Dr. Tom answers questions about herpes, Page 2

Do you have any questions or concerns about what Herpes is, how it's spread, about the virus itself?
Receive advice from Dr. Tom Neblett, a Doctor who has devoted much of his life to the study of viruses and Sexually Transmitted Diseases.


Is herpes on my thigh genital herpes?


Dear Dr. Tom:

I have genital herpes and instead of having the outbreaks on my genitals, I usually get them on my right upper thigh. Is this considered herpes too? Also, when I do have an outbreak, I am extremely tired and feel very weak, is this normal? Also, I seem to get depressed and anxious too.
Thank you, Sue

Dr. Tom's Response:


Dear Sue:

A herpes outbreak cannot be considered normal, but so far as your description goes, a herpetic infection might be expected to manifest itself in the ways you have described. All of the conditions you have listed may be expected from a herpes recurrence.

Dear Dr. Tom:

Both my wife and I have had genital herpes for the past 14 years. Until recently we have had unprotected sex with no problem except for an occasional tingle. For the past few months though, we have both had pretty severe breakouts with bumps, severe itching, etc., brought on originally I think, by an off-brand clothes detergent we had never used before. Now we can't seem to get rid of it! When one lesion heals, another one pops up. Are we just re-infecting each other? According to your other answers I have read, unprotected sex between two married infected partners should not be a big concern. Can you elaborate on that and is there anything that can be done to alleviate the severe itching, which seems to be the most annoying factor?

Dr. Tom's Response:


Dear Couple Married for 14 years:

From the brief description of your situation, some factor has entered the situation that has not been there for the relatively uneventful period of your marriage. Re-inoculation is possible, but more likely some other inciting variable is active now. You should consult a dermatologist to seek relief from the intensive itching. If the lesions appear to be the same, your herpes is most likely making an annoying disturbance for a reason that I cannot answer. A clinical examination and conference with your health care provider hopefully should give you the direct guidance needed.

Dear Dr. Tom:

My girlfriend of two years recently told me she has herpes and has known about for some time in which we were sexully active. I have not had any outbreaks that I know of, and wonder what I should do?

Dr. Tom's Response:


Dear Anonymous with a Girlfriend:

You did not indicate if your sexual activity had been protected; if so, you have prevented infection. Keep up the vigilance. If not, I suggest you change to protected sex, because you have been lucky. The other possibility is that you have acquired an infection that remains asymptomatic because of a low virulence viral strain or because of an excellent immune response from your own system, perhaps both.

Dear Dr. Tom:

Is it possible for me to have herpes and not show any symptoms?

Dr. Tom's Response:


Dear Anonymous:

Yes, one can have a herpetic infection and not know it. Such an occurrence is infrequent, but possible.

Dear Dr. Tom:

I have Herpes Labialis, or, of the mouth. It usually manifests about two to three times a year, during periods of high stress and low rest. I am taking 800 mg of Acylclovir 4 times a day, and for the past five days, it doesn't seem to have done much on the sore I currently have. Usually, it is effective much faster. Is it possible that the virus is building up an immunity, such that I would need another treatment? Also, I got this from my girlfriend. She had the virus in the form of a small cold sore, and I got it from an open wound in my mouth, due to mouth-to-mouth contact. When I have a sore with a white covering, signifying that I am contagious, does she have to worry about contracting the virus, maybe a worse type or as a different type of virus, even though she's the one I got it from?? Is she at risk?
Thanks, Distressed

Dr. Tom's Response:


Dear Distressed:

Yours sounds like what is referred to as a "ping-pong" infection. Only in ping-pongs, one partner is cured, while the other partner re-infects him/her. Microorganisms, including viruses do not become immune. They can become resistant to a variety of anti-microbial substances used to treat the infections they cause. Some of the following facts may help your thinking, hopefully without confusing you: Isolation of acyclovir resistant mutants of HSV isolates was reported in 1980. These were laboratory studies. Virus which is less sensitive to acyclovir possibly may result within those persons taking that drug. Such patients are advised to take pre- cautions they do not transmit the virus if they experience active sores while they are taking the drug. Acyclovir is not equally effective in all persons. A quantative relationship between laboratory susceptibility of HSV to acyclovir and its clinical effectiveness in humans has not been established. If the two of you have not participated sexually with any others, the likelihood of another virus strain in the scenario is nil. See your health care provider who put you on acyclovir in order to discuss the way your treatment has gone.

Dear Dr. Tom:

I was wondering if genital herpes is commonly a disqualifying factor, when found in a pre-employment doctors physical. (Police, Fire & Medical Fields) Does genital herpes "show up" in a blood test that is conducted in these physicals ?
Thanks for your time.......Karen S.

Dr. Tom's Response:


Dear Karen S.:

I cannot vouch for the way communities screen their candidates' pre- employment public service physicals, so I am unable to state what they commonly do/do not look for. I doubt seriously if any pre-employment blood test examines specifically for anti-herpes antibody. These pre-employment tests are usually CBC (complete blood count), blood chemistry and nearly always a urine screening procedure for presence of drugs in the system. At one time a routine VDRL or RPR card test (on blood serum or plasma) for syphilis was done, but that has been dropped in many places. Consult your local library for a manual that will describe the requirements and limitations for many such jobs, commonly shelved within the Documents section. These information manuals will usually state clearly any disqualifying conditions.

Dear Dr. Tom:

I was diagnosed with herpes about 6 months ago. I now have a partner who, unfortunately, contracted the herpes from me. My question is, when either of us has an outbreak, will the other necessarily have an outbreak if protection is not used? Thank you!

Dr. Tom's Response:


Dear Anonymous:

Having unprotected sex between two herpes infected persons is not reason for one partner to be triggered into an outbreak when the other is having one - unless, of course, the sexual union is a stressful one. Not likely then perhaps. The risk of unprotected sex lies in the possibility of spreading the virus to other parts of each other's bodies, somewhat of a mutual auto-inoculation. The risk also lies there, unless each of you have made some determination of your abilities to shed (or not to shed) virus asymptomatically.

Dear Dr. Tom:

Is famvir sold over-the-counter or only by prescription?

Dr. Tom's Response:


Dear Anonymous:

Famvir is a prescription drug.

