Living with Herpes

Herpes is for life. This is a hard pill to swallow for most individuals who contract the disease as most sufferers
are otherwise healthy, young people who have never had to deal with the prospects of having a chronic,
lifelong condition. Denial, anger, depression, embarrassment, self-deprecation and helplessness are common
reactions in encountering the diagnosis. The most important factors in living with this condition is to
understand it and learn how to control it.

Some 75% of Americans have herpes simplex 1 that causes cold sores. Up to 25% of adult Americans suffer
with herpes simplex 2 although over 80% are unaware of their diagnosis. This is because they are either in
denial, misdiagnosed, have atypical symptoms, have a single outbreak without recurrence or have little or no
signs or symptoms of the infection at all.
Of those suffering with genital herpes about 15-20% actually have type 1 infections in the genital. This is an
important distinction since type 1 in the genitals tend to be a milder disease. Type 2 herpes, when
symptomatic usually causes disease within 2 weeks of contact with an infected partner. However, in many
patients, it can remain dormant for years prior to the initial presentation. Those with herpetic outbreaks tend to
get 6-12 outbreaks in the first year after contracting the disease. The best course of treatment in these
patients is to take prophylactic anti-viral antibiotics for the first 6-23 months and then switch to symptomatic
therapy only.  In general, herpes type 1 infections in the genital area occur only once or twice and do not
become recurrent problems.

The diagnosis of herpes is sometimes difficult, especially in women, because the symptoms can be vague,
associated sores may be internal and thus undetectable unless a pelvic examination is done during the
outbreak. Outbreaks are often confused with yeast infections, abrasions from sexual activity, razor burn, or
other forms of vaginitis. A blood test specifically testing for herpes simplex type 2 is helpful in cases where the
diagnosis is in question.

Although herpes is generally thought of as a disease that is for life in many individuals it does not cause any
outbreaks at all or never recurs after the first outbreak. It is important to recognize that this does not mean that
the individual is free of the disease. Even in such individuals there is a possibility of transmitting the disease to
a partner or to a baby during labor.

Seever outbreaks can occur in 10-20% of those who contract the disease. Symptoms include:

1) Symptoms begin to appear within 2 days to 2 weeks of initial transmission.
2) Pain in the genitals, groin, low back or legs can be severe and accompanied with burning, itching, painful
urination, discharge.
3) Flu-like symptoms such as fever, muscle aches and fatigue.
4) Lymph glands in the groin may swell.
5) Skin usually turns red and irritated with swelling.
6) One or more vesicles appear within 24-48 hours of the onset of symptoms. Usually the vesicles are grouped.
Depending on the severity of the infection one or more groups will appear.
7) Vesicles will eventually come to a head like a pimple and burst. A tender ulcer with a reddish, wet looking
ulcer will result. Over a period of days this ulcer will crust over and form a blister.
8) Subsequently this blister will heal as new skin forms over it from the outside in.
9) The entire process usually lasts about 2 weeks in the initial outbreak.

Recurrences happen in up to 80% of sufferers who have a symptomatic outbreak once. They may occur
frequently in the first year but usually occur up to 4 times a year in untreated individuals after the first year.
Individual factors determine the frequency and severity of herpetic outbreaks. Even in patients with the most
severe initial infection the subsequent course of the disease can be successfully controlled with appropriate
education, behavioral modification and medical treatment.

Recurrences are usually less severe and resolve faster. They occur in the same locations as the first outbreak.
If more than one area was involved in the first outbreak subsequent outbreaks will usually involve one of those
areas during each outbreak.

