Dr. Tom answers questions about herpes, Page 3

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.



Do you have questions about genital herpes?



Dear Dr. Tom:

:I have been dating a wonderful man for several months and we are about to enter into a sexual relationship. We both have genital herpes but neither have had an outbreak in a long time. Is there a likelyhood of spreading or increasing our infection by not using condoms? Thanks for your help.
Suzie

Dr. Tom's Response:


Dear Suzie:

You and your wonderful man both have genital herpes which is an implication of previous sexual partners by each of you. At least one factor in the decision to omit condoms during your sexual relationship is whether either of you may be carrying another sexually transmitted disease than genital herpes. Herpes infection may not travel alone. The principle, that each of you will be having intercourse (microbiologi- cally speaking) as well with every other partner each of you has had, applies here. Some of the other STDs can be asymptomatic or nearly so in women. This might be something for you to think about or give consideration to checking into. This might be something also to discuss with your wonderful man with whom it seems you should have such a relationship by now that an intimate discussion of this sort would not be difficult. Herpetic auto-inoculation from one part of the body to another is always possible but not always predictable. Oral-genital contact would be a likely way for cross-infection. That neither of you has had an outbreak in a long time is suggestive of mutually quiescent infections, and if neither of you are shedders, then the likelihood of cross or auto inoculation is in my opinion nil. However, remember the ?ifs?. The safest practice under the circumstances you have described is to use barrier protection.

Dear Dr. Tom:

My sister-in-law has genital herpes. I have an 8 week old baby girl. Should I let her change her diapers?

Dr. Tom's Response:


Dear Mother of the Eight Week Old Girl:

Unless your sister-in-law has lesions on her hands, she is unlikely to pass the infection along. However, precautions should be taken that none of her affected body areas contact the baby. Does she have frequent, infrequent, or no known recent outbreaks? A normal precaution followed by many persons including neonatal care personnel is the use of one of the hand sanitizing lotions that contain ethyl alcohol. These are pleasant smelling, evaporate quickly, and although they do not produce sterile conditions, they lower the normal skin microbial population. I do not know if any of several available across-the-counter have been specifically tested by their manufacturers against HSV. Ethyl alcohol generally is effective against HSV. You might purchase a container and ask the local pharmacist if he has any anti-microbial data about the product specifically related to HSV. If he sells the product, he should have the data and should be willing to share it with a customer. As an alternative and at the possible risk of offending your sister, you might ask her to wear a clean, new pair of disposable latex gloves each time she handles the child. This is also standard procedure in a neonatal care unit and is nothing outrageous to be asked of a family member. Never re-use such gloves.

Dear Dr. Tom:

I have several questions. I am 33 years old, I've had herpes since I was 18, I got it from my first sexual encounter which was contact and not intercourse, so my breakouts are always on the outside. This is a big relief to me because I would be afraid of not being sure when I had breakouts, if they were inside. I have an obsessive compulsive disorder, with real concern about contamination. You can imagine how this has affected my sex life. I have been married for seven years. My husband has no problem with the fact that I have herpes, but I can't get over it, mostly because of my contamination obsessions. Here are my questions: If he catches herpes from me, can I get it back on other parts of my body? 1- If I perform oral sex on him, can I get it on or in my mouth? 2- If we have intercourse can I catch it and start having breakouts inside? 3- If he gets it orally and we kiss, can I get it on or in my mouth?

If you could answer these questions for me, I will either be able to stop worrying, or deal with it, but at least I will know. I have been reading a lot lately about herpes, trying to be better informed, but my questions haven't yet been answered. Thank you for your help.
Vickie

Dr. Tom's Response:


Dear Vickie:

Yes, it is possible to spread herpetic infections through such cross contamination. However, unless you have some immune defect, you and your husband are most unlikely to become an ever increasing pair of herpetic masses in a kind of viral ping-pong game. If your husband has genital herpes and is shedding virus, performing fellatio on him can likely lead to sores in your mouth, or you may acquire vaginal lesions through unprotected intercourse. Yes, cold sores or the zoster type of herpetic infection can be transmitted by kissing. To prevent ping-pong sexual diseases it is important for both partners to discuss their situation freely and seek medical attention at the same time.

DR. AMY'S RESPONSE

Dear Vickie:

If having your questions about herpes answered by an expert like Dr. Tom is not enough to stop your obsessive thoughts - or if these concerns shift to another area, you may want to seek treatment for obsessive compulsive disorder (OCD). There have been great strides in the treatment of OCD including medication, behavioral/cognitive therapy, and psychotherapy. Since you state that this concern has affected your sex life, a clinical sexologist could help with addressing and improving the sexual issues and behaviors. This is a treatable disorder and there are specialists who can help you.
Dr. Amy

Dear Dr. Tom:

I have a couple of questions. First, can herpes be spread by drinking after other people? Second, can herpes ever cause tonsillitis? If so, would the tonsils first appear black and then white? Thank you so much for your being available to answer questions!

Dr. Tom's Response:


Dear Anonymous Who Asks About Second Drinking:

If we consider that herpes virus in saliva is capable of causing herpetic whitlow in personnel who perform such tasks as handling dentures without gloves in elder nursing home residents, then I suppose by parallel logic, herpes is transmissible by drinking immediately after someone who is infected. I do not know of such an actual case. Perhaps my advisors at the CDC or other professionals out there may have more definitive data or know of a case. Both HSV-1 and HSV-2 are capable of causing acute tonsillitis and pharyngitis, and yes, a whitish exudate can result from the sometimes extensively ulcerated area. Both types may be transmitted among other ways by oral-genital contact, and a study of these two conditions in University of Wisconsin students was published in the 1964, J. Am. Med. Assn., (JAMA), vol.190, p.699. In some cases such patients have been treated erroneously for streptococcal sore throat.

Dr. Tom writes about Viral Shedding

Herpetic sores
should be considered as infectious at all times.

Dear Dr. Tom:

I am curious to know if when you have genital herpes and have the sores else where on the body, are those sores contagious? What are the possibilities of contracting the virus if the person has not had an outbreak for a very long time?

