The New Scarlet Letter

By John Leo

After chastity slouched off into exile in the '60s, the sexual revolution encountered little resistance. Indeed, in the age of the Pill, Penthouse Pets and porn-movie cassettes, the revolution looked so sturdily permanent that sex seemed to subside into a simple consumer item. Now, suddenly, the old fears and doubts are edging back. So is the fire and brimstone rhetoric of the Age of Guilt. The reason for all this dolor: herpes, an ancient viral infection that can be transmitted during sex, recurs fitfully and cannot be cured. Also known as the scourge, the new Scarlet Letter, the VD of the Ivy League and Jerry Falwell's revenge, herpes has emerged from relative obscurity and exploded into a full-fledged epidemic.

Spurred on by two decades of sexual permissiveness, the disease has cut swiftly through the ranks of the sexually active. "The truth about life in the United States in the 1980s," says Dr. Kevin Murphy of Dallas, one of the nation's leading herpes researchers, "is that if you are going to have sex, you are going to have to take the risk of getting herpes." An estimated 20 million Americans now have genital herpes, with as many as half a million new cases expected this year, according to the Centers for Disease Control in Atlanta.

Those remarkable numbers are altering sexual rites in America, changing courtship patterns, sending thousands of sufferers spinning into months of depression and self-exile and delivering a numbing blow to the one-night stand. The herpes counterrevolution may be ushering a reluctant, grudging chastity back into fashion. Eight years ago, Alex Comfort, the expansive apostle of coitus, could say of sex: "There is nothing to be afraid of, and never was." Now, in the Age of Herpes, Playboy employees jokingly refer to the swimming facilities at Hugh Hefner's Los Angeles mansion as "the herpes pool." A Manhattan resident who had always longed to disport himself at a sexual playpen called Plato's Retreat now says he will go only if he can wear a full-length wet suit. Flesh Merchant Al Goldstein, editor of Screw magazine, says glumly, "It may be there is a god in heaven carving out his pound of flesh for all our joys."

The existence of the herpes virus and its accompanying sores and blisters has been known for at least 2,000 years. It is said to have caused so terrible an epidemic of lip sores in ancient Rome that the Emperor Tiberius banned kissing. Shakespeare also was familiar with the blight. In Romeo and Juliet, he speaks of blisters "o'er ladies' lips." In 18th century France, genital herpes was so common among prostitutes that it was termed "a vocational disease of women." Yet it was not until the 1940s that herpes was found to be a virus, and not until the late 1960s that researchers isolated two types of herpes. So little known was the virus that doctors confidently misdiagnosed it right up through the late 1970s.

Type 1 (HSV-1) is most familiar as the cause of cold sores on the lips. The more serious Type 2 (HSV-2) typically causes genital lesions. Yet the sores of the two strains cannot easily be distinguished from each other, nor do they stick to their own turfs. The astounding and belated news is that ordinary cold sores can be transferred to the genitals by finger or mouth and become a venereal disease. Indeed, oral sex may be a potent force in spreading both strains. One survey shows that one-third of young women under 24 who have herpes on their genitals are actually suffering from HSV-1.

Once herpes has penetrated the skin, it multiplies rapidly. The first symptoms may be a tingling or itching sensation. Blisters may appear within two to 15 days after infection. In genital herpes, the first episode lasts on the average three weeks, as opposed to around five days for subsequent attacks, and blisters may be accompanied by fevers and pounding headaches (see following story).

Why the dramatic rise now in the incidence of herpes? Sexual freedom is obviously implicated. "With herpes, every new case is added to the pool," says Dr. Yehudi Felman, a New York City VD specialist. "The increase is exponential after a while." Not only are more people indulging in sex, they are also more active--starting younger, marrying later, divorcing more often. The wider acceptance of oral sex has also played a role. Richard Hamilton, a San Francisco family physician and author of The Herpes Book, thinks science has wrought the herpes epidemic: penicillin allowed greater sexual contact with little risk, and the Pill and other contraceptives largely replaced condoms, which prevent direct contact with sores.

Herpes is hardly the worst disease in the world, or even the worst venereal disease. Untreated, syphilis and gonorrhea do far more damage. But few modern ailments have altered so much basic behavior so quickly. Perhaps the reason is its sudden upsurge and incurability. As many family doctors put it: "It won't kill you, but you won't kill it either." "Herpes is a puzzle, an enigma," says Dr. John Grossman, a Washington, D.C., gynecologist. "The medical community doesn't do very well with viruses anyway, and with this one, our bodies aren't able to give us any assistance in killing it." All by itself, says New York Group Therapist Dominick Riccio, herpes has changed the uneasy balance between sex for pleasure and sex for commitment. "People are beginning to realize that romance is what relationships are all about," Riccio says. "They're disillusioned with free sex and terrified of getting herpes and having it forever."

