(Nov 4) FIRST, there is a tingly, itchy sensation.
Then a rash develops. Blisters form and burst, developing into painful ulcers. The sensation is constant and severe.
Finally, two to four weeks later, the ulcers dry and heal. The ordeal ends - only to start again the following month.
And all this is happening on or near one's genitals.
That is possibly the worst-case scenario for people who suffer from genital herpes, which is a form of sexually transmitted infection (STI).
Genital herpes, like other STIs, is spread through sexual contact.
The situation was bad enough for a man to want to take a woman to court about it.
It was reported last week that a company director had sued an accounts executive for allegedly giving him herpes.
According to court documents, he claims she told him she was 'clean' before they became intimate in August 2004. They broke off their relationship after a month, after he was diagnosed with the infection.
The man, who is single, claims herpes has caused him frequent and recurring pain. He sought general damages for the infection she allegedly caused, on top of the $300,000 in medical bills and lost man-hour costs which he wanted reimbursed as special damages.
The civil suit, believed to be the first of its kind before the High Court here, was scheduled to be heard last Friday but the outcome was unknown.
Genital herpes is one of the most common STIs here and worldwide. Although it is not known how many people suffer from it here, about one in four people has been infected by it in the United States, according to the Centers for Disease Control and Prevention in the US.
Doctors say it is possible for the condition to be debilitating, but are quick to add that having the symptoms recur every one to two months is uncommon.
Associate Professor Roy Chan, director of the National Skin Centre, points out that many patients get no more than one or two attacks a year.
The most serious episode is the first, when the blisters are usually abundant and can persist for two to four weeks. Subsequently, there are fewer blisters and they are likely to clear up after 10 days.
In fact, some people may carry the herpes simplex virus (HSV) for many years - or even their entire lives - without showing any symptoms, says Prof Chan.
'As such, many people may not know that they are carrying the virus,' he notes.
It is also possible that the virus may lie dormant, only to show symptoms years later.
HSV is responsible for genital herpes and is part of the family of herpes viruses. There are eight types altogether and they cause different illnesses, ranging from chicken pox to infectious mononucleosis, a condition that is characterised by fever and a sore throat, says Dr Chris Foo, a consultant dermatologist at Raffles Hospital.
Of these, two are herpes simplex viruses: type-1 (HSV-1) which usually causes cold sores on the lips and mouth, and type-2 (HSV-2) which usually causes genital herpes.
However, HSV-1 can spread to the genitals through oral sex and lead to genital herpes and vice versa.
The presence of antibodies to the virus - which means the person has been exposed to the virus - can be confirmed with a blood test.
When the virus is activated, it multiplies in the skin, destroying the skin and causing blisters to form.
The condition is incurable because once the virus enters the body, it settles permanently in the nerves near the spine. It tends to resurface at times when a person's immune system is weak, such as during periods of stress or fatigue.
It is similar to chicken pox, which is caused by a different type of herpes virus and can also resurface later in life as shingles.
Genital herpes hits women slightly more than men. The old, who have weaker immune systems, and those who are immuno-suppressed - like chemotherapy or transplant patients - are more susceptible as well.
Nevertheless, most people who contract genital herpes are able to lead normal lives, says Dr Choo Wan Ling, a consultant obstetrician and gynaecologist at Pacific Specialist Practice.
Although the virus remains in the body, there is no need to be on constant medication. Instead, anti-viral pills are taken only when there is an attack.
Only in cases when the recurrence is very frequent do anti-viral pills have to be taken daily for a prolonged period to prevent the attacks, she says.
The pills help to suppress the effects of the virus and shorten the duration and severity of the attack.
Dr Choo estimates that the cost of medication for the first attack is around $100 to $200, dropping to $50 to $100 for subsequent attacks as the blisters subside more quickly.
The course of anti-viral pills usually runs for a period of five to 10 days.
Psychological impact is greater
AS FOR sex, genital herpes sufferers can continue to have a normal sex life, as long as they inform their partners about their condition and are careful to use a condom during intercourse.
The chances of spreading genital herpes are higher when the sufferer is showing symptoms. However, if the symptoms are severe, it would be too painful to have sex.
The greater danger then is in having sex when the symptoms are so mild that they go unnoticed. The infection can also be spread even if there are no visible symptoms.
Wearing a condom, though not fail-safe, significantly reduces the chances of the infection being spread.
Anti-viral medication, if taken in tandem, further reduces the risk of transmission.
Indeed, the greater problem of sufferers may not be physical but psychological.
'Some patients are crippled by it,' says Prof Chan. 'They feel they are diseased and are paranoid about passing it to other people.'
However, such thoughts only persist in a small number of patients. With proper counselling and guidance, most patients can overcome this obstacle.
Dr Choo adds that patients' partners may also need to be counselled as they may associate the condition with promiscuity and this could strain their relationship.
'The natural reaction to hearing that your partner has genital herpes is that he or she has been sleeping around,' she says.
'But they might have merely gotten it from their previous partners. Since the virus can stay dormant in the body, it can be passed on to a susceptible individual in a subsequent relationship.