Dr. Tom's Response:


Dear Anonymous:

Herpetic sores should be considered as infectious at all times. Some time ago, we used to advise people that once the sores had dried and crusted, they were no longer capable of passing the virus. That may still be the case with some, but other infected persons who are known as shedders can transmit the virus even after the sores have healed. The possibility of contracting the virus from a person who has not had an outbreak in a long time seems to be much less. Examples are numerous couples married for years where one has a quiescent infection while the other has failed to acquire it. If a person is known to be infected, the safest procedure is to give the virus no opportunity to pass over into a non-infected person.

Dear Dr. Tom:

Is one of the symptoms scratching all over the body? How is it transmitted? Could it be transmitted in its dormant stages?

Dr. Tom's Response:


Dear Anonymous Who Inquired About Scratching:

I know of only one rare case where a herpes infected person had itching over nearly his entire body. This was a male child who was severely immune-compromised, meaning nature failed to provide him with the barest fundamental immune response capabilities at birth. Scratching would be an anticipated reaction to herpetic sores at affected locations. The virus is transmitted sexually, via intercourse and orally, by kissing as in fever blisters, through contact as in mild to severe skin abrasions and on the hands as in nursing and dentistry. Yes, the virus can be transmitted by some persons while in its dormant stage. These are known as shedders. Not all herpes infected persons can do so, but because some are able to do so, the best advice we can offer is to consider all herpes infected persons to be infectious at all times.

Dear Dr. Tom:

I am a 17-year-old female that has been having some itching and blisters in my vaginal area. I have had sex only once and it has been about 4 years ago. However, these blisters and so on have only been present for about the last 6 months. I have gone to the doctor and they have taken a sample and are currently researching it. I have read that it usually only takes about 2-20 days before the symptoms start. Do you think that it is possible that I have herpes?
Thanks, Confused.

Dr. Tom's Response:


Dear Confused:

Vaginal itching and blisters in the vaginal area sounds suspiciously indicative of a herpes infection, among other possibilities. The way the virus manifests its disease conditions varies, so the sample taken by your doctor should provide some additional definitive information.

Dear Dr. Tom:

Can the herpes virus cause chronic fatigue even if there is no current outbreak? I'm a 36 year old female, contracted herpes about 6 months ago, and taking suppression medication. I haven't felt well since the initial outbreak: I need more sleep (about 8 to 10 hours), can't work out like I used to (a couple of times a week versus 6 days a week), and feel run down all the time. Also, a month after the initial outbreak I got another, plus the flu (which believe it or not I've never had), plus a sinus infection which lasted a couple of months. Could this be related to the herpes? What do you recommend I do to increase my energy level and improve the effectiveness of my immune system? I'm feeling desperate.
Madison

Dr. Tom's Response:


Dear Madison:

Yes, the conditions you described might be attributable to your herpes infection, but because of their non-specific nature, they might stem from other conditions as well. You did not indicate what suppression medication you are taking, whether it is a prescription drug and how closely you may be following the usage recommendations. If your medication was prescribed, I suggest you discuss your fatigue with your prescribing physician and perhaps undergo further evaluative procedures. Either through your physician or by other means, I also suggest you consult a nutritionist. I hope you determine the problem and soon feel better..

Dear Dr. Tom:

A couple of weeks ago I had contact with a woman about whom I cannot be sure if she is infected with HSV or not. Intercourse did not take place, but she did sit on my upper thighs and there was skin-to-skin contact. She had no lesions visible. About ten days later I noticed what I thought was a bug bite, a reddish inflamed area on my inner thigh. I didn?t think much of it, but then it occurred to me that it might be a symptom of herpes. The affected area did not have sores, and is fading away. Is it possible that this is herpes? I am unable to get to a doctor for at least two weeks. Is there any way to see if I was infected even after any possible symptoms have disappeared? Thanks for the info.
Will

Dr. Tom's Response:


Dear Will:

Development of a strange red lesion at the site following a skin-skin genital area contact with a female stranger would certainly drive most persons so exposed to see a physician. If you haven?t by now, I suggest that you do so. The red lesion could be caused by a number of possible causes, and to begin to list them here would not be helpful. The answer to your question is yes, you may be examined and tested after the symptoms have disappeared. Serologic tests can be performed on a sample of blood, and the skin area can be gently scraped and cultured for the presence of micro-organisms if any of the redness remains. Medical laboratories in most states will not perform such diagnostic tests without a physician?s request. The knowledge and experience of a physician could provide a simple and explicit answer to put your mind at rest.

Dear Dr. Tom:

Can the herpes virus be spread through bath water? The reason I am asking is that I usually bathe my three-year-old son. We bathe in the Japanese style, which means we first wash outside of the tub and then enjoy a neck deep soak in hot (about 42 C) water. I always avoid skin to skin contact with my son in the bath and give bathing duty to my wife if I have a visible outbreak. My wife and I have been together for 12 years and I have managed not to spread the virus to her. I have typically had only two or three outbreaks per year, but lately due to stress have been having 6 to 8 per year and I fear I may be shedding the virus asymptomatically. Should I worry about infecting the child while in the bath together?

Dr. Tom's Response:


Dear Anonymous Bather:

You seem to have been successfully precautionary about bathing together, and marriage at large, since the virus infection has not spread to your wife of 12 years. Some items to consider which might help you are: 42?C is not an ideal temperature for the virus, so your bath water, while not a virus killer, does not promote its survival. However, that is only +5? above normal body temperature where HSV survives. The information suggests that you are not likely a shedder which makes your son?s safety more optimistic under the conditions you described. Avoidance of skin-skin contact enhances the safety factor for your son, but it does not protect him completely. Prudence might be a reason to consult your doctor about why you might be having more frequent episodes than you have experienced in the past. The fact that you have an HSV infection poses some risk to your family of cross-infection. You could alter your household bathing habits and lower the risk to your son further or you could continue what is probably an immensely familialy intimate experience with the realization that some risk of infectiousness may be there.