Many swingers have dropped out because of herpes. And a trip to a prostitute is a high-stakes gamble. For a book on herpes, Philadelphia Writer Frank Freudberg interviewed 20 prostitutes in several cities and found they all had the disease. "Of course it wouldn't be good for business to mention it," said one popular pro in Atlantic City. "I bet me and my sister must have given it to a thousand guys --laugh. But this sure isn't a convent down here, honey."

The epidemic has clearly made married philanderers extremely wary. Few things cool extramarital ardor like the specter of passing on an incurable disease to a mate and then having to explain where it came from. A chemical engineer from New York knows how the one-night stand can go these days: on a business trip a beautiful woman invited him up to her room. He went, but was troubled by thoughts of herpes sores. He asked the lady outright. Her denial was not enough; he was impotent. "I wanted to go through with it," he confided to a friend, "but my body wouldn't respond."

Wives now give husbands smiling lectures on the ravages of the disease to keep them faithful. In a Washington, D.C., bar, a woman recently delivered an impassioned speech to her boyfriend on the many advantages of marrying her, the chief one being that he could escape herpes by dropping out of the bachelor life. Some middle-aged men refuse to date women under 30 in the belief that younger people are more likely to have herpes. A West Coast woman finds that having herpes gives her an excuse for avoiding casual sex. Once she acknowledges that she has the disease, nonserious suitors disappear, and "any man involved with me is really interested in me."

In a monogamous relationship, the unsuspecting person who picks up herpes from a partner is hit with a double whammy: evidence of betrayal and a lifelong disease as a memento of the event. Some marriages and many relationships end in the discord and lingering suspicion caused by herpes. When only one partner has herpes, anger is a heavy factor, and so is emotional overload: the herpes sufferer leans too much on the mate and the tottering relationship collapses. Says Psychiatrist Elisabeth Herz of George Washington University Medical Center: "Don't expect to cry on the shoulder of the partner. That's what drives couples apart."

Psychotherapist Michael Herships of Long Island says his recurrent attacks a couple of years ago, for about ten days each month, contributed to the collapse of a serious relationship. "A lot of time I couldn't be sexual," he says. "She saw it as a way of rejecting her. I withdrew emotionally and she didn't understand. Finally she moved out. I felt guilty, asexual." Many feel asexual enough to swear off sex. Seattle Medical Assistant Mike Remington says: "We hear it over and over: 'I won't have sex ever again.' "

Those who resume a full sex life often think they will be safe with partners who already have the disease. But the sufferer can be reinfected in different parts of the body, or may receive a different strain of the disease. "I probably wouldn't see another person with herpes," says a thirtyish New Yorker. "I know that sounds awful, but I can't risk re-exposure and a possible parallel case."

any people who contract herpes go through stages similar to those of mourning for the death of a loved one: shock, emotional numbing, isolation and loneliness, sometimes serious depression and impotence. Often there is a frantic search for a doctor who will give a different diagnosis, or a kind of magical bargaining with the disease ("Maybe if I don't have sex for a while, it will go away"). Almost always there is rage--at the carrier, the opposite sex in general and the medical profession. Says a Los Angeles woman: "When I first got it, I wanted to pass it on to everyone for vengeance until everyone had it and it became normal." Some people act out their fantasies of revenge. A Midwestern woman says she has infected 75 men in three years. Says a Philadelphia man who brags that he infected 20 women: "They were just one-night stands, so they deserved it anyway."

A homosexual, 42, who drives a cab in Cambridge, Mass., thought he had an allergic reaction to a laundry detergent. Two doctors and a second attack later, he knew. "I was an angry person before and I'm angrier now," he says. His earliest fear was that herpes scars on his genitals would make him unattractive to other men, but that no longer concerns him. Now, like many sufferers, he has become a "professor of herpes," plunging into the medical literature when he has time, trying to control the disease by understanding it. He refuses to risk infecting others, so he stays celibate. "I didn't get this till I was 39," he says. "I had 15 years of sexual freedom. If I was 20, my attitude might be different."

Says Detroit Psychiatrist Elliot Luby: "As time goes on there is a 'leper' effect, and some patients describe convictions of their own ugliness, contamination or even dangerousness." Says Kim Robertson, 35, a furniture repairman who lives near San Francisco: "I thought anyone in their right mind would stay away from me." Robertson did not date for two years, and when he did he avoided intimacy. "You don't take the phone number. You don't want to go through the rejection."

