Living with herpes: Navigating relationships and mental health

Unhappy Couple after an argument at their home. [Getty Images] In today's dating scene, intimacy often comes with unforeseen risks. For many, discovering they have herpes can be a pivotal moment one that challenges perceptions, tests relationships, and prompts difficult conversations about health, trust, and stigma. Joyce*, a 24-year-old university student, experienced this firsthand when she woke up one day with a swollen lip that persisted. "I initially dismissed it as a common cold sore," she recalls. "But when I went for a check-up, I was in for a shock." Joyce was stunned when the doctor prescribed medication for HSV-1 (Herpes Simplex Virus Type 1), a diagnosis she had never anticipated. Joyce's story is not unique. According to the World Health Organization (WHO), an estimated 3.7 billion people under age 50 (67 per cent) have HSV-1 infection globally. While often associated with oral herpes, HSV-1 can also cause genital herpes. An estimated 491 million people aged 15-49 (13 per cent) worldwide have herpes simplex virus type 2 (HSV-2) infection, the main cause of genital herpes. Most HSV infections are asymptomatic or unrecognised, but symptoms of herpes include painful blisters or ulcers that can recur over time. Infection with HSV-2 increases the risk of acquiring and transmitting HIV infection. Dr Khamadi, Senior Research Scientist at Kenya Medical Research Institute (KEMRI) and a virologist, explains the complex nature of herpes simplex virus (HSV) infections: "Stress appears to play a significant role in triggering herpes outbreaks," Dr Khamadi says. "When we're under stress, the virus, which lies dormant in our nerve cells, can reactivate and travel along nerve pathways to the skin, causing visible symptoms." He notes that other factors can also trigger outbreaks, including fever, emotional stress, and a weakened immune system, which might occur due to certain medications. Dr Khamadi further explains the life cycle of herpes viruses: "The virus replicates through a multi-step process," he says. "It starts by inserting its DNA into the host cell's nucleus. This DNA then produces proteins in a specific order, which ultimately leads to the formation of new virus particles." These new viruses, he continues, are then transported out of the cell nucleus and acquire their outer coating before being released, often causing the host cell to die in the process. A key characteristic of herpesviruses, Dr Khamadi emphasises, is their ability to establish latent infections. "These viruses can hide in specific cells in the body for long periods," he says. "For example, herpes simplex viruses hide in nerve cells near the spine, while the Epstein-Barr virus can hide in certain immune cells and salivary glands." The virologist points out that these dormant viruses can reactivate at any time, though the exact mechanisms aren't fully understood. "We know that stress, hormonal changes, and even sunlight can trigger reactivation of herpes simplex viruses," he says. "However, we're still researching exactly how these factors interact with the virus at the cellular level." He notes that when herpesviruses reactivate, they may not always cause noticeable symptoms. "Sometimes reactivation goes unnoticed," Dr Khamadi says, "but in other cases, it can lead to significant health issues. This unpredictability is part of what makes managing herpes infections challenging." For Dominic, a 35-year-old high school teacher, the diagnosis of genital herpes has left him grappling with his new reality. "I'm struggling to come to terms with this," he says. "I had no idea I was infected. There were occasional signs - itching around my genitals, painful urination - but they would come and go. I didn't think much of it until the symptoms became more persistent. That's when I finally decided to get checked out." Dominic's experience highlights a common challenge with herpes infections - the symptoms can be subtle or intermittent, leading many to overlook them until they become more severe or frequent. Valary, 28, shares a similar journey. Her diagnosis came after a series of recurring urinary tract infections and yeast infections. In 2020, she noticed swollen blisters around her genitals. "At first, I didn't think much of it," she recalls. "The blisters weren't painful and they disappeared on their own. But then things got worse." The progression of Valary's symptoms was distressing. "Urinating became painful, and my vulva was extremely sensitive. Sitting and walking became unbearable - it felt like tiny razor blades were cutting me." When Valary finally returned to her gynaecologist, the diagnosis came swiftly and unexpectedly. "The doctor didn't hesitate to tell me I had genital herpes," she says. "I was in shock. I'd only been intimate with one person - my partner. I felt betrayed and cheated." The emotional impact of a herpes diagnosis often extends far beyond the physical symptoms. A fear of rejection is a common thread among those living with herpes. Michael*, a 35-year-old accountant diagnosed with HSV-1 genital herpes five years ago, shares, "Telling potential partners about my status has been the hardest part. I've faced rejection, but I've also met understanding people. It's taught me a lot about communication and honesty in relationships." The challenge of disclosure is a significant hurdle for many. Dr Elmard Rigan, a Counseling Psychologist emphasizes the importance