Dear Dr. Tom:

My boyfriend and I were debating about the transmission and origin of herpes. He thinks that the everyday mouth sores that people get (like canker sores) aren't the same as oral herpes sores. Also, he thinks that the only reason someone would have oral herpes is because they have genital herpes, and the virus travels through the bloodstream to the mouth. I, on the other hand, thought that all mouth sores were caused by the herpes 1 virus, and that you could have them regardless of whether or not you had genital herpes, since genital herpes is a completely different form of the virus. We would be very thankful if you could clear this up for us!
Thank you, K&M

Dr. Tom's Response:


Dear K&M:

Oral herpes sores and canker sores are not the same, so your boyfriend is correct on that issue. However, oral herpes sores can be the result of familial casual contact during the early years (birth to about 18 months) of life and may remain asymptomatic or may flare as childhood cold sores. Such herpetic infections are mild and are often herpes virus type 1. Mouth sores can be aphthous or the canker type, possibly resulting from several non-infectious causes, e.g., vitamin deficiency, or they can be herpetic, hence transmissible. Oral herpes infections are viral, transmissible and can be non-genital. Oral herpes lesions can also result as transmissions from a sexual playmate?s mouth to genital contact, cunnilingus or fellatio. Whether these are type 1 or 2 viruses, and they can be either, they must be considered genital herpes infections. The transmission is direct, from genital to the moist tissues of the mouth, tongue, or lips. The herpes simplex virus group have a liking for nerve tissues where they hide away during their dormancy. HSV is not considered a bloodborne infectious agent, although much still needs to be learned about the shedding mechanisms.

Dear Dr. Tom:

This is in reference to Herpes being passed through contact of sweaty bodies, specifically in a martial arts/wrestling arena: 1.Is this Herpes Gladitorii(sp?)? 2.Since one of my fellow students has been diagnosed with this strain and I have recently noticed two Herpetic lesions on my arm, what precautions should I take to a.not spread it to my girlfriend, with whom I sleep? i.e. Do I need to change the sheets daily, sleep away from her until this possible infestation has passed, bandage the area...? b.not spread it to my training partners? c.not spread it to other parts of my body? 3.Treatment/management suggestions?
Thanks, possibly cursed

Dr. Tom's Response:


Dear Possibly Cursed:

First of all, let me assure you that you are not cursed. The correct term is herpes gladiatorum, and it is also designated as traumatic herpes or wrestler?s herpes. The preventive precautions would be the same as for any other herpetic infection: keep the infective virus away from any potentially susceptible, non-infected recipient. This means protected sex and appropriate cleanliness. I doubt if your sheets become as grimy as wrestling mats can be, but this infection has been transmitted to wrestlers from the mats. Changing the sheets with such zealous regularity would certainly be of assistance to the prevention of spread, and I doubt if touching your girlfriend would be as traumatic as a wrestling bout. Local treatment of the lesions would be the same as for any other herpes outbreak, as directed by your personal doctor. The infection can be spread to your partners; that?s why it?s named herpes gladiatorum. You might talk to your doctor (or preferentially to a dermatologist) about use of one of the antiviral creams which are intended for cutaneous use only. My sources indicate these have no prophylactic benefit, and they should not be used in the eye. Such material on your skin would seem eventually to find its way into another wrestler?s eyes. Infected persons can auto-inoculate other parts of their bodies, but this can be curtailed by remembering not to rub one?s (especially) eyes, anal and penile tissues if/when active lesions are present on hands. Treatment and management would be as for any other herpetic infection, especially trying to avoid contact with others when you have lesions. Some but not all infected persons are shedders. You might be one of those who could be non-infectious in the absence of symptoms. The safest course for all others is for an infected person to consider him/herself capable of transmitting the virus at all times.

Dear Dr. Tom:

OUR SIX YEAR OLD SON HAS HAD OUT BREAKS SINCE HE WAS 1 1/2 YEARS OLD. NOW IT HAS MOVED INTO HIS EYE. WHAT CAN WE DO? THE LOCAL DOCTORS ONLY TELL US THERE IS NO CURE. IF THIS IS THE CASE WHAT TREATMENTS WOULD YOU RECOMMEND? WILL HE GROW OUT OF THIS? CAN THE VIRUS MOVE INTO HIS OTHER EYE? LOOKING FOR ANSWERS. THANKS

Dr. Tom's Response:


Dear Looking for Answers:

Your local doctors are correct about having no cure for the herpetic auto-inoculation into your son?s eye. While the possibility exists that the virus can move to the other eye, I think the best approach to both prevention of further spread and treatment would be to seek the advice of a pediatric ophthalmologist. That person might consider seriously evaluating your child?s present system of immune globulins and his genetic immune precursors. The immunoglobulins are proteins formed by all of us that tend to protect against invading micro-organisms. Formation of these immunoglobulins by the human body has as its origin genes which determine the capability to produce the protective serum and tissue proteins. Immune response capability tends to increase with age, so your son?s developing immune defense to infectious micro-organisms should improve if he has the necessary genetic predisposition. You are most likely to find a physician with such credentials attached to a major medical center or a university medical center. I am not qualified to advise you on treatment. That would be the domain of your pediatric specialist. I am aware, however, of a child who was helped to respond to his herpes infection through a tissue implant (homograft) that enhanced his ability to produce immunoglobulin. A computerized search of the medical literature should help to locate publications dealing with such problems if, in fact, your child had some deficiency. Your pediatric specialist would be the person to request such a search. I wish you the best.

Dear Dr. Tom:

Is it possible to have herpes that is not directly in the genital area? I am 33 year old female who had an outbreak about twice a year for the past ten years, but only in one small place on the back of my leg. Never in the genital area itself. This seems strange, although I'm glad for it. Can this be what is known as genital herpes?

Thanks! Confused.