Dear Dr. Tom:

It's the first time I've got herpes and my doctor prescribed famciclovir and penciclovir for 5 days. What are my chances of getting out of this disease?

Dr. Tom's Response:


Dear Anonymous Who Asked About Famciclovir:

With today's knowledge you have no chance to escape a herpetic infection through treatment. Famvir is an anti-herpetic drug, but herpes is still forever. The prescription antivirals make herpetic infection more tolerable, and they are being studied for their possible ability to lessen shedding.

Dear Dr. Tom:

My husband and I have recently been diagnosed with herpes. Prior to this occurance, we were anxious to start a family. Can he and I "reinfect" each other since we've both been exposed? What threat does this disease pose to an unborn child? What are the long term effects of the virus? Does it cause infertility? Any information provided would be greatly appreciated.
Curious

Dr. Tom's Response:


Dear Curious:

Your short question poses some very important issues for would-be new parents. Hopefully, some of these answers will be of some value to you. The herpes virus can be spread to other parts of the body within and between persons who are already infected. Two risks are at issue for HSV infection during pregnancy: an increased risk of spontaneous abortion or premature birth plus transmission risk to the neonate during birth. However, uninfected children are regularly born to infected mothers. Congenital transmission is rare. Skin lesions, sometimes mis-diagnosed as impetigo or inflammation of a follicle, occur in about half of infected neonates. Invasion of the eye is also seen. About 3/4 of infected neonates show disease distributed throughout the body with general symptoms such as fever or sub-normal body temperature, vomiting, irritability, lethargy and poor feeding. The outlook for infected neonates is not good. In one study, about 60% of neonates died, and 18% survived with some residual nervous system or ocular disease. The remaining 22% survived with no harmful after effects. I am unable to answer specifically about influence on fertility. The best advice on childbearing for an infected mother should come from someone who deals with that professionally. Herpetic pregnancy and neonatal sequelae should be discussed with a pediatrician or a neo natologist and/or a family planning counselor. What seems to be important is that the mother keep her ob/gyn doctor informed of her status, re: outbreaks and recurrence cycles if known. Frequent virus cultures of the mother during her last few weeks of pregnancy to monitor the likelihood of possible viral presence at birth are inconvenient but quite helpful to guide delivery planning. I wish you well.

Dear Dr. Tom:

My current boyfriend and I have been monogamous for over two years. Within our first three months of dating, I had my first outbreak of herpes. At that, he had a small cold sore on his mouth, and to this day, we still wonder if that was the cause. He was tested, and showed nothing. I have not had an outbreak in two years. Once I was diagnosed, we started using condoms all the time. We just moved in together and are wondering how safe it is for us to have sex without condoms. I understand that during open lesions, or if there is any suspicion of an oncoming outbreak, condoms should be used. I have consulted my gynecologist about condom free sex, and she was positive, while still pointing out the slim change of transmission. My boyfriend's doctor was less positive. Your opinion is greatly appreciated. Thank you.

Dr. Tom's Response:


Dear Anonymous:

Within the first three months of monogamous dating you had an herpetic outbreak, and your boyfriend experienced cold sores on his mouth. If it quacks like a duck, it probably is a duck! Cause is immaterial now; the task is to control further spread. Based upon the simplest concept of infection control: prevent an infectious agent from reaching a susceptible host by interposing a barrier between the two.. I think the safer outlook seems to come from your boyfriend's doctor. Your gynecologist has given you the caveat of a slim chance of transmission as well.

I was diagnosed without a test


Dear Dr. Tom:

I was diagnosed with herpes about 16 months ago. I went to my school health clinic and they said it was herpes; I had all the signs. What confuses me is that they never did a test to prove it; they just looked and said it was herpes. My problem is, I have never had another "outbreak" since, and my boyfriends have never gotten it, and I have had unprotected sex and have been given oral sex. I am wondering if it was a false diagnosis, and I can't get tested again, because I never have outbreaks. The last one; if it was; was that long ago. Please help.
Anonymous in Michigan

Dr. Tom's Response:


Dear Anonymous in Michigan:

The person who examined you in your school clinic probably has seen sufficient cases of HSV infection that the visible signs were obvious and typical, and that no test was necessary to establish what appeared obvious. While the possibility exists that yours was a false diagnosis, the fact that you have not had more recent outbreaks or seemingly have not transmitted the infection through your sexual activities does not mean you do not have herpetic infection. Asymptomatic cervical recurrences can occur in women. Rather than undergo anguish over your situation I suggest that you seek medical help from someone with whom you are comfortable and who is most likely to have thorough knowledge of sexually transmitted diseases. Such a doctor can draw a blood sample for antibody level determination and can take exocervical swab samples for possible viral isolation if that is what s/he thinks may be necessary.

Dear Dr. Tom:

About four years ago, I noticed these brown bumps on my husband?s lower abdomen. I was very concerned and asked him how he got them. He stated they appeared after taking a shower at his father's house, after the use of one of his washcloths. I was suspicious so I took my husband to a doctor's office. My husband claims the doctor told him they are warts. I personally have had no symptoms or breakouts of herpes. It is possible for him to have herpes these last four years and never pass it on to me?
Confused, Ami

Dr. Tom's Response:


Dear Confused:

Warts are caused by viruses within a group known as papilloma viruses. The fact that your husband has/had abdominal warts does not imply that these lesions are related to a herpes infection that could be transmissible to you. Molluscum contagiosum is a member of the pox virus group, and its lesions can appear on the abdomen and may sometimes be wrongly diagnosed as warts. Human papilloma viruses and molluscum contagiosum are sexually transmissible. If the warts or lesions persist, a dermatology specialist should be consulted, who would very likely remove some of the material for laboratory identification.

Dear Dr. Tom:

I have very small, painless, white bumps in my mouth. I do not understand what they are; I do not have symptoms for herpes. Please, please tell me what these bumps could be. Thanking you in anticipation.
prodiesal

Dr. Tom's Response:


Dear Prodiesal:

Painless white bumps in your mouth could be symptoms of several conditions which are impossible to identify from what you have written. A visit to either your personal physician or dentist or both would be the place to begin. Those practitioners may be able to ascertain your difficulty by examination without further investigations, and they would be able to remove tissue samples for more definitive diagnosis if they thought that to be necessary.

