When a herpes epidemic struck the Roman empire 2,000 years ago, the Emperor Tiberius took decisive action: He banned all kissing. Not surprisingly, the emperor's solution was not effective. Ever since, the medical profession has been searching for a way to control the virus infection which causes painful blisters on two areas of the body: the mouth and the genitals. With 300,000 to 500,000 new cases of genital herpes a year, the U.S. is now experiencing a full-fledged epidemic. Perhaps as many as 30 percent of all Amerilcan adults have been infected. Affluent, better-educated suburbanites—those who have access to good health care—are less likely than inner city residents to suffer from gonorrhea and syphilis; they have no such defense against herpes. There is no cure for it, and once a person has the virus it never goes away; the sores and symptoms may recur at intervals of two weeks to several years. Herpes has been linked to cervical cancer as well as to birth defects. Leading the attack on the virus is Dr. Paul Wiesner, 38-year-old director of the VD division of the federal Center for Disease Control in Atlanta. Wiesner and his second wife, Nancy, live there with their three children—two sons from his first marriage and a daughter from hers. Wiesner talked with Judy Kessler of PEOPLE about the spiraling health threat posed by herpes.
What is genital herpes like?
It is similar to a cold sore on the lips. Everybody knows what they are. In fact, the common cold sore is caused by a similar virus.
What types of herpes are you studying?
There are two. Herpes type 1 is most common on the lips. Herpes type 2 is most common in the genital area. However, each can occur in either location. This can be caused by oral-genital sex or by an individual's transferring the virus from one part of the body to another by touch. This is called auto-transmission.
Is sexual activity the only way herpes type 2 can be contracted?
That's clearly the odds-on favorite, except for auto-transmission. By and large, genital herpes is a sexually transmitted disease. When I see patients who have it, I don't have to talk about toilet seats and so forth because they know where they got it.
Can anything be done to cure herpes?
No, but there are things you can do to prevent getting it. You can choose to be either celibate or monogamous—but neither of those choices is extremely popular. Real prevention depends on communication between sexual partners. The virus is not infectious all the time, although we're not precisely sure when it isn't. We do know that when the patient has a sore or blister, the disease is most infectious. Many male and female patients feel a burning sensation on the lips or genitals before the blisters appear. Some women say it always happens to them during the menstrual period or during a time of stress. If someone can predict when a blister is about to occur, then he or she can prevent transmitting herpes to somebody else—either by avoiding sex or having the male partner wear a condom.
How long does an average attack of herpes last?
It depends upon whether it is the first episode or a recurrence, and upon the sex of the patient. The incubation time is usually the same; very short, one to two days. For women the first episode is usually a three-week period with sores and a high degree of suffering. They have fever, flu-like symptoms, headaches and severe vaginal discomfort. Then it goes into a latent phase. The recurrence is usually of shorter duration, 7 to 14 days, and the time between attacks varies with the individual.
Is it less bothersome for men?
Yes. The first episode tends to be shorter in duration—maybe only two weeks—and there is nowhere near the kind of pain and discomfort. Then the recurrences tend to be very brief—three to five days. Actually, part of the problem is that the genital sores in men may not really inhibit their sexual activity that much. Men also don't have to worry about cervical cancer. Almost across the board, sexually transmitted infections are not "equal opportunity" infections. Women suffer the burden, and, in my view, that is part of the reason we have done so little to find a cure.
Are some people immune to herpes?
Undoubtedly. There are people who are exposed to it but never seem to acquire it. A few have what we call subclinical infection—they may not have the real blisters but may be infected just enough to develop an immunity. Some people believe that having lip herpes protects you from genital herpes, but this is uncertain.
Why is it so difficult to develop a herpes vaccine?
It's difficult to develop any vaccine, first. Then, this is a dangerous area. The herpes virus increases the risk of cervical cancer, but it may not just be the virus. It may be the virus plus some body reaction to it on the cells in the womb. We may be inducing that reaction in some way with a vaccine.
What is known about the connection between herpes and cervical cancer?
There are many suspected links, but we cannot definitely say herpes causes cervical cancer. We can say if a young woman has herpes today she has a five-to seven-fold increased risk of developing cancer.
Can anything be done to prevent cervical cancer?
There is action a woman can take—like having yearly Pap smears on an absolutely religious basis. Cervical cancer is a disease that can be prevented by early detection of precancerous changes in the cervix.
What is the danger from herpes to the newborn?
The danger is from a mother who has an active case at the time of her delivery. In at least half the cases infants will be infected, and of those that are infected half will die. The virus goes throughout their bodies, into their brains, their livers—all their organs. Of those that survive at least half will be left with some mental deficiency. So it's a serious infection, but it is relatively rare; and it is preventable with cesarean section, because the infant does not come through the infected birth canal.
Is there a test to detect the presence of herpes?
Yes. There is a culture test, but it will be positive only at the moment the virus is present in the area of the body being sampled. Unfortunately, in the dormant stage the virus could still exist somewhere else in the body but would not show up in the test. If a woman has had herpes, even in the distant past, she should tell her gynecologist so a sample can be taken during pregnancy. This kind of corrective prevention is not spoken about enough.
What can a couple do if one has herpes?
They can avoid transmission through use of a condom or periodic abstinence. The one good thing about herpes is that most of the transmission of infection occurs within a fairly defined period of time. But nothing is foolproof.
Is any treatment effective?
None that removes the infectious virus. The history of herpes treatments is very long, but each supposed cure has fallen by the wayside. However, there are now some new drugs that look very promising when they are tested on laboratory animals. One of these drugs is taken orally and is reported to decrease the duration of the sores and diminish the recurrence rate. It seems inevitable that somewhere along the line there will be a breakthrough.
Can you predict when there might be a cure?
No. But there is more hope now than a year or two ago. More funds are being invested by the private and public sectors to deal with herpes. People said we couldn't do anything about gonorrhea, either—it had been increasing for 10 years at an average rate of 12 percent a year. There has been no further increase in the last three years. There is similar cause for optimism about herpes.
The disease is more painful and serious for women than for men