Dr. Tom's Response:


Dear Confused:

Yes, herpes infections can manifest themselves in body areas other than the genitalia. The simplest explanation is that if herpes virus lesions appear in the genital region, it must be considered genital herpes, irrespective of whether it is HSV-1 or HSV-2. Conversely, if lesions appear in non-genital areas, then the infection must be considered non-genital. Examples are herpetic whitlow, where painful lesions emerge on the hands, herpes corneac of the eyes, and herpes gladitorum passed between wrestlers? sweaty bodies. Of course, these conditions also could have resulted from genital cross infection or auto-inoculation. I can offer you no explanation for the outbreak site on the back of your leg. If the virus behaved the way we would have expected it to do, you perhaps experienced the initial infectious contact there during past years. Recurrences do not always take place at the original infectious contact site, but they do more often than not.

Dear Dr. Tom:

Hello, I was diagnosed with HPV, my doctor had burned them off and told me not to have sex for 1 month well i did after 2 weeks, I thought I was healed. After 2 days of having intercourse with someone I don?t really know I have a blister near the entrance of my vagina and it?s red and swollen and when I urinate I'm in absolute pain, I freaked out and thought it was herpes. I went to my Gyn, he told me it looks like I irritated the tissue of my vagina where he burnt the warts off, he said it does resemble herpes lesions but he said he strongly doesn?t think it is, I?m not sure if he?s right; could you give me some advice on this?

Dr. Tom's Response:


Dear Diagnosed with HPV:

HPV, human papilloma virus, causes lesions within the genitalia which are uncomfortable and sometimes embarrassing. Most HPV infection types are uncomfortable nuisances, but a limited number of the types can lead to cervical cancer, so knowledge of their presence is quite important to one?s well-being. You have taken the appropriate action by continuing to consult with your gynecologist. He is highly likely to be correct in his evaluation of your case and was assuredly correct in his advice to abstain from vaginal intercourse until the excised sites healed. Urine contact with an open, irritated, soft tissue lesion, will burn like fury, and the secondary infection of the unhealed tissues is a possibility. You are wise to pursue the issue to a clear understanding, because HPV is implicated in cervical carcinoma. An independent second viewpoint from a physician experienced in dealing with CIN, cervical intra-epithelial neoplasia (a term meaning new growths in the cervical outer tissues), might help to reassure you. Such a person may be found through either your local county medical society or the state medical society. These organizations usually will not recommend a particular physician but will give names of their society members who have such training, experience, hence expertise. In most localities such data is computer available. Do not fear offending your present gynecologist.

Dear Dr. Tom:

I have a little zit type of thing in my crotch I don't know what it is it isn?t in side of me but I am scared. I have never been sexually active and I am 15. What?s wrong with me or what is this???? Please help!
Stephanie in California

Dr. Tom's Response:


Dear Stephanie in California:

Since you are 15, understandably you don?t know what the problem is. A number of things are capable of causing the zit you have experienced. These could include non-specific dermatitis caused by friction rub from underclothing, possibly too tight jeans or irritation possibly caused by shaving the bikini area. Conditions caused by infectious micro-organisms could include contamination from your own skin or anus if personal hygiene were a bit lax, a condition known as tinea cruris-a fungal infection better known as jock strap itch- is transmissible a number of ways, including from your own feet. The list of suggestions could go on, including the hands of an exploratory boyfriend, even though you haven?t been sexually active. To put your mind at ease, seek medical help from your family physician or from a less personal facility such as a walk-in clinic or a woman?s health facility. If you have concern about confidentiality, that is controllable. Your conditions sounds more like an inconvenience than anything threatening, but rid yourself of the anxiety by seeking dispassionate clinical evaluation. Communicate again to tell us your decision and the outcome if you wish.

Dear Dr. Tom:

OK, I am a health care professional a nurse and I was recently exposed to type 2 I don?t have any open lesions or anything that Id classify as vesicles, no drainage just red raised bump like areas started with a small group on the penile shaft, that didn?t hurt but they itched if pressure applied it is like an intense itch, that first group disappeared in a matter of days then one red raised area appeared above it, same thing , no fluid filled vesicle no pain or drainage just the itch, now I have 2 more right on the rim of the head of the penis , no blister, no drainage the other is about to disappear. I have had no malaisia or flu like symptoms, no intense burning or pain , what do you think?
LONE TXN

Dr. Tom's Response:


Dear LONE TXN:

Your communication suggests that you have assumed your contact with type 2 has caused an infection that resulted in the penile lesions you have described. That may very likely be the case, even though the symptoms do not include fluid-filled vesicles and do not fit exactly the textbook type clinical expectations. These viruses are biologic entities which are both quite predictable and simultaneously perhaps totally unpredictable in other ways. As a health care professional, you are most likely aware that other sexually transmissible agents can often share the genital tract at the same time. I think you may have become infected with a herpes virus and should consult a physician or a social hygiene clinic for a complete and accurate diagnostic workup to include evaluation for other STDs. Your partner who provided your type 2 contact should be advised of your activity and evaluated as well.

Dear Dr. Tom:

My wife wore another woman?s swimsuit who we knows has herpes about three weeks ago. She has developed a small swollen spot above and left of her clitoris. This spot resembles an ingrown hair and does not bother her at all. I did shave her within the past week, how worried should we be.

Dr. Tom's Response:


Dear Reid:

We cannot make diagnosis over the internet, but we can offer you what, hopefully, will be helpful information. Herpes has been documented to have been transmitted by one person using another infected person?s damp towel. This is an uncommon way for the virus to be transmitted, but that is possible. The lesion resembling an ingrown hair could have resulted from localized skin infection possibly caused by an invading micro-organism which entered minute abrasions created during shaving. The woman?s genital anatomy, unfortunately, is located dangerously close to the anus, terminal end of the most highly microbially populated portion of the human body. Plenty of available potential microbial invaders are close by. Note that so many feminine gynecologic problems have microbial origins, e.g., ?yeast infections?, etc.

