My husband and I both have herpes. My outbreaks are much less frequent than his, but I get so many more symptoms than he does. It barely affects him, and I feel totally awful and sick. Why is this?

S.M.

Herpes is a viral infection that is never really eradicated from the body. (For more information on the virus and its spread, see my column Partner with Genital Herpes.) Many if not most people continue to have recurrences throughout their lives. Recurrent genital herpes causes multiple vesicles (blisters) that rapidly burst to form ulcers. The patient can also have whole-body complaints such as fever, malaise (ill feeling), headaches and even meningitis (inflammation of the covering of the brain and spinal cord).

There is no way to predict which patient will have frequent or severe outbreaks versus few or mild outbreaks. Women and men may have recurrences frequently or rarely. In general, however, a woman's outbreak is more likely to be severe than a man's, with more whole-body symptoms. Exactly why is not clear. It may have to do with the location of the blisters and the ability of the herpes virus to travel along nerves. Women get sores on their external and internal genitalia, while men tend to get lesions on the penis. When herpes infects a woman's genitalia, especially her internal genitalia, there is somewhat less distance for it to travel along the nerves to get to the central nervous system, which includes the spinal cord. That may make the infection more likely to cause some of the generalized signs and symptoms of illness.