|
|
Do you have any questions or concerns about what Herpes is, how it's
spread, about the virus itself?
Receive answers from Dr.
Tom Neblett, a Doctor who has devoted much of his
life to the study of viruses and Sexually Transmitted Diseases.
Ask Dr. Tom
[ Previous
Page | page 1 | page
2 | page 3 | page
4| Next
Page ]
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.
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.
Dr. Tom
[ Previous
Page | page 1 | page
2 | page 3 | page
4| Next
Page ]
|
|