Dear Dr. Tom:

I went to a doctor about three weeks after I noticed a red sore near the head of my penis (between the head and the top of the shaft). He said it was probably just from friction from masturbation, and not a STD. However, he said it is hard to tell since I didn't go to see him when the irritation first developed. As a precaution, he took a blood test which he said he would have tested for syphilis and herpes. The result for syphilis was negative and the test for herpes has not come back yet. He said that I need to get another blood test in approximately two weeks to confirm the results for the syphilis test. Why is this? Also, he said that the blood test for both STDs are not conclusive. Why is this? I asked him, but didn't really understand his answer. Can you help me to understand both the inconclusive nature of the blood tests, as well as why it is necessary to have a comparison test for syphilis? I would really appreciate it if you could clear up these issues for me. I am very worried and anxious about my condition. Thank you.
Worried and scared.

Dr. Tom's Response:


Dear Worried and Scared:

Serologic tests for syphilis (STS) fall into two types: presumptive and confirmatory. Presumptive tests are intended to give a rapid answer (high sensitivity) and tend to be somewhat less specific. The confirmatory tests are also known as treponemal tests because they use an actual extract or fraction of the infectious treponeme as a test component. The treponemal procedures tend to be highly specific but have a lower level of sensitivity. Perhaps your doctor wants to be sure about a possible diagnosis of syphilis and is doing both types of tests. If he felt the sore resulted from friction rub caused by masturbation, he might have taken a skin culture in an effort to attempt to identify the causative agent. STS are based upon the ability of a medical laboratory to detect immune proteins in your blood serum (antibodies) that arise in response to presence of the infecting micro-organism. In all serologic procedures some false positives and some false negatives occur for a variety of reasons. This is why your doctor said that the blood tests were not conclusive. The physician attempts to make a decision based upon the best total information available, in your case a clinical exam and a complete STS battery. Thank your doctor for this, because positive STS results are reportable to the public health authorities under penalty of law; positive herpes serologic test results are not. In primary syphilis the initial sore disappears, leaving the infected person much relieved that it went away. Alas, however, it will return in a different form if no treatment is received. The reason for lawfully required reporting is to insure that persons who test with positive STS results see a physician and receive treatment. Untreated syphilis can have dire results. Nero, Caligula, and Bloody Mary Tudor were examples. Your anxiety is understandable, but syphilis is completely curable by antibiotic treatment, while herpes is not.

Dear Dr. Tom:

I am worried because I recently noticed a blister or boil on the shaft of my penis. It's rather embarrassing to say, but I didn't have oral or regular sex with anyone in the past few months. I did have, however, what some call a "hand job" from a promiscuous female. I, in turn, placed my fingers into her genitalia. I washed up right afterwards, but I think I must have gotten something from her, because what else could have caused this boil. And the sad thing is, I was avoiding sexual contact because I am pretty paranoid about STD's, but I didn't exercise enough will power that evening. Is it possible to catch herpes in this fashion? It seems possible. Thanks for whatever advice you can give,
Todd

Dr. Tom's Response:


Dear Todd:

A blister or boil on your penis is possible without it being herpetic. The possibilities are: Hands of the promiscuous female could have transmitted the herpes virus to your penis if she were herpes infected and if her hands were contaminated with her own virus. Similarly, your fingers inserted into her genitalia could have become contaminated with the virus from her vaginal fluids, and thereby, you somehow transmitted it to your own penis. Best immediate advice is to determine with certainty that the blister or boil is herpes. It could be a localized infection from friction rub.

Dear Dr. Tom:

I have had genital herpes for two years with outbreaks every two months until 4 months ago. I started taking famvir daily and have not had an outbreak since. I have had unprotected sex many times over last 2 years only when no symptoms have been present and have never infected my partners - after reading this web page I need to know how to ascertain whether I can shed or infect anyone in between outbreaks. I understand only one in six people can. Is there any tests available?
Thanks, Alan

Dr. Tom's Response:


Dear Alan:

Drugs such as famvir only interfere with the herpes virus? activation cycle and thereby promote personal comfort, etc.. These anti-herpetic compounds do not eliminate or ?kill? the virus akin to the way antibiotics do for bacteria. Once the virus is in the body, it is capable of doing what such viruses are known to do. Some persons secrete or shed virus even though they may not be experiencing an outbreak. The concept is widely accepted that shedding of the virus within the genital tract in the absence of symptoms is a means to transmit an infection, and having unprotected sex poses a risk of infection for the other partner. Almost constant testing for the presence of virus in your body fluids would be necessary over a period of time to determine if you are/not a shedder. I know of no one time test to do so. It is safest for all to assume that you are a shedder and always will be.

Dear Dr. Tom:

I don't know what to do; my mom and my sister are afraid of me touching them. I don?t know what to do? My husband does not seem to understand what it?s like? Can you help me?

Dr. Tom's Response:


Dear Anonymous:


The family situation you describe seems as though it can be relieved only through counseling by a professional.

Dear Dr. Tom:

If you have oral sex with someone who is infected with herpes and get herpes in your mouth, when it reoccurs, does it then become genital herpes, or would it just reoccur in your mouth?

Dr. Tom's Response:


Dear Anonymous:

Oral sex whether by fellatio or cunnilingus brings the virus from the penis or vagina into the mouth of the recipient. Herpetic infection of the genitalia is genital herpes. Recurrent outbreaks are most likely to occur in the mouth and adjacent areas. Self-inoculation to one?s own genitals and eyes has been reported. Also remember that this is a peculiar virus which has not read our textbooks.

Dear Dr. Tom:

How long do symptoms appear after contact?

Dr. Tom's Response:


Dear Anonymous:

The infectious response to herpetic exposure varies widely. One man reported to us on the web page that he experienced penile discomfort within a few hours after cuddling, but not having intercourse with his wife who was undergoing a recurrence. Many report experiencing symptoms within 6-8 days following exposure. Young children seem to acquire HSV-1 at an early age and go into asymptomatic latency which can last for years.

Dear Dr. Tom:

Can valtrex be passed on to my baby through breast milk and can valtrex be sporadically released into my system weeks after an outbreak, stored in cells? I have periodic problems with my son that can't be explained.

