Genital Herpes Simplex is a chronic recurring disease associated with physical and psychological discomfort which affects 20 million Americans. One third of those affected experience four or more recurrences per year during which painful blisters or ulcers are present on their genitals for one or two weeks. Patients and health professionals believe that recurrences are associated with stress. However, there is sparse empirical evidence for such a relationship. This investigation will examine the effects of major life stress and minor stresses on reactivations of genital herpes. To do this two studies are being proposed. In Study 1, 150 HSV seropositive male and female subjects with a history of genital HSV will be followed prospectively for a six month period during which stressful events will be monitored monthly and recurrent lesions will be cultured to document their occurrence objectively. Indices of both major and minor stressful events will be utilized to account for a wide range of stressful events--from a death in the family to traffic problems. Because stress affects individuals differently, evaluations will be made at the beginning and end of the investigation of characteristics that have been shown to modify the effects of stress: perceived degree of personal control, arousal seeking tendency and social support. The research will identify characteristics of patients which make them susceptible to frequent HSV recurrences under varying conditions of stress. This will clarify our understanding of the stress/illness relationship and ultimately lead to more effective preventive and therapeutic approaches. Study 2 will expand and elaborate on the findings of Study 1. Based on the findings of Study 1, 15 female subjects who are determined to be at risk for frequent HSV recurrences will be recruited for participation in an intensive, month long investigation. They will monitor minor life stresses on a daily basis and provide daily samples of vaginal secretions for detection of asymptomatic viral shedding, by viral culture and by immunoperoxidase staining of imprint smears. In this way, a temporal relationship of stress to viral activity may be demonstrated, without the bias of retrospective reporting of stressful events.