Many sufferers compulsively change towels and sheets and wash their hands dozens of times a day. One sign of the herpetic, says Psychotherapist Herships, is chapped hands from overwashing. "You never think you're clean enough," he says. Since friction can trigger a recurrence, tight jeans, the uniform of the sexual revolution, are out. Men switch from jockey to boxer shorts, and women often give up wearing panties or pantyhose. One New York woman, a ballet dancer by avocation, could not dance for a year because tights and leotards were too painful.

A Washington lawyer, 28, spent a month in bed with her first bout, then stayed drunk for half a year, dividing her time between ritualistic repetitions of the phrase "This hasn't happened to me" and harsh daydreams of revenge against the man who gave her the disease. She stopped wearing makeup, ironing her clothes and shaving her legs. "I felt as though someone had pulled the plug," she says, "and let all my sexuality and self-confidence swirl down the drain."

Perversely, some sufferers begin to resent their own attractiveness. An afflicted New York lawyer, married and the mother of a baby girl, was enraged when a construction worker would flirt or whistle. "You bastard," she thought, "little do you know I'm poisoned." New York Architect Geoffrey Meisel refused to go into bars for months after he got herpes, because he felt like a fake. "You're putting on this great front when you know that deep down inside you is this lesion."

Women often have a harder time than men. They appear to suffer more physically in both the initial and subsequent episodes. During recurrent attacks of herpes, they have more lesions than men do, and the pain lasts twice as long. On the other hand, to complicate matters further, there are some women who are barely aware of their herpes outbreaks and the periods during which they are high transmission risks. They sometimes have internal, hard-to-see lesions, they may be carrying the virus in their genital secretions, and a few may spread the disease via shedding from the cervix without showing any overt symptoms. For many women, the disease exacerbates their doubts about casual sex; they feel they were pushed into it by a permissive culture, then made to pay a heavy price.

Unsympathetic friends and relatives can be an additional burden. New York Therapist Michele Krieg, a divorcee, 33, after gathering the courage to tell her mother, heard in response: "But, dear, no one will ever marry you again, will they?" Then a pregnant friend coldly told her to stop visiting until after the baby was born. In one Manhattan office, co-workers of a woman who had herpes refused to use the same phone and got up a petition to ban her from the office, lest she somehow harm an employee undergoing chemotherapy. Some law firms have been making discreet inquiries of doctors, wondering whether it is legal to fire a worker for having herpes. Almost anywhere, at any time, some prattler is bound to say, "Herpes is a very trendy disease, isn't it?" as if the sufferer contracted it to achieve stylishness.

Part of the pain for herpes patients is the conviction of being damaged goods. George Washington University's Elisabeth Herz reports "intense guilt feelings" among women who get the disease, and hears again and again the feeling that they are unclean, dirty. "We're all looking for someone to love," says a New York woman, a freelance artist. "In this world our chances seem so slim anyway. Then you add herpes and you think, 'Why should anyone want me now?' " A doctor in Amityville, N.Y., says the same glum view has invaded the ranks of teenage herpes sufferers, who come into his office, cry and say, "No one will ever want to marry me."

Susan, a Massachusetts housewife and part-time secretary, had herpes for six years and was eight months pregnant when she read in a book that her disease was linked to cervical cancer and could damage babies during birth. "I wanted to take a knife and cut the skin right off me," she says. "I was just so scared about my baby." A healthy girl was born, and for six months Susan was "hysterical" about protecting the youngster, now 3 1/2. "She is probably the most paranoid kid on the block," says Susan, because of elaborate warnings and precautions. Susan douses the house with quarts of Lysol when friends come over, and admits to "enormous" sexual problems with her husband, who caught herpes from her.

Stan, a married man in his 30s who chases women in Manhattan bars, has his own patented method of checking for herpes. When the chitchat has moved far enough along that the woman is peering his way with bedroom eyes, he caresses her right hand, then presses his thumb sharply down on her wrist and barks: "You have herpes, don't you?" "If her pulse jumps, she has it," he says. "If she doesn't, she just laughs." Sometimes, of course, a woman is offended by his personalized lie-detector test. "I lose a few women that way," he says with a shrug, "but at least I don't have herpes."

With visions of herpes sores clouding each new encounter, would-be lovers who used to gaze romantically into each other's eyes now look for the telltale blink or averted glance of the dissembling herpetic. One male skeptic even called the best friend of a woman he wanted to sleep with and asked if his intended had the disease. In the new etiquette of the ailment, a direct question ("You don't have herpes, do you?") is regarded as tacky. Standard openings have evolved. "You would tell me if you had anything I could catch, wouldn't you?" is admired for its implication of trust and its we're-in-this-together coziness. "Have you ever had a cold sore?" is a bit chatty and oblique but not confrontational. The most straightforward query for a woman is simply "Do you mind wearing a condom?"