Dr. Tom's Response:


Dear Anonymous:

Standard drug reference source on this product indicates no experience with nursing mothers. Valtrex (called valacyclovir hydrochloride) is a derivative of acyclovir (Zovirax). However, acyclovir has been found in breast milk following oral administration of the drug. The caveat is offered that valtrex should be given to a nursing mother with caution. I suggest you consult a pediatrician about your son?s problems if you have not done so already. Pediatric medical centers retain professionals on staff who have expertise in pharmacologic and toxicologic matters.

Dear Dr. Tom:

Is herpes only a sexually transmitted disease?

Dr. Tom's Response:


Dear Anonymous:

No. Herpes is not exclusively a sexually transmitted disease. For example, I am aware of a child bitten on the cheek in a day care center by another pre-school child. The bitten child began to have recurrences of herpetic lesions on his face shaped as the profile of the biter?s tooth marks. Herpes virus can infect skin of the hands to cause a condition known as herpetic whitlow, an occupational hazard affecting primarily nursing personnel and dental practice workers. Current dictates of the concept of Universal Precautions to glove during health care has lowered this risk remarkably.

Dear Dr. Tom:

I have been having some discomfort in my vaginal area for a while. Each time I feel like this I go to my doctor for a pap smear and nothing shows up. My GYN said that it could be a possible allergic reaction to the kind of soap I use or the kind of underwear I wear. Is this possible? I trust her because she hasn't failed me. I really began to trust her when I went in for a second opinion once I had this discomfort again. I was told the same thing. Now they say that I should look for blisters in my vaginal area when I get this discomfort, and when I do, I see nothing. I have an appointment for a colposcopy to see if I may have cervical cancer. If there is a chance of me having cervical cancer could the discomfort I feel be part of this?
Worried

Dr. Tom's Response:


Dear Worried:

If your discomfort were caused by soap allergy or reaction to the type of undergarments you wear, changing both of these seemingly should have eliminated the problem. Blisters or lesions in your own vagina may be difficult for you to observe directly. Presumably, since these changes in soap and underclothing have not provided relief, the colposcopy is an important adjunct to the solution of your difficulty. The procedure is an aid to the detection of possible new vaginal tissue growths and a condition known as cervicitis. Only after careful and thorough clinical evaluation, laboratory findings and follow-up conference with your Gyn should you even remotely consider the notion of cervical cancer. The repeatedly negative Pap smear is good news. Cool your worried jets until you have more specific information about the cause of your discomfort.

Dear Dr. Tom:

What is Herpes simplex I?
How do you contract it?
How contagious is it?
Is Herpes simplex I, a sexual transmitted diseases?
Is Herpes simplex I, airborne?

Dr. Tom's Response:


Dear Anonymous:

1. Herpes simplex virus type 1 is a member of the herpes group associated with but not restricted to the upper part of the body. It is the fever blister agent. Many infants contract asymptomatic infections with it by 18 months as a result of familial household exposure. It is prepubertal and associated primarily with the head and mouth. 2. HSV-1 is transmitted usually by primary infection of the respiratory tract. 3. Although HSV-1 is more likely to remain latent, hence asymptomatic, the virus is nonetheless infectious to others. This fact is often the answer to, ?How did I get it?? Oral sex is a known means for it to become the agent of genital herpes in a sex partner. 4. HSV-1 is assuredly a sexually transmitted disease agent, and the differentiation between HSV-1 and HSV-2 as genital area infectious agents is becoming less distinct. 5. We like to think of herpes viruses as not being airborne, but the entry of HSV-1 as a primary infectious agent of the respiratory tract and the tendency of young family members to become infected casually at home tends to argue against the non-airborne concept.

Dear Dr. Tom:

I got herpes several months ago from having oral sex with my boyfriend. Since I was diagnosed, I have not had another identifiable outbreak. A few itchy spots, a bump or two, but they did not blister and scab over the way the initial outbreak did. (I do shave my bikini area, so I think the bumps were just irritation, though they might not be.) I had an itchy bump few days ago, but after a couple of hours it was completely gone.
Now, I have a localized rash on my wrist, my shoulder, and one ankle. I am allergic to lots of things (grass, insect bites, etc.), but usually this results in an all over breakout of hives that goes away within a day. The rash I have in several spots has been there for several days now. It gets itchy when it touches something (clothing or my watch, for example), and puffs up a little more if I scratch it. Could this be herpes? Would it look different due to the different area of the body or because it's a recurrence? Or am I just overly concerned about an allergic reaction?
-Concerned

Dr. Tom's Response:


Dear Concerned:

Because of your previous history of an established herpes diagnosis and your allergies too, ?lots of things?, an outsider reading your description could only guess without conclusion. Herpes is a deceiver, and from your information, what you are experiencing could be one of its manifestations. If you are experiencing anxious concern over this, I suggest you consult your personal physician.

Dear Dr. Tom:

I have had herpes now for about three years. In the last six months I have had blisters on my hands. I have very sensitive skin and some lotions bother me. I am a hairdresser/nail tech so I went to the doctor about my hands and she said it was herpes. She had only been a doctor for about one year and even went into the next room to ask her husband, who didn't even look at it. I decided to get another opinion, that doctor said it wasn't herpes and gave me triamcinolone acetonide ointment. It clears it up but within a few days its back again. Do you think it is herpes? I am afraid of giving it to the people I work on but I was told that it's not herpes.
Please help me. What do I do? Do many people get it on there hands? I need your advice. Thanks.

Dr. Tom's Response:


Dear Thanks:

Your description resembles a condition known as herpetic whitlow, more common to nurses and dental practice workers but recognized as an occupational hazard. Lesions occur primarily on the hands, and the pain has been responsible for many lost work days in those so infected. The infection occurs less frequently now that gloving is a standard practice in all health care. If the affliction is not herpes as determined by the other doctor, the wise decision would be to determine exactly what the condition is rather than treating it empirically and having it recur. Also, you might consider working in latex gloves as is the common health care procedure.

