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Herpes and Stress

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A review of the research on stress and recurrences

The subject of stress as a trigger for herpes recurrences is one subject that has been revisited by researchers over the years. While there is a good amount of anecdotal evidence to suggest that psychological stress can indeed serve as a trigger for outbreaks, the scientific evidence is at this point inconclusive. Many studies that have been done are small or have serious limitations in generalizing the results. There is also the question of the chicken and the egg: does stress cause an outbreak or does the outbreak cause stress? Herpes and stress

For many people with genital herpes, the case seems clear—stress can indeed trigger an outbreak. In one study examining psychological factors of genital herpes infection, 78 percent of participants cited stress as a factor in provoking outbreaks. In a survey conducted by The Helper in 1991, about the same number of respondents—71 percent—reported that they believed stress triggered their recurrences as well.

Despite anecdotal evidence, however, researchers have been unable to establish a clear, empirical connection between stress and recurrences. While some studies suggest a statistically significant link between stressful experiences or reported stress by study participants and recurrences, many others do not. Additionally, participants in some studies are asked to assess stress and mood retrospectively, sometimes weeks or months after a recurrence. Thus, not only does memory create a problem, but it is difficult for participants to recognize in retrospect whether the perceived stress of the period preceded the recurrence or was the result of it (the chicken and egg debate again).

So what does the research show on the subject of herpes and stress? One result that might not surprise you—a genital herpes outbreak, whatever the trigger, can be the cause of stress. In a study published in the Annals of Internal Medicine, 64 participants completed a daily questionnaire that measured psychological and emotional stress in six areas: physical health, relations with friends, relations with family, relations with sex partner(s), financial, and vocation/education. Researchers analyzed the results to compare stress reported on each of the 6 days before a recurrence with that on days during or after a recurrence, as well as days not temporally related to recurrence. They found that not only were stress scores on the 6 days before a recurrence not significantly different from other days, but that stress scores did rise appreciably on days following a recurrence.

Of course, some studies have shown some relationship between stress and recurrences, but suggest that other mitigating factors, such as time and social support, play a more important role. In a study of factors that influence adjustment to a genital herpes diagnosis (Aral, Vanderplate, et al, 1987), researchers also looked at the question of whether or not stress was a trigger. While the study indicated a positive association between stress and outbreaks for those who had been diagnosed within the previous four years, they found no relationship between stress and outbreaks in those who had been infected for a longer period of time (more than four years). Yet while time alone mitigated the effect of stress on recurrences, researchers further found that there was no correlation between stress and recurrences in study participants who reported receiving social and emotional support, no matter how long they had been infected.

While factors such as time and support are important to consider, so too may be the type and duration of the stressors under consideration. One such study that examined these questions (Cohen, Kemeny, et al, 1999) followed 58 women for 6 months to examine the effects of both short-term (defined as less than 1 week in duration) and persistent (lasting for more than 1 week) stress on recurrences.

While the study found no connection between short-term stress, and even major life events, and genital herpes recurrences, it did find that high levels of persistent stress increased the probability of recurrence. Why the difference? Researchers suggest the immune system may play a role. As they note, “long-term stress has been associated with decreased natural killer-cell activity and impairments in cell-mediated responses in humans, and immunologic processes may control viral replication or destruction of the virus at the local site.”

Indeed, the notion that chronic stress can affect the immune system, and influence herpes recurrences as a result, is the subject of a review in the current issue of the International Journal of STD & AIDS. The authors (Goldmeier, Garvey, et al, 2008) reexamine several previous studies with an eye toward how stress modulates immune responses, and how the immune system in turn interacts with the central nervous system. Citing animal research that demonstrated a significant reduction in HSV-specific CD8 T cell function under conditions of persistent stress, they suggest that a decrease in immune function would compromise immunity at the skin level.

The authors also examined the role that cytokines–produced in a maturing herpes lesion–play in mood changes. Cytokines, proteins that function in the immune response, may have a systemic effect on the central nervous system. Cytokines produced by a herpes recurrence can result in fatigue, anxiety, and mood alternation.  Perhaps it’s not the chicken and the egg after all? The interplay of immunological, neurological and psychological factors perhaps link stress and recurrences in a more complex fashion.

So what’s the final word? The research is inconclusive.  And experts note that recurrences can occur spontaneously, in the absence of specific physical or psychological factors. Yet whether or not there is empirical evidence to indicate a conclusive link between stress and herpes recurrences exists, reducing stress is an important step to improve one’s health. On that note, the research is more clear—stress can have a negative effect on overall health. Genital herpes is of course only one small aspect of your overall health. But managing your stress level can only be of benefit.

There are certainly simple, concrete steps you can take to reduce your overall stress level and improve your general health and well-being. These are probably steps that you are aware of and may already be taking. Get enough sleep, exercise regularly, find emotional support, and eat a balanced diet . . . maybe including some chicken and eggs.


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