Does chronic stress lead to increased rates of recurrences of genital herpes--a review of the psychoneuroimmunological evidence?

It is a commonly expressed expert view that stress is associated with frequent recurrences of genital herpes (GH) but the evidence for this is poor and it is often asserted that stress is the result of GH rather than any other cause. We have reviewed the recent literature on this topic, restricting evidence to only prospective studies. We have further combined and integrated this evidence with both human and animal work in the psychoneuroimmunological field to come up with suggestive evidence that recurrence rates of GH are indeed associated with antecedent chronic stress/depression, whatever might be the cause. We further discuss the psychoneuroimmunological underpinning of the systemic features of the recurrent GH prodrome. Recommendations about holistic management of recurrent GH that include both pharmacological and psychological therapies are given.

Psychological factors in recurrent genital herpes.

OBJECTIVES: To review recent research into psychological aspects of genital herpes and assess possible implications for clinical practice. METHODS: Review of all papers in the field on Medline 1985-96. RESULTS: Much attention has been paid to possible links between stress and recurrent genital herpes. There is no convincing evidence that stress in itself causes recurrences. It may be that recurrences are preceded by a prodromal period of altered mood. Patients with recurrences show considerable stress as a result of the disease, although most individuals eventually adjust psychologically. The impact of social support on adjustment remains unclear. The little evidence available suggests that antiviral treatments can help adjustment and the effects may perhaps outlast the period of active treatment. CONCLUSIONS: Existing research gives some clues to optimal patient management but there is a need for future research to focus much more clearly on clinical issues, particularly on means of alleviating psychological distress and on the impact of antivirals.

The prevention and management of genital herpes: a community health approach.

The incidence of genital herpes, a sexually transmitted disease (STD) of epidemic proportions in the community, is increasing. Meeting the health needs of clients and the public concerning genital herpes is a challenge to community health nurses (CHNs). Little information is available concerning both the physical and psychosocial responses of young adults to genital herpes. This article reviews the changing epidemiology of genital herpes and the psychosocial consequences experienced by those living with the disease--emotional distress, stress associated with recurrences, sexual responses, alterations in interpersonal relationships, and coping and adaptation. The Permission-Limited Information-Specific Suggestion-Intensive Therapy (P-LI-SS-IT) model, a model for intervention and referral, can be used with clients who have the disease to prevent the disabling consequences of the disease. Educating the public is necessary to prevent transmission of this silent epidemic among the population.