Dear Dr. SerVaas: After more than 45 years of marriage, I developed a herpes simplex type 1 infection in the vaginal area. Neither my husband nor myself have had other sexual contacts.

Please list any possible cause, since sex is not, in my case. I was given a ten-day prescription of Valtrex, but it appears to be coming back. Are there other treatments?

What are the signs of recurrence, and how can I know when it would be contagious to my husband? How often can it recur?

name withheld
Honolulu, Hawaii

Dear Reader: Two closely related types of the herpes simplex virus (HSV) can cause genital infections. HSV-2 accounts for most cases and is spread by sexual contact. HSV-1, however, may be contracted much like the common cold. Small blisters appear within about six hours of tingling discomfort or itching.

Dr. William Hanke, clinical professor, Indiana University School of Medicine, and medical director, Laser & Skin Surgery Center of Indiana, responds to your questions:

"Herpes simplex is a human-specific virus that infects individuals across the globe. HSV-1 usually causes nongenital infections (of the mouth, lip, and eye) and is contracted through exposure to it, much like the common cold. The incubation period is from three to ten days following exposure. Painful lesions may develop on the mucous membranes for one to three weeks.

"Patients with acute outbreaks can infect others through physical contact. Mature lesions usually appear as pustules on top of redness and swelling on the skin. Once the lesions begin to crust and heal, the herpesvirus appears to be latent within the nerves. It can reactivate in the epidermis of the skin and cause recurrent lesions. Twenty to 45 percent of people infected with HSV-1 develop recurrent infection.

"Physical and emotional stress, sunburn, and systemic infections contribute to recurrence. Fortunately, effective antiherpes drug treatment is readily available. Some patients are required to take medication continuously in order to suppress frequent outbreaks."

Many Post readers have told us that they successfully treat cold sores and other HSV-1 lesions with lysine, an inexpensive amino acid available without prescription. As we have previously reported, longtime lysine researcher Dr. Richard Griffith recommended that cold-sore sufferers take 500 mg per 22 pounds of body weight daily. Treatment is most effective if begun when symptoms first occur.