayes A, Klimas N, Schneiderman N. Reductions in herpes simplex virus type 2 antibody titers after cognitive behavioral stress management and relationships with neuroendocrine function, relaxation skills, and social support in HIV-positive men. Psychosom Med. 2000 Nov-Dec;62(6):828-37.

Fox PA, Henderson DC, Barton SE, Champion AJ, Rollin MS, Catalan J, McCormack SM, Gruzelier J. Immunological markers of frequently recurrent genital herpes simplex virus and their response to hypnotherapy: a pilot study. Int J STD AIDS. 1994 Nov;10(11):730-4.

Genital Herpes - CDC Fact Sheet. Centers for Disease Control and Prevention. May, 2004.
Accessed August, 2006.

Gould SS, Tissler DM. The use of hypnosis in the treatment of herpes simplex II. Am J Clin Hypn. 1984 26:171–4.

Kiecolt-Glaser JK, Glaser R, Williger D, Stout J, Messick G, Sheppard S, Ricker D, Romisher SC, Briner W, Bonnell G, et al. Psychosocial enhancement of immunocompetence in a geriatric population. Health Psychol. 1985 4(1):25-41.

Koehn KA, Burnette MM, Stark CJ. Applied relaxation training in the treatment of genital herpes. Behav Ther Exp Psychiatr. 1993 Dec;24(4):331-41.

Longo DJ, Clum GA, Yaeger NJ. Psychosocial treatment for recurrent genital herpes. J Consult Clin Psychol. 1988 56:61–6.

Lutgendorf SK, Antoni MH, Ironson G, Klimas N, Kumar M, Starr K, McCabe P, Cleven K, Fletcher MA, Schneiderman N. Cognitive-behavioral stress management decreases dysphoric mood and herpes simplex virus-type 2 antibody titers in symptomatic HIV-seropositive gay men. J Consult Clin Psychol. 1997 Feb;65(1):31-43.

Pfitzer BE, Clark K, Revenstorf D. [Medical hypnosis in cases of herpes labialis improves resistance for recurrence. A pilot study] [Article in German] Hautarzt. 2005 Jun;56(6):562-8.

[no authors listed] Sexually Transmitted Diseases Cooperative Research Centers NIH Guide. 1994. Volume 23, Number 18, May 13.
Accessed August, 2006.

Shenefelt PD. Hypnosis in dermatology. Arch Dermatol. 2000 Mar;136(3):393-9.

[no authors listed] The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior. U.S. Department of Health & Human Services. July 7, 2004.
Accessed, August, 2006.