Long-Term Stress May Trigger Herpes Outbreaks

Nov. 11, 1999 (Atlanta) -- For women afflicted with genital herpes, persistent life stress can be a predictor of recurrence. A new study reported in the November 8 issue of the Archives of Internal Medicine shows that the greater a woman's stress, the more likely it is that she will suffer an outbreak of the herpes lesions.

Herpes is caused by one of two viruses: herpes simplex type 1 (HSV-1) or herpes simplex type 2 (HSV-2). Herpes is different from many other common viral infections. Most importantly, it doesn't go away. The virus tends to lie dormant in the nerve root causing no symptoms whatsoever. But, at any time, it can travel the nerve pathways in a particular part of the body and cause an outbreak. This means that even though HSV may not be causing "cold sores" or genital signs and symptoms at a given time, it can still cause symptoms later. Some believe the outbreaks are related to certain events such as sun exposure, extreme short-lived stress, and menstrual periods.

Although it's well known that people can contract herpes from skin-to-skin contact with an infected person, herpes's triggers are poorly understood by scientists. According to the American Social Health Association, based at Research Triangle Park in North Carolina, known triggers for genital herpes include surgical trauma and excessive friction in the genital area, as well as stressful situations.

Previous clinical studies have suggested there was a link between stress and moods and the recurrence of oral or genital herpes simplex virus (HSV) lesions. However, the study's lead researcher, Frances Cohen, PhD, tells WebMD, "It is long-term stress that can cause outbreaks." Cohen is an associate professor at the department of psychiatry at the University of California, San Francisco, School of Medicine.

To determine whether short- and long-term stress or negative moods could trigger genital herpes outbreaks in women, the researchers studied 58 women, aged 20-44 years, with a one- to ten-year history of visible genital herpes and at least one outbreak in the previous six months. The researchers used weekly assessments of stress levels and mood, monthly assessments of life-altering events, and diary reports of genital herpes recurrences confirmed by medical examination when feasible.

Examples of short-term stressors reported included flying on an airplane, being a victim of vandalism, and breaking a leg. Examples of long-term stressors included being worried about relatives, job security, or finances.

Researchers discovered that the more persistent stress reported, the greater the likelihood of a herpes outbreak the following week. Also, an increased recurrence rate occurred after participants experienced their highest levels of anxiety the previous month. "There were no significant associations between recurrence and short-term stress, life events, depressive mood, anger, or phase of menstrual cycle," says Cohen. "Persistent stressors and highest level of anxiety [caused] genital herpes recurrence, whereas transient mood states, short-term stressors, and life-changing events did not."

Why weren't men included in the study? "Because we believed that men and women might differ in how they experienced or reported negative moods and stressors, and could show different relations between stressors and recurrence, we limited our study to women," writes Cohen.

According to her, "Women with herpes can be reassured that short-term stressful life experiences and dysphoric mood states do not put them at risk for increased outbreaks of recurrent genital herpes." She recommends that women with genital herpes who face persistent stress be referred to counseling in conjunction with receiving medication designed to suppress lesions.

According to the CDC, in the U.S., 45 million people aged 12 and older, or one out of five of the total adolescent and adult population, is infected with genital herpes. It is more common in women (25%) than in men (20%).