"The problem should be demystified. It's just cold sores in the wrong place," says Paul cheerfully, if not entirely accurately. He is a New York real estate agent who is divorced. "I picked it up in 1974," he says, "on the only one-night stand in my life." He bolsters his self-esteem by telling himself, "Basically there are a lot of people out there as miserable as me." He has occasional bouts of depression, dabbles in herbal remedies and recently took out a personal ad in New York's weekly Village Voice seeking a woman with herpes. Aside from the ad, he never tells women about his herpes. "I don't want to doom myself to being rejected," he says. "If I tell everyone about herpes, there will be a lot of no sales."

When or whether to tell a date that you have herpes is a thorny matter. The only agreement these days is that you don't do the telling in bed. Says a Seattle secretary: "Never in the bedroom. You can't make management decisions there." Among sufferers, there is a feeling that women are more moral and honest than men about confessing to the disease. Says Fran Simon, a p.r. woman for a Philadelphia hospital: "I sure as hell wouldn't want it on my conscience, passing the disease on to somebody." But a quick admission amounts to a warning bell that scares off potential mates. "It was a dilemma every time I met someone new," says a Miami architect. "I used to rehearse telling people before a mirror." The architect is now happily married, though he has passed the disease on to his wife. A woman in Washington hid her herpes from her boyfriend for three years, and a New York man, possibly the world record holder, kept the news of his herpes sieges from his wife for ten years, mostly by inspired excuses at bedtime.

Psychotherapist Herships changed his mind about candor. He was involved with a woman while on vacation in Montreal. After he told her, "herpes became the focal point for our relationship. It made her anxious. It made me anxious. It diminished the experience." His solution: if you are not having an attack of herpes at the time, then don't tell, because the risk of transmission is low.

Many herpes sufferers think that it is not necessary to tell early in a relationship, or on one-night stands. The idea is to tell only when the relationship reaches a stage in which intimate matters come up naturally. Even then one may face rejection. A schoolteacher in Los Angeles developed herpes blisters on her genitals and legs a month before her scheduled wedding. Her fiance, who had given her the disease, walked out. So did a later boyfriend. "Now I don't tell anybody, and I won't unless I'm having a serious relationship," she says. "What am I supposed to do, say 'How do you do, my name's Ilene, I have herpes'?" Surprisingly, many doctors counsel silence on the first encounter, mostly because their patients' psyches are shaky. "Due to the rejection some of my patients were getting," says New York Gynecologist Michael Truppin, "I finally began advising them not to tell initially. If they tell at first, the other person disappears." Says another doctor: "Every time you kiss someone good night, do you tell them you sometimes get cold sores on your mouth?"

One herpes patient who believes in frankness is Paul Morris, 33, a fan-belt salesman in Houston. He caught herpes in 1976. Dr. A. a general practitioner, said it was syphilis or gonorrhea. Dr. B. a dermatologist, thought it was an unknown skin ailment, and Dr. C. a specialist in infectious diseases, could not identify it but was positive it was not herpes. Only Dr. D. an old friend, had the wit to take a culture that showed the problem was herpes. When Morris informed the woman who gave it to him, she brushed it off with "No big deal." Morris felt betrayed, but so vulnerable that he stayed with the woman, although his infection rendered him sexually inactive during all but three weeks of the next twelve months. When he met his wife-to-be, he immediately told her of his herpes, and after some soul searching she decided that his honesty was more important than the disease. She and their baby daughter are free of herpes.

Frequently, herpes seems to strike nice, healthy, educated, clean-cut Caucasians of the middle and upper classes. Indeed, one survey says that 95% of sufferers are white. Skeptics point out that blacks and the poor, who are not part of the self-help culture, are unlikely to turn up in herpes surveys, and may have more crushing problems to cope with than venereal disease anyway. "Blacks get it, they just aren't obsessed with it," says Tom W. Moore, who works at a Mississippi VD clinic. Some researchers suggest that middle-class hygienic habits cause vulnerability: children who are kept squeaky clean do not get as many cold sores as poor youngsters and thus are generally missing antibodies that protect them against herpes. A study from Paris backs up the theory. It shows that only 30% of high-income French men and women have immunity to genital sores by age 20, but in lower-income brackets almost all children develop the antibodies by age 5.

