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Frances Cohen, PhD; Margaret E. Kemeny, PhD; Kathleen A. Kearney, PhD; Leonard S. Zegans, MD; John M. Neuhaus, PhD; Marcus A. Conant, MD

Arch Intern Med. 1999;159:2430-2436.

Background  Results of several studies suggest that psychological stress and negative mood can trigger genital herpes recurrences, but results are inconsistent.

Objective  To determine whether short-term or persistent psychological stress or specific negative moods are predictive of genital herpes recurrences in women.

Methods  A prospective cohort study followed up participants for 6 months using weekly assessments of stress and mood, monthly assessments of life change events, and diary reports of genital herpes recurrences confirmed by medical examination when feasible. The community sample consisted of 58 women, aged 20 to 44 years, with a 1- to 10-year history of visible genital herpes recurrence and at least 1 recurrence in the previous 6 months.

Results  Persistent stress predicted recurrence in the subsequent week (odds ratio, 1.08 per unit increase in stress; 95% confidence interval, 1.01-1.15; P=.03). After adjusting for recurrence in the previous week, the more weekly persistent stress reported, the greater the likelihood of recurrence the following week. Also, an increased recurrence rate occurred after the month during which participants experienced their highest levels of anxiety (P=.03). There were no significant associations between recurrence and short-term stress, life events, depressive mood, anger, or phase of menstrual cycle.

Conclusions  Persistent stressors and highest level of anxiety predicted genital herpes recurrence, whereas transient mood states, short-term stressors, and life change events did not. Women with herpes can be reassured that short-term stressful life experiences and dysphoric mood states do not put them at risk for increased outbreaks of recurrent genital herpes.

From the Health Psychology Program, Department of Psychiatry (Drs Cohen and Kearney), and Departments of Psychiatry (Dr Zegans), Epidemiology and Biostatistics (Dr Neuhaus), and Dermatology (Dr Conant), University of California, San Francisco, School of Medicine; and Departments of Psychology and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (Dr Kemeny). Dr Kearney is now with the Department of Quality and Utilization, Kaiser Permanente, Oakland, Calif.

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