Taking Control

By learning about the disease and following some simple guidelines the hassle of having herpes can be
minimized.
Each infected individual should be encouraged to pay attention to the specific warning symptoms that signify a
“pro-drome” to the actual onset of an outbreak. Most individuals will experience tingling, burning, itching,
painful urination, constipation, numbness, flu-like symptoms and head aches hours to even days prior to the
onset of an outbreak. Intervention during this time is often successful in preventing the outbreak or reducing its
severity or shortening its course. Such measures should include:
1) More strict adherence to dietary restrictions.
2) Lysine 500 mg three times a day with meals.
3) Treatment doses of Acyclovir or Valtrex as directed.
4) Motrin 200 mg or equivalent after meals.
Learn which factors stimulate a recurrence of herpes in your body. Common stimulants are:


Any event that reduces immunity:

1)        any illness such as a cold that can cause a fever
2)        fatigue, sleeplessness, prolonged periods of stress
3)        decreased immunity
4)        plane flights
5)        immediately following an outbreak
6)        frequent alcohol or drug use

Local trauma:
1)        sexual activity
2)        very tight clothing
3)        other genital infections
4)        prolonged exposure to heat such as in a Jacuzzi or sauna or sunbathing
Prevention: since celibacy is not an option for most use latex condoms religiously (not sheep skin), tell your
partner about your chronic medical condition and remember any skin to skin contact in the affected areas can
transmit the virus potentially at any time not just during outbreaks.


Dietary Recommendations

The logic for dietary recommendations for prevention and treatment of herpes is as follows: herpes virus
requires large amounts of the amino acid Arginine in order to replicate. Arginine and lysine use the same
transport mechanism to enter cells. Thus they compete for entry through the same door into cells that are
infected with the herpes virus. Taking supplements or eating foods that are high in Lysine will hinder the ability
of Arginine to enter cells thus depriving the virus of a nutrient essential for its growth.
Many individuals can associate outbreaks with intake of foods high in Arginine. Taking Lysine will not by itself
prevent outbreaks but it can reduce the severity of outbreaks. In addition, It may be helpful to take Lysine
supplements following ingestion of foods with high Arginine content in order to balance the ratio of the two
amino acids.

Best Foods (in order of relative Lysine content)

Dairy Products, best being yogurt with live yeast
Mango, Papayas
Beets
Apricots
Sherbert
Fish
Potatoes
Meat
Apples, pears
Figs
Eggs
potatoes
Soybeans



Worst Foods (in order of relative Arginine content)

All nuts and their products (walnuts, peanuts, Macadamia nuts, almonds,….)
Seeds
coconut
Garlic
Wheat Products (whole grain bread, shredded wheat, …)
Grapes, raisins
Blackberries, blueberries
Caffeine
Peas, Tahini
Orange, tangerine
Cucumbers
Mushrooms

   Prophylactic Antibiviral therapy

Taking antiviral antibiotics every day is a good option for a large number of people who have been herpes.
These include:

1) Individuals with frequent recurrences (more than 6 outbreaks a year).
2) Those with dermatitis (chronic irritation or dryness in between outbreaks) or severe outbreaks with long
healing times
3) Pregnant women with HSV 2
4) Individuals in relationships where one partner is HSV 2 positive and would like to minimize the chance of
passing on the disease.

Prophylaxis is easy and involves taking one or two pills per day of Acyclovir or Valcyclovir (Valtrex) medications
that are generally well tolerated by most individuals. Most people who require prophylaxis will need to
continue for a period of time, usually 6-12 months. At appropriate intervals prophylaxis should be discontinued
to assess need for continued prophylaxis. In addition to prophylaxis boosting the immune system will also aid
in reducing outbreaks frequency and severity. One potential intervention is using high doses of vitamins and
minerals in oral or intravenous forms. In addition, magnesium infusions are highly effective in reducing pain
from Herpetic outbreaks including Herpes Simplex and Zoster (shingles) outbreaks.  Those with most severe
disease are usually those with a deficient immune system, high blood sugars, recurrent or chronic infections
elsewhere in their bodies. Besides these factors the main determinant of the frequency and severity of
outbreaks is the load of virus contracted at the time of initial infection. Thus, contracting the disease as a
result of repeated contact with a severely infected individual with a large outbreak will result in a more
aggressive disease compared to contracting the disease from someone without an outbreak but with minor
viral shedding between outbreaks.