One national group that tries to encourage constructive talk about herpes is the Herpes Resource Center in Palo Alto, Calif., an organization with 30,000 members in 45 chapters known as Help groups. The chapters function as a large group-therapy session, letting newcomers talk out their problems and assuring herpes sufferers that they are not alone.

The Herpes Resource Center tries to foster the notion of living normally. It is a difficult task because everything about herpes is conducive to irrational fears. No form of protection is absolute, and there is no sure way to know who has the disease, even after a close inspection. Says Dr. Philip Lake of Georgetown University: "As many as one out of six of the general population may from time to time be asymptomatic shedders of the herpes virus."

Doctors have little advice about how to avoid herpes. Though nothing is foolproof, it is best for the man to use a condom. A spermicide may also be helpful. In addition, sex partners should be known well enough to be trusted, and it should be borne in mind that oral sex is a contributing factor. VD Specialist Dr. Felman recommends getting a good look at the prospective sex partner with all the lights on. Says he: "If there are any sores or discharge, it's time to put your clothes back on and find another partner." That kind of clinical inspection leaves little room for mystery and candlelight.

Two u.C.L.A. researchers have reported that herpes viruses can live on towels for up to 72 hr. and on toilet seats for at least four. In one test, a seat used by a woman with thigh lesions showed live herpes viruses 90 min. later. But most doctors down-play the U.C.L.A. study. Dr. Harold Kessler of Rush Presbyterian-St. Luke's, in Chicago, says herpetics should use their own towels, though the chances of passing on the infection via a towel are only about 1%. The virus dies so fast on a toilet seat, he says, that the risk of infection from that source is very slight indeed.

The elusive nature of information about herpes causes much of the frustration among its sufferers. One major perplexity is why herpes recurs, sometimes after lying dormant for months or even years. "This thing seems to have a mind of its own," says Debera Edwards of Washington, D.C., who works in a law office. She contracted herpes in 1978 and complains about its vexing propensity for popping up at inopportune moments: "It knows exactly when you're going away, or when you're really looking forward to something." Says Dr. David Baker, a New York obstetrician: "Stress can reactivate the illness. It may just feed upon itself and create a vicious cycle."

For now, those who have herpes can do little but try to control the negative emotions and stress that often trigger attacks. Many herpes patients use yoga, Transcendental Meditation, biofeedback, hypnosis, talk therapy or simply "imaging," an attempt to conjure up happy images and serene thoughts. One Boston woman reports success by envisioning a golden globe sending off rays that heal herpes. Another woman says that smiling constantly when she felt a cold sore coming on kept the blisters from appearing. Says Dr. Hamilton: "The placebo effect is so strong that 60% of patients treated with any technique are going to get better."

This balming of the sore by the psyche may be the best palliative. Once anger and aggression are dealt with, says Therapist Riccio, a herpes sufferer can develop the kind of psychological calm that makes recurrences milder and rarer. Most manage that within six months, according to Fordham Professor Oscar Gillespie, a co-founder of the New York Help chapter. "Given the appropriate information," Gillespie says, "90% of herpes sufferers will adjust after the initial crisis."

For Fran Simon the clouds parted the day that her therapist asked whether herpes was one of the crucial facts about her life. "I realized then that it wasn't. It wasn't one of the ten most important things about me." One Atlanta man came out of his depression when the outbreaks began to ease. "I looked at it this way: 95% of the time I didn't have herpes. I worked it out and came to terms with it." For others, progress depends on a change of attitude, from victim to manager. Says Marilyn Anderson of Cleveland Heights: "I have this problem, yes, but I feel I have it under control and I can handle it mainly by taking care of my body and my mind. People who have herpes shouldn't downgrade themselves. You have to be positive."

That is a useful reminder: herpes is only as devastating as a patient allows it to be. It is not life-threatening. After the first bout, pain is usually less severe. The virus can be subdued without drugs, by applying the oldest of American remedies--positive thinking. Indeed, herpes is so dependent on mood and emotion that once a sufferer regains self-confidence, many outbreaks can be tamed and managed. "I see an enormous number of people who really do cope," says Seattle's Dr. Lawrence Corey. "They have to live with having the disease, but it doesn't consume them."

For now, herpes cannot be defeated, only cozened into an uneasy, lifelong truce. It is a melancholy fact that it has rekindled old fears. But perhaps not so unhappily, it may be a prime mover in helping to bring to a close an era of mindless promiscuity. The monogamous now have one more reason to remain so. For all the distress it has brought, the troublesome little bug may inadvertently be ushering in a period in which sex is linked more firmly to commitment and trust. --BY John Leo. Reported by Maureen Dowd/New York with other bureaus

With reporting by Maureen Dowd

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