Dear Dr. Tom:

Gosh.. where do l start?? l don?t know. l am 21 and l think that l have genital herpes. Of course l am so upset by this. Not sure if this is what l have or what. l kinda wanna talk to someone about it, and get some answers to some ?s. l have looked at lots of info on it lately, but just still not sure. What should l do? And is there some kinda online doctor that l can actually chat with about it???

Dr. Tom's Response:


Dear Where Do I Start:

To help answer some of your questions you might wish to consult the Herpes Hotline, 1-919-361-8488, where persons are available to answer directly and conversationally. These are not doctors, but they are selected for their knowledge and ability to discuss personal and emotional problems related to herpetic infection.

Dear Dr. Tom:

I 'm 23 yrs old..I read a little about Herpes diseases..and I think I've got one...even though I don't know where it came from, because me and my boyfriend have been together for 6 years truthfully..I knew it because I went to see the doctor..but I didn't do the blood test yet..because I was afraid..I just wanted to know how it spread..and how to live with it .. and to prevent from infecting other people..

Dr. Tom's Response:


Dear 23 year old Anonymous:

Reticence to receive bad news is an understandable explanation of failure to undergo laboratory testing, but consider that the results might be good instead of bad.

Dear Dr. Tom:

I have had a rash, which was like Jock Itch....I went to the doctor and she said it was probably a yeast infection of some sort. I used a Jock Itch cure, and it went away....however, I am afraid it might be something worse. The rash was red, itched, and lasted about two weeks. It was located on my legs and around my genital area. I also was tested for HIV at our community health center, I don?t know if they do any other tests on the blood.....Is there anyway I can be sure what this was?

Dr. Tom's Response:


Dear Anonymous with a Rash Like Jock Itch:

The way to be sure what your itching and rash were would be to seek treatment from a dermatologist who specializes in skin diseases and related disorders. Skin scrapings can be examined under a microscope, and laboratory cultures can be performed to identify more specifically what your affliction is.

Dear Dr. Tom:

I think I may have a herpes cold sore on my lip. 6 days ago, I had oral sex with a man who said he'd always had the bump on his penis and it was not dangerous. So now I feel like an idiot. I have a tiny tingling bump on my lip, which I originally thought was a pimple, and I have a slight sore throat. My concerns are: 1. How can I keep from spreading it? Can I keep the sore from getting too gross? 2. I have had diabetes for 25 years, will this cause any special problems for me.

Dr. Tom's Response:


Dear Lady Who Feels like and Idiot:

Let me assure you are not. Your mistake was failure to be more cautious about oral sex in the presence of the man's unidentified penile bump. There are non-herpetic conditions in the male that produce such bumps. Your symptoms suggest oral herpes infection and pharyngitis (sore throat). See your doctor who will probably discuss diet and possibly treatment with an antiviral drug to help control gross appearance, spreading, and any possible immune-compromise you may be experiencing because of your diabetes.

Dear Dr. Tom:

My son has sores around his abdomen. Although the sores are not on his genitals, his doctor thinks it might be herpes, even though no culture was taken. The sores are below his navel. They are white heads, sometimes open sores. Some seem to be drying up with a mark. How can I know for sure what he has. Do you think it is herpes? My son is only 17 years old. The doctor says that because he was wearing protection, the sores did not travel to his penis. Please respond.
Sincerely, Concerned Mom

Dr. Tom's Response:


Dear Concerned Mom:

My suggestion is to return your son to his/your doctor. If you have not already done so for a more definitive diagnosis by culture method. Your description fits herpes and also some other possibilities.

Dear Dr. Tom:

Can herpes be transmitted to a person, and then that person not have any symptoms for two years?

Dr. Tom's Response:


Dear Anonymous:

Yes, a person may become infected with HSV infection and not experience symptoms for a period as long as two years, possibly even longer.

Dear Dr. Tom:

I had a burning sensation on my inner thigh, which crept its way up to the area mid-way between my belly-button and penis. I noticed that I had some small blisters and the area was red. The blisters are not on the shaft and I wonder, is this HSV?

Dr. Tom's Response:


Dear Anonymous:

The inner thigh burning sensation followed by migration upward on your body accompanied by blisters fits the common description of herpetic infection. See your doctor for an examination and test by culture.

Dear Dr. Tom:

I was wondering, how long can herpes lay dormant?

Dr. Tom's Response:


Dear Anonymous:

Herpes viruses can survive for just a few short hours outside the body or cloth or hard surfaces, but once in the body, they have been known to remain dormant for years in rare cases. Symptoms usually appear within a few days after exposure.

Dear Dr. Tom:

My sister has genital herpes, is it possible she can spread the disease to the rest of my family by: sharing drinking glasses? sharing towels? toilet seat? swimming pool? sauna?

Dr. Tom's Response:


Dear Concerned about Sister's Genital Herpes:

If your sister has shown no mouth lesions (herpes labialis), and her infection manifests only in the genital area, then spread by drinking glasses to rest of the family is most unlikely. The disease can be spread that way if a person with mouth sores uses a glass, and another immediately uses the unwashed glass. A report on herpes shedding and survival from fever blisters was published in the April 1982 journal, Pediatrics, p. 547. I am aware of at least one case where genital herpes was transmitted to another person who re-used an infected person's damp towel immediately afterward. The inherited infection was also in the genital area, suggesting that both persons towelled in the groin. Some would argue (without substantiation) that fresh fluid from a herpetic lesion deposited on a toilet seat could pass the infection along to an immediate next user. I have never known this to happen, nor have I been made aware of any sexually transmitted disease micro-organism being passed along on toilet seats. Swimming pool chemicals are unfavorable to most micro-organisms, including HSV. Sauna temperatures and chemicals are detrimental to survival of HSV. As a general principle, herpes viruses are not spread by fomites.

Dear Dr. Tom:

1. How effective is suppression therapy in stopping asymptomatic shedding? 2. It appears from your other answers that familial contact with a carrier increases the risk of contracting HSV by non-infected family members. If so, what precautions can be taken (in light of your advice that every infected person be presumed to be an asymptomatic shedder) by non- infected family members who absolutely don't want to get the disease? Please be candid and painfully honest. Specifically, what physical contact and context can an infected person (with known genital HSV) safely be around extended family if the goal is to not elevate the risk of the non-infected above ordinary social risks we take every day in the public arena? 3. What is the probability that a non-infected female fianc? will eventually get the disease from her genitally infected husband (HSV-2). What will be her experience with the disease, given that she already has another chronic auto-immune disease (eg. Type 1 diabetes). Are there any safeguards she can take to ABSOLUTELY guarantee she will not get infected? 4. Where can we go to further research the risk of transmission of HSV to family (non-spousal) members (both children and adults)?

