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may i ask about herpes instead?
Aug 10, 2008

hello dr. bob. how are u?it's me again,medical student in prague (AGAIN???).well last time when i told u that my test results for stds came out negative after 5weeks of exposure.i actually got that through the phone only coz i simply couldnt find time to go to that lab and get the paper.on the phone she said all negative and i have nothing worry about. so yesterday i went there just to collect the paper.and she said that everything is negative except for herpes type 1.the result for herpes type 1 is 449/ML. my questions are 1)she said that i dont have to worry about it because everybody has it.and also she said that it is not dangerous at all.is that true? 2)because the result was positive after only 5weeks,does it mean i already have it all these while?(means before i had sex with that escort) 3)could this virus actually gave me all the symptoms that i told u earlier? 4)is my sex life affected by this? 5)and finally if u could give me any link or tell me which part in this website i can find more info about herpes.

dont worry about our wooohoo duet dr.bob.i'll still be woohhooing as long as i dont get infected by hiv.about this herpes i was just a bit shocked by it and because i still dont know much about it yet.i'm sorry for taking your time again dr. bob.and u dont have to answer this if it shouldnt be answered in this forum coz i'm aware that people only ask about hiv here,but like i told u that WE ALL simply like u so much so i cant help but to ask u. thanks dr.bob and take care.

medical student,prague

Response from Dr. Frascino

Hello Medical Student from Prague,

Eventually you'll be learning about all these ailments in the course of your medical training. You may well be at the top of your class in those courses by having studied all this information now. I'll reprint below some information about herpes from the archives. To briefly address your concerns:

1. Well, not "everybody" has herpes type 1 literally speaking, but the prevalence is indeed extremely high and I, too, agree you shouldn't be worried about this.

2. Chances are good that you've had herpes type 1 for a long time.

3. Nope.

4. Nope.

5. See below.

Dr. Bob

Herpes Simplex (Cold Sores and Genital Herpes)

What Is Herpes?

Herpes simplex refers to a group of viruses that infect humans. Like herpes zoster (shingles, see Fact Sheet 509), herpes simplex causes very painful skin eruptions. Itching and tingling are usually the first signs, followed by a bump that breaks open and becomes very painful. The infection goes dormant for periods of time. It can become active again with no warning.

Herpes simplex virus 1 (HSV1) is the common cause of cold sores (oral herpes) around the mouth. HSV2 normally causes genital herpes. However, through sexual activity, HSV1 can cause infections in the genital area, and HSV2 can infect the mouth area.

HSV is a very common disease. Approximately 45 million people in the US have HSV infection -- about one in five people over the age of 12. The US Center for Disease Control estimates that there are 1 million new genital herpes infections each year. The rates of HSV infection have increased significantly in the past ten years or so. About 80% of people with HIV are also infected with genital herpes.

HSV2 infection is more common in women. It infects about one out of four women and about one out of five men. Genital HSV can cause potentially fatal infections in babies. If a woman has active genital herpes at delivery, a cesarean delivery is usually performed.

Repeat outbreaks of HSV are most likely to occur in people with a weakened immune system. This includes people with HIV disease, and anyone over 50 years old. Some people also believe that repeat outbreaks are more common when someone is very tired or experiencing a lot of stress.

HSV and HIV

HSV is not one of the infections that are part of the official diagnosis of AIDS. However, people infected with both HIV and HSV are likely to have more frequent outbreaks of herpes. These outbreaks can be more serious, and last longer than for people without HIV.

Herpes sores provide a way for HIV to get past the body's immune defenses and make it easier to get HIV infection. A recent study found that people with HSV had three times the risk of becoming infected with HIV as people without HSV. A recent study found that treating HSV can lead to a significant reduction in HIV viral load.

People with both HIV and HSV also need to be very careful during outbreaks of HSV. Their HIV viral load (see Fact Sheet 125) usually goes up, which can make it easier to transmit HIV to others.

How Is HSV Transmitted?

HSV infections are passed from person to person by direct contact with an infected area. You don't have to have an open HSV sore to spread the infection!

Also, most people with HSV don't know that they are infected and aren't aware that they could be spreading it. In fact, in the US only about 9% of people with HSV2 infection knew that they had it.

How Is Herpes Treated?

The standard treatment for HSV is the drug acyclovir, given orally (in pill form) up to five times a day. Another form of acyclovir is valacyclovir. It can be taken just twice a day, but it is much more expensive than acyclovir. Famciclovir is another drug used to treat HSV. New drugs are being tested. ME609 (by Medivir) for oral herpes is finishing Phase II trials. PCL-016 (by Novactyl) for oral or genital herpes is in Phase II trials.

These drugs do not cure HSV infections. However, they can make the outbreaks shorter and less severe. Doctors may prescribe "maintenance" therapy -- daily anti-herpes medications -- for people with HIV who have had repeated outbreaks. Maintenance therapy will prevent most future outbreaks.

Can Herpes Be Prevented?

It is difficult to prevent the spread of HSV. Partly this is because many infected people don't know that they carry HSV and can spread it. Even people who know they are infected with HSV may not realize they can transmit the infection even without an open herpes sore. Condoms can reduce the rate of HSV transmission. However, they cannot prevent it. HSV infections can be transmitted to and from a larger genital area, such as that area covered by "boxer shorts" -- and also around the mouth. If people with herpes take valacyclovir every day, they can reduce the risk of transmitting herpes to others.

Drug companies are working on vaccines to prevent HSV. One vaccine showed good results against HSV2 in women, but not in men. No vaccines have been approved yet to prevent HSV infection, but research is ongoing in this area.

The Bottom Line

Herpes simplex is a viral infection that can cause genital herpes or "cold sores" around the mouth. Most people infected with HSV don't know it. HSV is transmitted easily from person to person during sexual activity or other direct contact with a herpes infection site. Herpes can be transmitted even when there is no visible open sore.

There is no cure for herpes. It is a permanent infection. People with herpes have occasional outbreaks of painful blisters. When each outbreak ends, the infection becomes latent for a while. People with HIV have more frequent and more serious outbreaks of HSV.



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