I read in a magazine that if you have genital herpes, that by around age 50 you usually don't get the lesions any more. Is this true? Does the virus ever leave you?

J.P.

Herpes is a topic we have addressed on this site before. I will try to summarize some of the important features of the disease while answering your question. There are two viruses that cause genital herpes: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). HSV-2 causes most cases of genital herpes, but HSV-1 is responsible for some cases. On the other hand, HSV-1 is the most common cause of oral herpes. (For more information on these viruses and how they are transmitted, please see my previous column on genital herpes.)

Herpes is spread by direct contact with the virus. When someone is first infected, he or she may develop a primary attack. If it is a genital infection, blisters (vesicles) appear that are multiple and bilateral (on right and left sides of the genitals). Later, they burst to form ulcers. The sores are painful and itchy. They totally heal, usually in less than three weeks. The virus then becomes dormant in the body. Most people with genital herpes will have recurrent attacks, and as many as 90 percent may have a recurrence in the first year. Recurrences are usually not as severe as the primary episode. They usually go away more quickly, and the lesions are fewer and typically unilateral (on only one side). Recurrences also have fewer "extragenital" symptoms such as fever and headache.

Between recurrences, the patient is totally without symptoms, but he or she can still shed and transmit the virus to others. Condoms decrease the chance of spreading the infection. Because herpes can be spread through contact with skin lesions, rather than just the genitals, condoms cannot totally prevent transmission of the virus when active lesions are present.

The rate of recurrence varies greatly from person to person and over time in the same individual. Some people have few or no recurrences, while others may have more than 10 in a year. If the primary attack is especially prolonged, the frequency of recurrences may be higher. It seems to be true that the number of recurrences may decrease over time. However, this is by no means an absolute. Some patients continue to have frequent recurrences throughout their life.

It is doubtful that herpes simplex viruses are ever eradicated from the body. It is also doubtful that any treatment will be able to get rid of the virus. The virus remains dormant within nerves, a very difficult area for medication to act upon. We can treat patients with acyclovir and similar drugs to minimize symptomatic recurrences and symptomless shedding, but that is not quite the same thing as curing someone.