Dr. Tom's Response:


Dear Anonymous Who Asks 4 questions:

1. The effectiveness of suppression therapy to curtail or control asymptomatic shedding of HSV is currently under clinical investigation, but the results won't be known for some time. The Glaxo-Wellcome Co., manufacturer of valtrex, is collaborating with medical investigators at the University of Washington on a program involving married couples, only one partner of which is infected with HSV. This study was described to the public within recent months in the Miami (Fla) Herald and also in one of the Seattle newspapers. Since it has just begun, obviously no data are available. The manufacturers are optimistic about the drug?s effectiveness through some smaller preliminary evaluations that have been made and published. 2. Remember the most fundamental principle of infection control: Keep the infectious agent away from a susceptible host. If this aim can be achieved, no infection can possibly result. Adapting that principle to a household is a matter different for every family, but these are some general infection control practices: Share no personal items, towels, washcloths, bedding, underclothing, toothbrushes (some do). Make sure that tampons/sanitary napkins are disposed of aseptically. Adopt the same standards of housekeeping that would be used in a first class community hospital: scrub each item after use; routinely wipe down with a sanitizer such locations as lavatory bowls, toilets, shower basins; add a small amount (non-destructive) of chlorine bleach to the laundry. Insure that dishwashing is hot and rinse is thorough. Handwashing should become a religion. Individual soap bars or small containers of personal soaps should be adopted. Family nutrition should be highly respected as a supporting pillar of overall health. If any family member develops lesions this should be revealed to the entire household, and no shame or social aversion should be attached to the occurrence. This might be difficult with teenagers who can tend to be quite private and status conscious. The prodromal phenomenon is most often the preliminary warning of an outbreak. Fluid from the lesions should be avoided. Serious effort should be made, if possible, to determine if infected household member(s) is/are virus shedder(s). The best way is virus culture. Not cheap. Counsel with a family physician can expedite this; patience should be employed, because multiple samples may need to be taken. 3. There are no ABSOLUTE safeguards except to remove the genitally infected virus carrier out of the other person's life. (Remember the original principle).... Hardly acceptable. Presence of some form of auto immune disorder compromises the uninfected person somewhat, because the body's natural immune functions help to protect, and those functions are frequently altered, weakened or compromised in auto-immune diseases. The U. of W. valtrex study will probably reveal a good bit more about how married couples live normal lives where only one is infected and remains so. There are many examples of that out there today. Protected sex will provide additional protection not offered by the broad infection control practices outlined above. We must not lose sight of the fact that HSV is a STD. 4. I suggest posing questions(s) of this nature to the American Social Health Association (ASHA) P. O. Box 13827, Research Triangle Park, NC, 27709, 919-361-8400. Their Herpes Hotline is 919-361-8488. I suggest also contacting the Centers for Disease Control (CDC) in Chamblec, (Atlanta) Georgia. Both of these organizations can supply educational, instructional, advisory and statistical material. ASHA will charge for certain of their publications. CDC is U.S. Health and Human Services, and usually has no charge for materials supplied. ASHA has a book available: Managing Herpes, newest ed. pub. Feb. 1998, $24.95 in paperback. One of their officials told me via telephone that copies may be ordered from the major chain bookstores. Best wishes to all of you.

Dear Dr. Tom:

I am a retired critical care nurse and I want to tell you my story that involved a herpes viremia which almost ended my life. I have been ill since the initial attack in 1983 and have been unable to find any doctors that will manage my symptoms. I am desperate and I hope you will patiently read this. It is long. In 1983 I contracted (first time exposure) Herpes Simplex through an eczematous finger lesion while suctioning a critically ill intubated patient. I do not know what all he had as he had bacterial, fungal, etc. infections. I was critically ill with a massive viremia and sores all over especially where I had eczema. I had it in my eyes and sinuses, nose, you name it was there (except never genital). I believe it was Type-1 but I am not sure. I had a white count of about 1500 to 2000 on admission. I was treated as a bacterial infection for 5 days, was semicomatose for a week. When my dermatologist returned, he made the herpes dx by skin slide and I was treated with IV Acyclovir (which, thanks to God, had just been approved for IV use). I was found to have T cell lymphopenia up to 4 years later. I continually had outbreaks in my eye and on my hands and face. So AT UCSF I was treated with oral acyclovir but had to come off because I had neurological side effects similar to M.S. Every one threw up their hands and I have continued to have a sequel of symptoms and illness that are immune related and were not present before this. No one know what to do for me and my life is miserable. Currently I have spent 16 years with chronic and painful lymph node swelling (size of small apples) in my neck with extreme fatigue, terrible memory problems, especially short term, chronic pain over my left face and some droop of the lid and mouth since February. The later seems to be related to a raw area in my left neck/throat which I believe is herpes (I had this dx on first outbreak) but no one knows how to find out if it is. I have had it for 5 months and it followed shortly after being put on a respiratory steroid inhaler. I wonder if it could be causing the throat thing. I do know that nasal steroid inhalers cause it in my nose. Sores sometimes break out on my face over the numb areas. I wonder if the herpes is damaging the trigeminal nerve? Concurrent with the viremia I developed an off the scale IgE level with all sorts of arthritic/ lupus symptoms. I also developed chronic cardiac arrhythmias some times with rates up to 280. I am currently on high doses of Prednisone for that, and interestingly, the eye and mouth droop are gone, and a lot of the pain. I also was positive for CV virus and EB virus but I was not tested till years later. One doctor told me I am at risk for lymphomas but no one will check my chronic hard nodes. Most doctors have never seen a case like mine. I have been seen so many times and NO ONE will listen to me that something viral is going on. Please do you have any thoughts. I was HIV negative, thank God. But I feel a million years old. I have to sleep after doing the easiest things. I never had cardiac symptoms before the herpes. Who knows what else I had as no cultures were done. What should I ask these doctors to look for? I am currently trying L-Lysine. Nothing helps the joints and rheumatologists have given up on me. They say I have an extremely overactive immune system (last IgE 6000). Did the viremia damage my immune system and it is fixable? I live near San Francisco. UCSF has been of no help. Thank you for any help you can give me.
Sincerely, R. Ch.

