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Genital herpes: how do we know for sure?
Dec 8, 2002

Dr. Kull, Please post this question, your answer will help a lot of us to clear up some of the comfusions about HSV2.

So how can we ever know if we are infected with genital herpes? In The Body, it states that 80 of the people are unaware that they are infected, cuz they have no symptoms, however, they are still able to pass on to their partners. Here are my questions:

1. The majority of the people who are infected do not develop symptoms? and why?

2. Can you rule out HSV2 if there is NO sore/blister around the genital? possible for HSV2 to show in a rash form, instead of sore/blister?

3. How can a person know if he is infected? assume there are no symptoms.

Here is what happened to me, I wrote a question to you about few weeks ago but did not get an reply so please answer this time. In mid OCT. 2002 I had a possible exposure. 16 days later while i was having sex with my girlfriend i felt burn/pain on the head of my penis. When i look at it, it looks like rash (red skin only on the penis head), and the skin started to peel off the next day. The whole thing subside after 2-3 days, however, the area is still a little red. After another 2 weeks, while having sex, exactly the same thing came back again. This time i went to see my doc. He said it's fungal infection (yeast infection). My concern is that, people who are infected with herpes can have very mild symptoms, and my doc only did a visual inspection, no test was conducted. This makes me worry that if i was infected with herpes but not accurately diagnosed. By the way, there was only rash on my penis head, NO other symptoms like fever, lymph gland swelling at the groin, hard to urin... etc.

Dr. Kull can you please give me your opinion? I know you can't diagnose over the internet, but can you please some thoughts? i really dont want to put my girlfriend at risk.

Thank you very very much for your precious time.

Response from Mr. Kull

1. Don't know. It's difficult to explain why people respond differently to infections like herpes, but they just do. There are so many different factors that will influence the course of infection, and this applies to so many different diseases.

2. If you do not experience symptoms related to herpes, then you shouldn't be worrying. If you are infected with herpes and never experience outbreaks, there's nothing to do. People who don't experience outbreaks are not likely to transmit the virus, even though it is possible. Some people who have been exposed use condoms all of the time to reduce the odds of transmission.

3. There are screening tests that can tell you if you have been exposed to HSV-2 (blood tests, antibody or PCR). If you are experiencing lesions, fluid from sores can be cultured. However, a positive blood test says nothing about the course of illness or the likelihood of transmitting the virus.

It is important that, if you begin to experience symptoms, that you visit your doctor so that she can take a look at what's going on. If you are concerned that you have herpes, even in the absence of symptoms, you can use condoms with your partner to reduce your anxiety about asymptomatic transmission.

RMK



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