I have too often heard these questions and the despair, guilt, remorse and fear of patients when told they have genital herpes: "How could this happen to me?" or "How can I tell my partner I have genital herpes?"
Now, a report in the journal Nature may help to decrease the spread of this disease and result in an effective treatment for what is called herpes simples virus Type 2 (HSV-2).
Today, it's estimated 20 per cent of the population is infected with HSV-2. But of this group, 80 per cent are unaware they have it. This means 50 million North Americans have genital herpes and that every year, another 500,000 are diagnosed with it. And once people are infected, no treatment will remove the virus from the body.
Dr. Larry Corey, director of the Fred Hutchinson Cancer Research Center in Seattle, puts some sacred cows to rest. It's been believed in the past that our immune system puts on battle gear to fight the acute viral infection. Then both sides call a truce until the virus re-emerges from its hiding during periods of emotional and physical stress.
Corey now says this is not the case. His researchers have discovered a specialized type of immune T-cell called CD8aa. These cells, which manufacture antiviral substances, try to keep the virus in check and usually do so. But, as in any war, sometimes the enemy breaks through the defences and wins a battle.
If this happens, viruses penetrate the skin, causing a recurrence of genital herpes. These relapses occur when there's a decrease in the number of CD8aa cells present.
This is not good news for patients who have genital herpes. Doctors previously told patients it was possible to have an active sex life if they avoided sex while herpes lesions were still present.
But they were warned that if they felt unwell, as if a cold was starting, to avoid sex, as this meant the virus could be present several days before the lesions appeared.
Now, not knowing when the virus will appear, having sex without a condom becomes a game of Russian roulette. The more often you pull the trigger, the greater the chance of leaving this world.
To add more flames to the fire, a Canadian study reports that a random sample of Canadians revealed 14 per cent tested positive for genital herpes and that the majority did not have symptoms.
So what does this mean? It reinforces what we have already known, that sexual activity carries the risk of many types of venereal disease.
The fact one in five are infected with HSW-2, even in affluent suburbs, should ring a bell. This is why I have often stressed to those who engage in casual sex to practise it like porcupines -- make love very, very carefully.
When genital herpes strikes, how do you break the news and how do you tell?
Woody Allen, in the movie Annie Hall, asks Diane Keaton immediately on meeting on their first date, "Can we have a good-night kiss?" She asks, "But why now?" He replies, to ease the tension so they can enjoy the evening.
This may work for a good-night kiss, but with herpes, it's not a good start. But neither should you use scary words such as "incurable" to describe the condition.
A good start is to talk about cold sores, as nearly everyone knows what they are. It's ironic that everyone accepts a cold sore as an annoying nuisance, but when the sore occurs in the genital area, its evil is magnified many times.
Of course, you can't escape the infectious nature of herpes, but at the same time, you can maximize the preventability of the disease.
When two responsible people co-operate, it's possible to decrease the chance of spreading the disease. Moreover, some people, after the first attack, never have another one due to a strong immune system.
If this is not the case, attacks often become less severe and infrequent. There are also antiviral drugs such as Zovirax, Famvir and Valtrex that help prevent recurrences. One can only hope that a vaccine will soon be available.