Dr. Tom's Response:


Dear R. Ch.:

Rather than try to muddle your already extremely confused medical history with the opinions of a non-observer, I will offer you the following suggestion with the hope that you may be able to take it: Since you are on the west coast my suggestion is that you try to make arrangements to be seen as an outpatient at the University of Washington Medical Center in Seattle. I am not acquainted with anyone there, but they had a Dr. King Holmes who was Professor in the Department of Medicine and active in the treatment of sexually transmitted diseases of which herpes is one. I heard Dr. Holmes speak when he gave seminars in my part of the county years ago and have respect for what he has done. Perhaps if you solicit the help of one of the doctors you have already seen locally for a referral, that would assist you. Most major medical centers such as U. of W. have physician referral offices staffed by administrative personnel who are quite courteous and kind. I have no idea if Dr. Holmes, by now, might be retired or practicing under a restricted (selectively) patient load. A phone call directly to their social hygiene clinic in your own behalf might suffice also. The U. of W. center is one of the foremost facilities for this type of activity. They are engaging currently in a study of the antiviral Valtrex supplied by the Glaxo-Wellcome Co., its manufacturer. I realize you might be a long distance from Seattle. UCLA also has a center with a high reputation that you might consider as well. I wish you the best of luck.

Dear Dr. Tom:

I tested 1.27 HSV-1 and 4.08 for HSV-2. I`m a 63 year old male in excellent health. I can`t recall ever having an outbreak of any lesions/ sores etc. in the genital area but had a cold sore on my lip about 6 weeks ago after spending several afternoons in the sun. I probably have experienced these very infrequently in the past but this time got tested with the results noted above. Q =testing positive for HSV-1, do I necessarily have genital herpes, and if so, can I TRANSMIT it even though there?s been no oral outbreaks. Is HSV-1 oral still genital herpes? Do I pass it on orally only ? My doc was of little help and what he did convey doesn`t track to me.

Dr. Tom's Response:


Dear Anonymous:

Herpes simplex viruses are widely classified as types 1 and 2. Type 1 infects primarily the oral cavity, lips, and sometimes the face and other upper body parts. Type 2 infects mostly the genital area and areas below the waist. The viruses haven't read the rulebooks, and sometimes move around. Type 1 on the genitals or related areas is considered genital herpes. Type 1 oral is not genital herpes. The reverse is true. Type 2 virus can appear on the lips, face, oral cavity and can cause herpetic sore throat. Herpes type 2 lesions have been known to appear on the face and lips of man after performing cunnilingus on a partner who has genital herpes. You may be able to transmit even though there is no outbreak, because some infected persons are asymptomatic shedders of the virus. The recent cold sore was quite likely a manifestation of Type 1 virus and is strongly suggestive that you can transmit orally. If you have had only cold sores and no genital lesions you probably do not have genital herpes. The results you gave indicated that you have both virus types in your body, hence should be considered capable of transmitting either.

Dear Dr. Tom:

I just had my first outbreak of genital herpes. I am a lesbian in a 15 year monogamous relationship with a partner who has oral herpes, so it is likely, I assume that I have Herpes 1. To what extent should I begin to do preventative things such as change my diet and take nutritional supplements? My doctor said to wait and see, as I may not have other recurrences, but I'm not sure if this is good advice. On the other hand, I don't want to give up foods I like and take expensive supplements if it's not necessary. Thanks very much for your advice.
Sincerely, Ellen

Dr. Tom's Response:


Dear Ellen:

HSV1 infections tend to be less frequent, less painful and to have fewer painful recurrences than HSV2. Your doctor has probably given you sound advice about waiting to see. If your doctor did not recommend a specific controlled diet why not give his counsel a chance to become reality? You might be wise to discuss further the dietary part of your life with him on another visit.

Dear Dr. Tom:

My case is unusual in that it took several years to develop. After the first symptoms I experienced, I've had about 2-3 a year, except for the past year which passed without an outbreak. Then I received a bad blister eruption about half way up my penis and have had this for almost two months. About two weeks ago, another outbreak occurred near the glans area (moist) and is showing no healing. What should I do? The glans infection is just like that, with pus and lots of stinging pain. I've tried cortisone to help. What's next??
Thanks, Bill

Dr. Tom's Response:


Dear Bill:

I suggest you see a dermatology doctor, a physician who cares for persons who have skin diseases. Dermatologists are trained to diagnose sexually transmitted diseases as part of their professional skills. Your description could be reminiscent of more than one condition, and that is why you should seek the skills of someone who will examine the sores on your body and penis and give you a well-founded diagnosis.

Dear Dr. Tom:

A friend told me she slept with a guy who has this, he told her about it, but said he hadn't had an outbreak for 2 years and that she could only get it if he was broken out. Is that true? With all the things she has been hearing, she is really worried.
Tina

Dr. Tom's Response:


Dear Tina:

Never believe such talk about not getting it if there's no outbreak. Some infected persons, but not all necessarily, secrete the virus asymptomatically. Right now this seems to be 5-10% of the infected population. This fact is the explanation for so many of the questions, "How did I ever get it?" Condom use or a new sleeping partner are ways to avoid contact with the virus from someone who may be a shedder. If it is a serious relationship another possibility is to perform a virus culture on the suspect person to determine if he is actually a shedder.

Dear Dr. Tom:

I recently found out that the man that I will be getting married to just found out this morning that he has herpes. Should I contact my doctor at once, I'm due for a pap smear in Sept, do I wait till then, or call today? I would appreciate any input regarding this matter. Thank you so much for having a site that I was able to go to for information.
cb.....

Dr. Tom's Response:


Dear cb....:

Learning that your future lifelong partner has herpes is not an enormous problem, but for your sake let me raise some warning flags: Do not wait for medical attention. Consult your doctor soon about this situation and obtain your smear result. Genital herpes is associated with human papilloma virus infections which can be adjunctive toward future cervical cancer. Possible future parenthood presents some problems to a herpes infected mother and her child. A pap smear will likely add helpful information. The bit about your future husband just finding out he has herpes puzzles me. Perhaps he has either had it awhile unknowingly, or now decided to tell you, or has contracted it recently. Each of you will, epidemiologically speaking, be having sex with every other partner each of you has had previously.

