Psychological and psychosexual implications of herpes simplex virus infections

Genital herpes causes considerable psychological and psychosexual morbidity. The most common emotional responses are depression, anguish, anger, diminution in self-esteem and hostility towards the person believed to be the source of the infection. These emotional problems appear to be worse in women than in men. The psychological morbidity in patients with first episode genital herpes is statistically significantly greater than that occurring in non-herpes patients attending sexually transmitted disease clinics. It was previously believed that stressful life events could precipitate recurrences. However, recent studies suggest that ongoing recurrences cause the emotional stress rather than vice versa. There is some evidence that premorbid personality may effect recurrence rates, but an equally plausible explanation is that frequent recurrences adversely affect personality. Long-term aciclovir suppression significantly reduces the psychological morbidity associated with recurrent genital herpes, over at least the period of treatment. Cognitive coping strategies and social support from a partner appear to assist with adjustment. Improving a patient's problem-solving skills, and long-term aciclovir therapy should form an integral part of the long-term management of recurrent genital herpes.