of open communication: "Disclosing one's herpes status to a partner can be anxiety-inducing, but it's crucial for building trust and ensuring informed consent. I work with patients to develop strategies for having these conversations effectively and confidently." Research supports the benefits of disclosure. A 2020 study in the Journal of Sex & Marital Therapy found that individuals who disclosed their HSV status to partners reported higher relationship satisfaction and lower anxiety levels compared to those who concealed their diagnosis. Dr Catherine Kithaka, a Counselling psychologist, explains, "Receiving an STI diagnosis can be profoundly traumatic," she says, "It's a loss that triggers a grief response, with individual reactions varying widely." She says one may experience common emotional responses such as shock, anger and denial. "Many individuals become stuck in denial," she notes. "This makes it challenging to be vulnerable, particularly with potential partners, due to fear of rejection. While self-preservation is understandable, it can hinder emotional growth and connections." The psychologist emphasises the importance of emotional processing: "We encourage individuals to connect with their emotions and work through the pain of discovery. This helps normalize the situation and move towards acceptance." On withholding information from future partners, Dr Kithaka cautions that concealing one's status can lead to betrayal, broken trust, and a lack of emotional connection. "Psychologists agree that establishing emotional connections is crucial for managing anxiety," she says. "Denial and isolation often re-traumatize the individual. The path to healing lies in openness, support, and gradual acceptance." Seeking support, the psychologist says, sharing with trusted confidants and mental health professionals can aid in processing emotions and developing healthy coping strategies. Dr Khamadi, explains that while herpes is a chronic condition, it can be managed effectively. "Antiviral drugs like acyclovir, valacyclovir, and famciclovir are commonly prescribed. These medications can be taken daily as suppressive therapy to reduce outbreaks or episodically at the first sign of symptoms. While they don't cure herpes, they can significantly improve the quality of life for many patients." Indeed, a 2015 study published in the Journal of Clinical Medicine Research found that daily suppressive therapy with valacyclovir reduced the risk of transmission to uninfected partners by 48 per cent compared to placebo. Sarah*, another individual living with herpes, shares her experience: "I've learned to recognize the early signs of an outbreak, like a tingling sensation or mild itching. When I feel these, I start antiviral medication immediately to reduce the severity and duration of symptoms." For many, like Sarah, learning to manage the physical aspects of herpes is only part of the journey. The emotional and psychological impact can be equally challenging. Support groups and therapy have proven crucial in helping individuals cope. Sarah found solace in an online WhatsApp support group. "Meeting others who understood what I was going through was incredibly healing. It helped me realize I wasn't alone and that herpes doesn't define me." Online communities have become valuable resources, offering safe spaces to share experiences and advice. These platforms can be particularly helpful for those who feel isolated or stigmatized in their local communities. Dr Rigan emphasises the value of Cognitive Behavioral Therapy (CBT) for individuals grappling with anxiety or depression following a herpes diagnosis. "CBT is a powerful tool for those struggling with the emotional impact of herpes," He says. "This therapeutic approach helps patients identify and challenge negative thought patterns, replacing them with more balanced and realistic perspectives." He elaborates on the benefits of CBT, "Through CBT, clients learn to recognise, evaluate, and respond to their concerns in healthier ways. It fosters cognitive reappraisal and positive self-regard, enabling individuals to build a stronger relationship with themselves." Despite the challenges, many individuals with herpes find ways to lead fulfilling lives and maintain healthy relationships. Education plays a crucial role in this process, both for those diagnosed and for the general public. Understanding the prevalence of herpes can help reduce stigma. In Kenya, for example, a study by the Guttmacher Institute found that more than a third of Kenyan men and women are infected with HSV-2. Among the 15,707 Kenyans aged 15-64 who were tested, 35 per cent were infected with HSV-2 (42 per cent of women and 26 per cent of men). These statistics highlight the commonality of herpes infections and underscore the need for comprehensive sexual health education and destigmatisation efforts. Looking to the future, ongoing research into new therapies, including potential vaccines, offers hope for even better management. A 2020 study published in Nature Communications reported promising results from a novel HSV-2 vaccine candidate in animal trials, showing both therapeutic and protective effects. Dr Khamadi remains optimistic: "We're making significant strides in understanding herpes viruses and developing new strategies to combat them. I'm hopeful that we'll see even more effective treatments and possibly preventive measures in the coming years."

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