Dear Dr. Tom:

I know a lady who just gave birth to a little girl this week. They say she may have herpes. She has a lot of red pimples all over her. My sister- in-law touched the baby. She was not aware of the herpes. Can she get herpes from holding the baby? She said she did not wash her hands right away.

Dr. Tom's Response:


Dear Non-Handwasher's Sister:

If the mother had herpes and gave birth during one of her outbreaks, the newborn could contract the infection by passage through the birth canal. However, not assuredly so. Infected mothers do not always pass the virus along, although the risk is present. Red pimples over the child's entire body may be for some reason other than herpetic infection. Yes, if the pimples were active herpes lesions your sister-in-law might contract the virus. Hand-washing is an essential health protective step both before and after touching another.

Dear Dr. Tom:

Can Herpes be spread by blood to blood contact?

Dr. Tom's Response:


Dear Anonymous:

Herpes infections are not among those we classify as blood-borne diseases. I do not know of such a blood-borne transmission, but that does not mean none exist out there in the medical literature. If any exist, they are rare, so that would infer the risk to be minimal. If any come to my attention, I will put it into future communications.

Dear Dr. Tom:

The only symptom I have had since being diagnosed with genital herpes is a small bump or two between my vagina and buttocks. Do symptoms get worse after awhile?

Dr. Tom's Response:


Dear Anonymous:

One cannot generalize too widely about worsening of future herpetic outbreaks. However, HSV1 infections tend to be less discomforting than those caused by HSV2. You failed to specify if you knew which you carried. In a number of cases the symptoms become less troublesome, because of the buildup of immunity to the virus which tends to lessen severity of subsequent outbreaks. While not a prediction, yours would not seem likely to worsen.

Dear Dr. Tom:

Your opinion, please. I recently was diagnosed (via a Western Blot Test) with HSV2. In other words, I have antibodies in my blood to the HSV2 virus. I have never had any symptoms of herpes-no outbreaks, blisters, anything, anywhere on my body. I have talked to four doctors since then two of whom have told me that if I don't have outbreaks, it means I don't really have herpes, and that I don't need to tell future sex partners about it. I tend to disagree with that, if I've got antibodies, I've got herpes, right? Can herpes stay dormant? Thank you!

Dr. Tom's Response:


Dear Anonymous Who Is Sero-positive for HSV2:

The Western Blot procedure is a reliable serologic test. However, we know virtually no serologic procedure that is 100% specific or 100% sensitive. The most reliable indicator for herpetic infection would be actual isolation of HSV2, and if you have never had an outbreak, the likelihood of a suitable test sample such as blister fluid is nil. I agree: if you have antibody against HSV2 then the antigen (HSV2) must be present to have stimulated the antibody formation. Yes, HSV can remain dormant, but for how long does not seem clear. One study published more than 20 years ago suggested that 70% of HSV2 infections can remain asymptomatic. A high antibody level in the body would tend to help keep the virus from becoming clinically active. Some alternatives to think about: A virus isolation might be attempted from saliva, semen, or urethral swabbings on the premise that you might be an asymptomatic shedder; another serologic test might be performed, or the Western Blot procedure might be repeated. How much do you want to spend for an answer? Other than the presence of antibody, you have nothing to suggest that you might be infective to a sex partner, but I admire your position of caution toward the physicians who suggest you are not potentially infectious. I too disagree, because all the information isn?t in.

Dear Dr. Tom:

I am wondering if my male friend has herpes. Here are the symptoms he exhibits. On Day 1, burning sensation while urinating - right near the tip of penis. On Day 2 and 3, pain becomes worse - but no blood or blockage. On Day 4, friend goes to the doctor, who diagnoses it as urinary tract infection, prescribes antibiotics. Later that day, a wide series of painful blister/lesions with white discoloration appear on inner side of lower lip - very painful but invisible to observers. It is now Day 6, and friend has fever at night with shivering and some muscle aches. Urinal stinging is abating (probably due to antibiotics) - but oral lesions continue and are painful - though it seems that they might be dying out. My friend has been monogamous for 1 year - but has only recently (6 weeks) begun performing oral sex on girlfriend.

Dr. Tom's Response:


Dear Anonymous Who Asks If Male Friend Has Herpes:

One cannot be a diagnostician from characteristics given via the Net, but the symptoms you described resemble herpetic infection quite closely. The burning described might also be subsiding because the herpetic outbreak is going into remission. Herpetic lesions do not respond to antibiotic treatment. Oral sex on the girlfriend is risky to her, because the painful oral lesions are quite suggestive of herpes labialis. The chances of transmission to her are good. Being a good boy for a year does not make your male friend a herpes safe guy. He may possibly have acquired the infection through sexual activities earlier than that.

Dear Dr. Tom:

I am a heterosexual 40 year old male living a mobile life as a professional travelling around Australia. I believe that I have had herpes 2 for about 10 years now which always manifests itself when I am under stress, as a pain either in my testicles or rectum before, within 2 days I get a blister on the end of my penis. This then disappears after about a week. Over the past three years I have created a fairly stress free life and have had no outbreaks. At the beginning of this month I decided on a lifestyle change and resigned from my job, and bingo, pain in my left testicle followed by the blister. This time however, for the past 30 hours there has been blood coming out when I pass stools and I am a bit concerned this may be unrelated to the herpes attack. Please can you advise whether you have ever come across a similar situation or do you think that it is most likely unrelated. Many thanks.
Clive

Dr. Tom's Response:


Dear Clive:

I am reluctant to offer more than fundamental advice about the bleeding problem you have described. Herpetic proctitis (inflammation of rectum and anus) and anorectal herpes are known, although these conditions occur more commonly among homosexual men. The condition is more rare among heterosexuals. Bloody and mucoid stools are among the symptoms. The condition can be caused by HSV1 and HSV2 and can involve the outermost few inches of the intestinal tract to the anal sphincter or opening. My best advice is to seek the specific treatment of a gastroenterologist, a physician who specializes in diseases of the intestinal tract. Such a doctor would evaluate your previous history of herpes, stress, etc., and likely, will diagnostically examine your rectal area further. A family practice doctor may not be trained or equipped to do so. This may not be a pleasant situation to contemplate, but you owe it to yourself to take the best steps for your own good health. If your condition is not found to be due to a herpetic infection, such a visit may be especially important to you.

