Background: After primary orofacial infection with the herpes simplex virus (type 1, HSV-1), up to 40% of HSV seropositive subjects suffer recurrent herpes infections which are characterized by painful erosions of the involved skin mainly around the lips (herpes labialis). Besides various other factors, there is growing evidence suggesting that psychosocial factors might trigger HSV. The present study was designed to investigate modulation of recurrent HSV infection by experimentally induced emotional distress. Methods: Among patients with herpes labialis (n = 91), subjects who showed recurrent HSV infection (>5 acute infections/year) and who reported to suffer from HSV symptoms exclusively after confrontation with dirty dishes, i.e. dirty plates or dirty glasses were selected by standardized interview. Subjects (n = 20) were randomly assigned to two treatment groups. The experimental group (n = 10) was first exposed to 5 slides showing dirty glasses and subsequently to the glasses previously presented on the slides in vivo. The control group (n = 10) was exposed to neutral slides and neutral objects. In order to determine the proportion of leukocyte subpopulations and concentrations of tumor necrosis factor α (TNF-α), blood samples were collected 15 min before as well as 40 min and 48 h after stimulus presentation. Saliva cortisol was obtained 45, 20, 15 and 1 min before and 1, 10, 20 and 30 min after stimulus confrontation. Results: Medical examination of the volunteers 48 h after the experiment indicated that four experimental subjects showed HSV-1 symptoms while not a single herpetic infection could be determined in the control subjects (p = 0.033). Moreover, significantly elevated concentrations of TNF-α were observed in the experimental, but not in the control group. No significant alterations of the number of leukocyte subpopulations were found 30 min or 48 h after stimulus presentation. Further, cortisol concentrations were found to be unchanged after the treatment. Conclusions: The present findings suggest that experimentally induced emotional stress such as disgust may be associated with reactivation of HSV.

Pereira FA: Herpes simplex: Evolving concepts. Genitourin Med 1997;73:253–258.
Whitley RJ, Kimberlin DW, Roizman B: Herpes simplex viruses. Clin Infect Dis 1998;26:541–553.
Blondeau JM, Embil JA: Herpes simplex virus infection. What to look for. What to do! J Can Dent Assoc 1990;58:785–787.
Scott DA, Coulter WA, Lamey PJ: Oral shedding of herpes simplex virus type 1: A review. J Oral Pathol Med 1997;26:441–447.
Spruance SL: The natural history of recurrent orial-facial herpes simplex virus infection. Semin Dermatol 1992;11:200–206.
Schmidt DD, Zyzanski S, Ellner J, Kumor ML, Arno J: Stress as a precipitating factor in subjects with recurrent herpes labialis. J Fam Pract 1985;20:359–366.
VanderPlate C, Aral SO, Magder L: The relationship among genital herpes simplex virus, stress and social support. Health Psychol 1988;7:159–168.
Glaser R, Kiecolt-Glaser JK, Speicher CE, Holliday JE: Stress, loneliness, and changes in herpesvirus latency. J Behav Med 1985;8:249–260.
Kiecolt-Glaser JK, Kennedy S, Malkoff S, Fisher L, Speicher CE, Glaser R: Marital discord and immunity in males. Psychosom Med 1988;50:213–229.
Kiecolt-Glaser JK, Glaser R, Shuttleworth EC, Dyer CS, Ogrocki Pl, Speicher CE: Chronic stress and immunity in family caregivers of Alzheimer’s disease victims. Psychosom Med 1987;49:523–535.
McKinnon W, Weisse C, Reynolds CP, Bowles CA, Baum A: Chronic stress, leukocyte subpopulations, and humoral response to latent viruses. Health Psychol 1989;8:389–402.
Glaser R, Kiecolt-Glaser JK: Chronic stress modulates the virus-specific immune response to latent herpes simplex virus type 1. Ann Behav Med 1997; 19:78–82.
Glaser R, Gotlieb-Stematsky T: Human Herpesvirus Infection: Clinical Aspects. New York, Dekker, 1982.