Dear Dr. Tom:

My girlfriend and i just had a baby, the baby was diagnosed with herpes after we needed to bring him into the hospital for seizures. We both new my girlfriend had herpes 1, but did not tell the doctors, and she did have a cesarian for other reasons. What would cause the baby to have herpes? I have not been checked and we did have sex up until the 6th month. If I don?t have herpes how could my girlfriend with herpes 1 give herpes to the baby.
Eagle

Dr. Tom's Response:


Dear Eagle:

Several unanswered questions arises while attempting to answer your inquiry: Was the baby also diagnosed with herpes 1? Why did your girlfriend not confide to her obstetrical physician of her infection with HSV-1? If you have not been checked, how can you be certain you do not also have latent HSV-1? The chances are that you do, because pregnancies are inhibited by condom use. The question would be answered better by an obstetrician, but the likelihood is that HSV was transferred to the newborn during the birth trauma, despite the caesarian delivery. All is not clear here.

Dear Dr. Tom:

Hi!! My name is Lorene and I am doing a paper on post herpetic neuralgia. I have been trying to find some information but not much luck.
I am trying to find a pathophysiology, risk factors, etiology and clinical manifestations (nursing stuff). While waiting for your response, I will be checking other resources.
Thank You!! Lorene

Dr. Tom's Response:


Dear Lorene:

If you are doing ?nursing stuff? you may be in the location where you have access to a university or medical library. If not, many community libraries are able to access such libraries via the web, consult Index Medicus alphabetically for what you seek. Biological Abstracts is another general index that may help you. You may find The Reader?s Guide to Periodic Literature helpful as well, and most community libraries have it. If you do not have computer access you can present your request at the reference desk of the libraries described and request a search. They will ask you to define a search period, ie., how far back do you wish to go, language, English only or world- wide, etc.. This will usually require a week or more, depending upon how busy the library may be. Such requests require a fee for service. Computer stations that serve as catalogs to shelved holdings in a university or medical library will give reference to textbooks that deal with the material you seek. Numerous hard cover texts dealing with herpes viruses are on the shelves. Such searches are usually fun. Good hunting!

Dear Dr. Tom:

Hi. I am a 58 year old male who acquired Herpes thirty years ago. For the most part, I experience frequent attacks on my penis, upper buttocks, both thighs, with a high frequency. Each area seems to have five to eight attacks per year, with little correlation between them.
Four months ago, I experienced a large outbreak on my right ankle, an attack which lasted for three times the normal period and which never did clear up completely . I have a square inch discoloration where it occurred. At the same time I experienced a lot of neuralgia, with my right side from the waist down feeling "tingly" for weeks. Two weeks ago, this same thing occurred, although it appeared four inches away from the prior site, (right ankle). Is this new appearance consistent with your normal experience with herpes.
Sincerely, Michael

Dr. Tom's Response:


Dear Michael:

HSV-1 and HSV-2 are viruses known to behave peculiarly and at times inconsistently with what has been recorded about them. The dictionary tells us that the word comes from the Greek, meaning, ?to creep?, and so it does. It is possible that the new affected area is served by the same nerve root ganglion that connect the other areas. Such activity would be expected from herpes, but if the occurrence is disturbing you might wish to consult a dermatologist. Failure to clear up completely might suggest presence of another cause.

Dear Dr. Tom:

My 17 yr. old niece has full blown herpes. I am wondering if it is possible that my 6 yr. old niece can get this by accidental transmission of urine from the toilet seat.
THANK YOU, CONCERNED AUNT DONNA

Dr. Tom's Response:


Dear Concerned Aunt Donna:

Transmission of herpes from urine on a toilet seat is most unlikely. This is just not the way herpes is spread. Familial herpes transmission within the same household is recognized, however, and the 6 year old could become infected by any number of other means while living within the same family structure. Perhaps the little one?s mother might wish to discuss this possibility with the family pediatrician who could control precautions that would tend to help prevent cross spread.

Dear Dr. Tom:

Over 9 years ago I was diagnosed with Type I genital herpes. After the initial outbreak, as expected, I have had few reoccurrences. Maybe averaging one every 1-3 years. My questions are how concerned do I need to be about genital sex with my husband and is it transmissible/safe to go into a hot tub or jacuzzi with my husband?
Perplexed

Dr. Tom's Response:


Dear Perplexed:

I too am perplexed, because your question does not make clear the duration of your marriage. Seemingly, your herpes diagnosis preceded your marriage by some time in order for you now to be asking about the safety of sex and intimate activities with him such as use of the hot tub. Is your husband aware that you are herpes infected? The preventative safety principle is always the same : a barrier between the infective agent and a susceptible host, in this case your husband, will remarkably lessen the likelihood of transmission. Sharing a hot tub or jacuzzi poses some risks for transmission, but I cannot cite any known infection brought about by this means. Home hot tubs are not chlorinated (except for levels in treated city water supplies), so no anti-microbial activity is present in the waters. Transmission would depend upon whether or not you are a shedder. If you are, then small amounts of virus might enter the water, and a remote possibility exists that your husband could become infected. The risk would be higher in water that recirculates where none passes on down the drain. As an unscientific personal opinion, I would be inclined to enjoy the pleasurable intimacy of the hot tub experience and have protected sex elsewhere.

Dear Dr. Tom:

Hi, my name is Ashley. For my CAPP class, I am supposed to research genital herpes, to spread awareness. Like many other students in my class, we were unaware of the dangers of sexually transmitted diseases, other than AIDS. We have decided to begin to tell others about it, and I just thought you should stress the importance of having safe sex. I just have one question: can your partner have genital herpes without having the listed symptoms? If yes, then shouldn't we all be tested?