Dear Dr. Tom:

Help! I desperately need to know if Valtrex and Famvir are equally effective in aborting asymptomatic viral shedding. First I am thankful that these medications are available to us today. But my main concern is that I do not want to be shedding virus around my home - I seem to have a fear of infecting my family through this means. My insurance will pay for one but not the other. But the one that my insurance will pay for says little about aborting asymptomatic viral shedding. It seems that both say about the same thing as far as duration of lesions and pain are concerned. But one boldly states that it aborts asymptomatic viral shedding while the other says little about that particular topic which is my main concern. I hope that you can shed some light on this for me. Thanks for being out there!
Seeker of Information

Dr. Tom's Response:


Dear Seeker of Information:

I was not aware of an antiviral drug that claimed to abort asymptomatic shedding of HSV, so I consulted the 1998 PDR (Physician's Desk Reference) to update myself once again about Valtrex, Famvir, and Zovirax. The specific data for each of these differ somewhat, but each drug has time values published for ability to promote lesion healing, pain relief and reduction of shedding, meaning curtailment of shedding time from lesions following an episode. Under PRECAUTIONS for each of the three drugs a statement is included to the effect that: 1) No data exist to evaluate if the drug will prevent transmission of infection to others, 2) The drug is not a cure for genital herpes and 3) Genital herpes can be transmitted in the absence of symptoms through asymptomatic viral shedding. Thus, physicians are advised under the most current descriptions of these compounds, that during their use, the risk of transmission still exists because of possible asymptomatic viral shedding. I have not talked to a local pharmacist to solicit possibly a copy of the package insert included with each drug. Examination also of several family drug guides failed to provide information as detailed as that published in the PDR. Curiosity has the better of me. Would you be so kind as to communicate again where you obtained that information?

Dear Dr. Tom:

Can herpes be spread in a swimming pool without direct contact?

Dr. Tom's Response:


Dear Anonymous About Swimming Pools:

Spread of herpes in a swimming pool is most unlikely. If the pool is maintained as pools should be, proper chlorine level, filtration, etc., such a physical environment outside a human body is unfavorable for HSV and its fellow travelers.

Dear Dr. Tom:

I have read that the symptoms of herpes (headaches, etc.) are the worst during the first occurrence, but my recurrences sometimes are barely noticeable, and then some of them I feel like I've been hit by a truck (aches, fatigue, headache, etc.). Are they supposed to fluctuate like that? Feeling like a hypochondriac.

Dr. Tom's Response:


Dear Feeling Like a Hypochondriac:

For many years I have known of a humorous expression passed around among my microbiologist colleagues: "The bugs haven't read the books". Yours obviously haven't, because otherwise they should know you expect them to behave consistently and more gently. You are experiencing the vagaries of a most peculiar infectious agent. None of us have any explanation for this, only to expect it to happen. Do not feel like a hypochondriac; it is the nature of the critter.

Dear Dr. Tom:

I have had the herpes virus for approximately 6 years. In that time, I have had only 2 outbreaks since the primary infection. The second outbreak just occurred after 4 years of being dormant. In addition, the outbreaks are very mild. Would this be likely because I have acquired the HSV-1 rather than type 2? My husband gets cold sores and he was the one I was with around the time I had my initial outbreak. He does not have genital herpes.
Thanks a lot. Lori

Dr. Tom's Response:


Dear Lori:

HSV-1 infections tend to be less severe than those caused by HSV-2, and they can remain dormant for long periods. HSV-1 tends to be localized in the upper body, ie., cold sores - what is referred to as herpes labialis. Neither of these tendencies are ironclad rules of behavior for members of this virus group.

Dear Dr. Tom:

I recently had unprotected sex with a woman who has genital herpes (several times within the past week). I am currently showing no symptoms. I do not believe that she had any sores or blisters. What are my chances of contracting the virus; and is there anything that I can do in the meantime?
Thanks, Joe

Dr. Tom's Response:


Dear Joe:

Following multiple unprotected exposures to a woman known to have genital herpes, your chances of contacting the infection are good. If your partner is not a shedder and she was not experiencing an outbreak, the infection may not have been transmitted. I suggest you contact your physician and explain your exposure. Your doctor will likely prescribe medication to lessen the difficulty of initial infection, which may likely occur. There are treatment guidelines to care for such eventualities. If you have not been infected and wish to remain that way, it would be in your best personal interest to commence use of condoms.

Dear Dr. Tom:

About a year and a half ago I went for an OB/Gyn visit and everything was normal. The nurse who performed the procedure was in a rush and I remember (or at least I've convinced myself that I remember) her pinching me. The next morning I awoke with one small blister on the outside of my labia. By that evening I went to the ER in a frantic state. The doctor performed a culture test and three days later it came back negative. The doctor told me that if the test came back negative and I did not have any other "outbreaks" to assume I did not have the virus. So, for a year and a half I did not have any symptoms. I might add that the blister did not hurt-there was no pain and none of the other common symptoms of herpes. Also I had not had unprotected sex in months. However about 2 months ago, I got a small bump type "thing" in about the same place. Once again, no pain just a sore-although I hate to call it a sore because it didn't hurt. It went away in about 3-4 days. I am not sure if it was an outbreak or just irritation because I often get paranoid and touch that area to feel for any symptoms. I have been with the same partner for almost two years now and we have unprotected sex, even when I had the "sore" and he has not had any sort symptoms. MY QUESTION, I GUESS, IS: HOW ACCCURATE IS THE CULTURE TEST- I HAD IT DONE WITHIN 12 HOURS OF ITS APPEARANCE? AND I KNOW YOU CAN NOT GIVE A DIAGNOSIS, BUT IN YOUR OWN OPINION, WHAT DO YOU BELIEVE THE CAUSE MAY BE.