Kiecolt-Glaser JK, Speicher CE, Holliday JE, Glaser R: Stress and the transformation of lymphocytes by Ebstein-Barr virus. J Behav Med 1984;7:1–11.
Glaser R, Pearson GR, Bonneau RH, Esterling BA, Atkinson C, Kiecolt-Glaser JK: Stress and the memory T-cell response to the Ebstein-Barr virus in healthy medical students. Health Psychol 1993;12:435–442.
Glaser R, Rice J, Sheridan J, Fertel R, Stout J, Speicher C, Pinsky D, Kotur M, Post A, Beck M, Kiecolt-Glaser JK: Stress-related immune suppression: Health implications. Brain Behav Immun 1987;1:7–11.
Kemeny ME, Cohen F, Zegans LS, Conant MA: Psychological and immunological predictors of genital herpes recurrence. Psychosom Med 1989;51:195–208.
Goldmeier D, Johnson A: Does psychiatric illness affect the recurrence rate of genital herpes? Br J Vener Dis 1982;58:40–43.
Katcher AH, Brightman V, Luborsky L, Ship I: Prediction of the incidence of recurrent herpes labialis and systemic illness from psychological measurements. J Dent Res 1973;52:49–58.
Sheridan JF, Dobbs C, Brown D, Zwilling B: Psychoneuroimmunology: Stress effects on pathogenesis and immunity during infection. Clin Microbiol Rev 1994;:200–212
Glaser R, Kutz LA, MacCallum RC, Malarkey WB: Hormonal modulation of Ebstein-Barr virus replication. Neuroendocrinology 1995;62:356–361.
Bartling G, Echelmeyer L, Engberding M, Krause R: Problemanalysen im therapeutischen Prozess. Stuttgart, Kohlhammer, 1980.
Dressendörfer RA, Kirschbaum C, Rohde W, Stahl F, Strasburger C: Synthesis of a cortisol-biotin conjugate and evaluation as a tracer in an immunoassay for salivary cortisol measurement. J Steroid Biochem Mol Biol 1992;43:683–692.
Biondi M, Zannino LG: Psychological stress, neuroimmunomodulation, and susceptibility to infectious diseases in animals and man: A review. Psychother Psychosom 1997;66:3–26.
Vassalli P: The pathophysiology of tumor necrosis factor. Ann Rev Immunol 1992;10:411–452.
Henderson B, Poole S, Wilson M: Microbial/host interactions in health and disease: Who controls the cytokine network? Immunopharmacology 1996;35:1–21.
Munck A, Guyre PM: Glucocorticoids and immune function; in Ader R, Felten DL, Cohen N (eds): Psychoneuroimmunology. San Diego, Academic Press, 1992, pp 447–474.
Wilckens T, De Rijk R: Glucocorticoids and immune function: Unknown dimensions and new frontiers. Immunol Today 1997;18:418–424.
Munck A, Naray-Fejes-Toth A: Glucocorticoids and stress: Permissive and suppressive actions. Ann N Y Acad Sci 1994;746:115–130.
McGowan JE, Chesney PJ, Crossley KB, LaForce FM: Guidelines for the use of systemic glucocorticoids in the management of selection infections. J Infect Dis 1992;165:1–13.
Lathey JL, Spector SA: Unrestricted replication of human cytomegalovirus in hydrocortisone-treated macrophages. J Virol 1991;65:6371–6375.
Sheridan JF, Dobbs C, Jung J, Chu X, Konstantinos A, Padgett D, Glaser R: Stress-induced neuroendocrine modulation of viral pathogenesis and immunity. Ann N Y Acad Sci 1998;840:803–808.
Dobbs C, Vasquez M, Glaser R, Sheridan JF: Mechanisms of stress-induced modulation of viral pathogenesis and immunity. J Neuroimmunol 1993;48:151–160.
Schmidt DD, Schmidt PM, Cabtree BF, Hyun J, Anderson P, Smith C: The temporal relationship of psychosocial stress to cellular immunity and herpes labialis recurrence. Fam Med 1991;23:594–599.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.