Herpes Simplex

Herpes Zoster

Restylane

  


REFLECTIONS ON THE MANAGEMENT OF PATIENTS WITH
HERPES SIMPLEX INFECTION




Stanley M. Bierman MD, F.A.C.P. (C2004)

   
The message that I wish patients to hopefully derive from this brief presentation on Herpes simplex is to maintain a positive expectation towards recovery, and an unyielding commitment to the means of attaining this goal. Genital Herpes is not the ultimate tragedy in life. The real tragedy is the unnecessary sense of futility and anguish that often becomes a pervasive part of the individual's life. Real or imagined concerns over Herpes result in some patients withdrawing from interpersonal relations. This separation from the physical and spiritual nourishment that comes from love deprives them of a source most helpful to their own recovery.

    Patients with genital Herpes often feel vulnerable, isolated and helpless in the face of the seeming therapeutic intractability of their malady. They may develop fears of never being able to sexually function in a normal fashion. They may even come to believe that the infection has been visited upon them as a penalty for real or imagined transgressions in life. This pervasive sense of frustration and depression that comes to typify the character and personality of the afflicted individual has biochemical equivalents in the host's body.

    It is my belief that the emotional concern and anxiety surrounding the patient's preoccupation with recurrent infection may be one of the main trigger mechanisms responsible for activating latent ganglionic infection. It has been known for some time that emotional stress can alter an individual's susceptibility to disease, but only recently have scientists gained insight into the complex mechanisms governing these matters. It is known that psychic stress is perceived within hypothalamic centers of the brain, thereby evoking neurochemical mediators from the pituitary glands which, in turn, stimulate hormonal alterations within the body by influencing endocrine gland function such as the thyroid, ovary-testis and adrenal glands. The profound changes in the finely tuned mechanism of the host's own internal chemistry, as evidenced by increase cortisone production from the adrenal cortex, has been demonstrated to influence those elements of the blood (T-cell lymphocytes) that govern both cancer surveillance and destruction of infective organisms. The consequence of a sustained fall in T-cell lymphocytes, which are required to fight viruses, may result in an increased susceptibility to infection, or may cause activation of latent infection from involved sensory ganglia.

    Jonas Salk, the Nobel Prize Laureate, has referred to a "psych-neuro-immunologic axis" in describing the somatic or body equivalents of emotional stress. This particular designation, psych-neuro-immunologic axis, has implicit postulates which tie together the emotional content of illness with the patient's capacity to fight infection. The composite of this perception may induce changes within the patient's body chemistry and immunologic competence. Ultimately this may have significant bearing on the host's adaptation or maladaptation to illness.

    Because infection with Herpes involves one of the most fundamental of human instincts, an individual's sexuality, the specter of a chronic and unremitting disease of the genitals, strikes at the core of this basic drive. Thus a disorder, Herpes simplex, which requires an intact immunologic response as a means of recovery, may induce an emotional state of mind in the sufferer (i.e. anxiety about sexuality, infectivity etc) that produces depression of immune function. Anxiety may result in suppression of those cellular agents (T-cell lymphocytes) that mediate recovery from infection. Cortisone from the adrenal cortex may be the hormonal mediator of this function and it is known that T-cell depression can persist for upwards of six months after periods of bereavement. Likewise it is also possible that adrenalin (epinephrine) from the adrenal medulla might be the neurochemical mediator that acts to trigger disease from latently infected ganglia. This complex neurochemical-immunologic circuitry that I have described above is an attractive model which is built on collaborative evidence in both animals and man, and has scientific foundation in Hans Selye's work on stress.

    Patients with genital Herpes often hear conflicting stories from both lay and professional sources. Many so-called "verities" regarding this infection have little foundation in scientific fact. Apocalyptic pronouncements from self-proclaimed experts often estrange individuals from seeking out help from physicians. These crass, usually non-medical, pundits who write for the lay press, cultivate a defeatist attitude towards therapy, and thereby engender further frustration in the minds of the sufferers who most seek reassurance and solace.

    At the other end of the therapeutic spectrum are groups espousing remedies for Herpes which are not only without merit, but are inherently dangerous. A good deal of superstitious dogma and Olympian assertions, carefully dressed up as authenticated therapeutic facts, have been laid before the public. Medicine, itself, has not been immune from these misrepresentations. Sadly, some physicians have enthusiastically endorsed bankrupt remedies for either specious reasons or else their inability to offer viable alternatives to patients.

    The concurrence by both the patient and the physician on the futility of finding a cure for Herpes, the intractability of the malady, sometimes to the physician's best efforts is perhaps one of the most serious psychologic barriers to recovery because of the influence of therapeutic defeat that is indelibly etched on the patient's mind. What is defective in this doctor-patient mutual despair is a preoccupation with the word "cure", and a de-emphasis of the fact that Herpes can be treated! Thus the attitude of therapeutic nihilism in Herpes simplex and resignation to disease flies in the face of good medical practice, and fails to acknowledge the known regenerative and restorative forces that are at the core of human uniqueness. The current awakening of interest in the subject of "wellness", and movements in the field of holistic medicine are tangible evidence that physicians, no less the patients they serve, are looking to adjunctive means of treating ailments.

    If infection with Herpes simplex is indeed triggered by endogenous factors such as emotional stress, depression and hopelessness as well as being the known resultant of over-exertion, sleeplessness and physical stress, it then follows that physicians must direct their talents to deal with these manageable imperatives. The physician's role in orchestrating patient's recovery from genital Herpes involves, in part, an ability to create healing milieux in which a feeling tone of enthusiasm and confidence is conveyed to patients. A sincere and realistic attitude must be engendered in patients that they will, in time, truly recover from infection. The recovery will be the consequence of good medical management, psychologic insights, stress reduction and an abiding faith in the restorative elements of their mind and spirit.

    This therapeutic approach embraces recognition that physical, emotional and spiritual factors are entwined in the fabric of the patient's illness. The physician must engage patients in a realistic goal of altering those factors that impede recovery. Holistic medicine, no less than orthodox medicine, has at its root the recognition that patients, themselves, must be active participants in their own recovery. Compliance with, and adherence to, the programs outlined to patients must be repeatedly emphasized. Physicians and patients must be bonded in a shared goal of recovery from infection. It is not beyond the scientific training and professional scope of the author to infer that mysterious, powerful and profound spiritual forces exist which facilitate recovery.

    Science has taken a strong hold in the pharmacologic management of patients with recurrent genital herpes simplex over the past several decades. Treatment was revolutionized in the 1980s with the introduction of Zovirax (Acyclovir) and now with more effective agents such as FamVir and Valtrex. Not only will these anti-viral agents foreshorten episodes of infection when administered intermittently, they can and do dramatically diminish viral shedding when given on a suppressive basis.

    An important responsibility of physicians is to assist patients to comprehend the nature of their affliction. In so doing, the specter of futility and anguish that characterizes many patients' perception of this malady can be lightened.