Dr. Tom's Response:


Dear Anonymous Who Inquired About The Culture Test:

Blisters on the labia are very suggestive of herpetic infection but not exclusively. The culture test is a laboratory procedure in which the actual viral agent is grown in cell culture using a sample taken from the suspected lesion. If the viral agent grows, it will produce evidence identifiable through a microscope. The possibility always exists that a false negative, a failure to grow the virus even though it may have been present, could result. I may be provincial in my regard for laboratory results, but it seems to me that 3 days is early to have reported a virus culture test as negative. My suggestion is to repeat the culture test at a time when you have a bump type thing. Your doctor should also consider the possibility of other STDs since you do not experience any pain or discomfort from the bumps.

Dear Dr. Tom:

I had the shingles about 15 years ago (was about 30), I was told it was a form of herpes simplex. The doctor stated that I had come in contact with someone with the measles and since I already had the measles as a child I developed the shingles. Just last year I developed a rash around my genital area that was diagnosed as herpes simplex. I stated that I had never had herpes in that area and ask him if it were possible to have gotten it from my husband (we had only been married for 1 1/2 years). I explained that he had a rash with small blisters in the hip area, and I have noticed that at times the area around his genitals are red and very irritated. The doctor would not consider him a possible source. Now, I have noticed another rash in the bend of the thigh and genital area. Would you explain to me about shingles and could that outbreak 15 years ago have affected me at this time. I was under more stress at the time of the shingles breakout than I am now.
Concerned

Dr. Tom's Response:


Dear Concerned:

Shingles is the name for a series of herpetic vesicles on the body that tend to follow along a peripheral nerve. The causative agent is named varicella-zoster (V-Z) virus. V-Z is spread from person to person, by aerosols and through fluid from blisters. Varicella virus causes chicken-pox in children; zoster virus tends to cause shingles in adults. Shingles is considered to be a recurrence of the virus that causes chicken-pox in children. In essence the viral agents are the same and are collectively referred to as varicella-zoster virus. The V-Z virus is a part of the herpesvirus group, but is not herpes simplex as is sometimes stated, and as you were told. Another name for this infectious agent is human (alpha) herpesvirus 3. The measles virus is a member of a different family and genus from the V-Z virus and herpes simplex virus. V-Z infections are not classified as sexually transmitted. I am puzzled that your doctor would not consider your husband a possible source of herpes simplex infection, based upon the descriptive information you have related in your Web question. However, his red and irritated genital area could have been a result of a fungal infection called tinea cruris, jockstrap itch, or one of several other possibilities. From what you have given, I suspect that the two events in your life were different and unrelated. You experienced shingles as an adult at age 30, and at another time you contracted herpes simplex infection - different agents; different infections; different times.

Dear Dr. Tom:

I contracted herpes ten years ago and have about four recurrences a year. Besides watching my diet, physical condition, etc., is there anything I can do medically to prevent the number and severity of recurrences?
Mishka

Dr. Tom's Response:


Dear Mishka:

A limited number of prescription drugs are available that have the capability to lessen frequency and severity of herpetic outbreaks. You should consult your personal physician and discuss ongoing medical control of your infection with her/him. These drugs have dosage guidelines and sometimes sequelae that are best judged by a physician's individual attention.

Dear Dr. Tom:

I am a 31 year old male. I first had an attack of HSV in 1994 it attacked my left eye (internal). I have been on antiviral and steroids since then. The attacks have reoccurred several times. Each time my sight deteriorates further. I need help.
Yours sincerely, Mr. G. M.

Dr. Tom's Response:


Dear Mr. G. M.:

I am extremely sorry for your deteriorating eyesight. For you to be on antivirals and steroids, you surely must have been under the care of an ophthalmologist (eye physician) who should have explained to you the possible pathway your infection might follow. If this is not the case, I strongly suggest that you consult such a physician in your community or that you go elsewhere for such care. Major medical centers in large urban areas or university medical centers will have such professionals on staff. I wish you the very best.

Dear Dr. Tom:

What do the herpes blisters look like? Do they cause any type of pain?

Dr. Tom's Response:


Dear Anonymous:

Herpes blisters can be painful and cause itching. Pharmaceutical companies have provided color transparencies for those who do lecturing on this topic, and it is difficult for me to describe the lesions to you from those. Many community libraries shelve books dealing with sexually transmitted diseases, and some of these depict actual color photographs of herpetic sores. I have seen such photographs in materials offered by community health groups and at health fairs. Sorry to put you off. Self-diagnosis is not such a good idea.

Dear Dr. Tom:

I have recently read that it is unlikely that herpes can be spread from a man to a woman when she is performing fellatio as long as there is not an outbreak. In addition, that it is difficult to pass genital herpes to a site on the mouth. Is there any truth to either of these?
Eagle

Dr. Tom's Response:


Dear Eagle:

We used to advise people that herpes virus infections were not transmissible when either there were no lesions or the sores had dried, crusted and scaled. That is no longer taught, because some infected persons are capable of shedding the virus, even though there is no outbreak. When shedding can occur, transmission is possible. The likelihood of actual infection depends upon the number of factors, including the immune status of the recipient. Genital herpes can be shed asymptomatically in seminal fluid and in cervical secretions from infected persons. The ease of transmission to the lips would depend upon a number of factors, both male and female. If the male were a herpes carrier, I?d bet on lip infection following unprotected oral-genital sex.

Dear Dr. Tom:

I am really concerned that I have contracted this virus. I have been to the doctor on numerous occasions, but have just been brushed off and told that I have not been infected. I have visited numerous sites and have all the symptoms associated with this virus, a stabbing pain on my labia, itching and a reddish yellow lump on my labia once a month, which disappears after a couple of days. My ex-boy friend and I constantly used condoms to no avail obviously. I also have this pain running up my buttocks, what do you think?

Dr. Tom's Response:


Dear Lady Who Has Been Brushed Off:

The symptoms you have described could be from a herpetic infection or possibly from another STD or even a non-sexual infection. My suggestion is for you to visit a social hygiene clinic where handling STDs is routine, and the familiarity with symptoms of these infections is current. Since social hygiene clinics are often on tight budgets, you might also consider consulting a venereologist, a physician who specializes in diagnosis and treatment of STDs in private patients. Such a person might be located by phoning your local county or state medical society office. I am puzzled that the doctor whom you have visited on numerous occasions has assured you that you are not infected with the herpes virus, yet seems to have left you hanging without definition of what the actual problem is. Since you mentioned no form of treatment, it seems this practitioner re- assured you and prescribed no treatment. I find that out of the ordinary.

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