Dr. Tom's Response:


Dear Ashley:

I find it most unfortunate that you and your fellow students have been so unaware of the presence of the more than 20 STDs other than AIDS. Numerous publications are available from specific organizations and libraries, but bookstores do not always maintain STD informative publications in their inventories. Those of us who do lecturing on the topic make every effort to spread the word.
Yes, your partner can have genital herpes without any symptoms. Universal testing would be helpful. Blood tests are not infallible. Virus culture procedures are costly, hence are not included in most health care plans and must be paid for privately. The quest for personal privacy and the beliefs of family religious practices impact upon the situation.
The only way a negative test result of either type can be reassurance is through maintenance of absolute monogamy, a difficult parameter to expect in our current society.

Dear Dr. Tom:

I'm wondering how many months should I go back in my intimate contact department to advise previous partners of my recently diagnosed Herpes?

Dr. Tom's Response:


Dear Anonymous:

Herpes is not a reportable STD, so any advising that you may do is a human kindness. I suggest that you consider the extent to which the spread of an insidious infectious agent may be curtailed and act accordingly. If you have already infected some, the damage is already done, but spread may be curtailed further if you act. You might be guided by any information as to when you became infected, but if you have been widely sexually active, that bit of information may be hopelessly lost in the contact pyramid.

Dear Dr. Tom:

I was diagnosed almost 2 years ago with herpes. My doctor first gave me Zovirax, which worked for about a year. Then I started to see ads for Valtrex and asked about that. That cleared up one outbreak. But then had no effect. I seem to have one outbreak after another, the last time I can remember not having any discharge at all was last fall. I'm tired of taking meds. They come to a point where they just stop working. Do you have any other suggestions?

Dr. Tom's Response:


Dear Anonymous:

We must be careful not to engage in the prescription of medications via the net. The most recent (1998) guidelines for treatment of STDs from the U.S. Dept. Of Health and Human Services includes Acyclovir, Famciclovir and Valacyclovir regimens for herpetic infections. You are taking the appropriate steps by staying in contact with your physician, and perhaps s/he may not have consulted this publication. Refer to MMWR, Jan 23, 1998/vol 47/No. RR-1. Medical and hospital libraries usually have it, or your physician may obtain a copy by calling the Centers for Disease Control, Atlanta, Ga.. This is a serious problem for you, so do not feel that you are overstepping by discussing newer treatment with your doctor.

Dear Dr. Tom:

A few years ago I went to my ob/gyn because I was having discomfort. He told me he was pretty sure it was genital herpes and that if it was, it was not a "bad" case. Since, he has tested me 3 times for not only herpes, but all the others - everything has always comes back negative. I don't understand this. If he can't tell me exactly what it is, how am I supposed to ever find out what was wrong?

Signed, Aggravated

Dr. Tom's Response:


Dear Aggravated:

I suggest consulting an ob/gyn practitioner in a major medical center if you are near one. I am aware of more than one person?s major gynecologic problem that has been sluffed over by physicians with busy offices and incomplete examinations. Without knowing what tests were performed and by whom, it is difficult to give any guidance other than to consult another practitioner.

Dear Dr. Tom:

I have a simple question for you regarding Herpes. I have not been sexually active foe quite some time (about 4-5 months) and when I was, it was always with a girlfriend or someone who I was in a relationship with (I am not in the habit of sleeping around). Some time in mid-April to late april, I noticed what appeared to be bumps, almost like pimples, the base of my penis and on the left side of my penis. The bumps also appear to be where the pubic hair grows though the hair shaft. I have been doing some research on Herpes and I have read all the symptoms and I must say that I really don't fit any of them. I have not had the feeling of being sick, muscle aches, burning, blisters popping, cold sores, pain or anything of that matter. There is some itching associated but nothing out of the norm.
What is beginning to worry me is the length of the "rash". Since I first noticed it, it hasn't gone away or become dramatically worse. All the info I read on the disease states that it comes in stages that lasts up until three weeks. I am way beyond the three week mark.
I have contacted all my past partners, asked if they have been tested and was fortunate to hear that they were with the results being negative for anything. I myself am getting tested and I would like to calm my nerves until my doctor appt. Are there any other sure tell signs that signal a herpes outbreak? Could it be poison ivy, jock itch, or something similar? Any advice you could give would be greatly appreciated.
Thank you. JS

Dr. Tom's Response:


Dear JS,

A male yeast infection known as balanitis affects primarily the glans of the penis, but in a small number of situations, it infects the shaft and also the scrotum. Jockstrap itch seems a possible candidate also. Consult a dermatologist who will have the skills to recognize the condition and the facilities to perform culture diagnosis and help to relieve your discomfort and anxiety.

Dear Dr. Tom:

Though I have never had an outbreak since the initial one, I want to thoroughly protect my present, uninfected partner. I have become aware that a women can be active without symptoms and thus spread the virus through bodily fluids. A condom alone could not protect spreading if she secretes heavily. How protective would a condom plus nonoxynol-9 gel or jelly be ????
Thank you for your time. It is much appreciated. CC

Dr. Tom's Response:


Dear CC:

Nonoxynol-9 is a spermicide that has been shown to have anti-HSV activity under laboratory conditions. A condom provides a barrier between a source of the virus and its possible recipient, but as you acknowledged, is fallible. A search of the literature on my part might turn up a clinical study in which this prophylactic anti-HSV combination has been evaluated. We should communicate again on this.

Dear Dr. Tom:

Can one develop multiple cold sores or multiple genital infection sites through continued contact or self infection? I can see risking a single infection to build a relationship with a wonderful woman, but a lifetime of caution and spreading infections seems daunting. Not kissing/whatever for a couple weeks a year is managable, but if in 30 years it progresses to months, I'd be sad.
On a Brink

Dr. Tom's Response:


Dear On a Brink:

Herpetic infections can spread from one portion of the body to another, for example, from an active genital lesion to the eyes by one?s own hands. Likewise, the herpes virus capable of causing cold sores can be passed to a non-infected person by kissing. This is why loving relatives are sometimes asked not to kiss infants.
Withholding intimacy from one's loved partner is, as you said, 'manageable', during the duration of an outbreak by one partner or the other. I know of no evidence to suggest that each intimate contact between partners, where one or both are infected, carries with it the threat of compounding the extent of lesions, and thereby, the length of privation.

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