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From:
Sent:
To: drgian@stdweb.com
Subject:

Dear Doctor,

I am married for two years to a man who has had herpes for over 25 years.  I have never had an outbreak ( we have no contact whenever he is active for 10 days, and he can usually feel it coming on before it's actually there, so we are never surprised). But I do have nose ulcers/sores (that seem to respond well to bacitracin or neosporin) ever since I've been with him-something I've never had before and he has very often.  I'm wondering if this can be related to Herpes?
Also, we have a one year old daughter who has a problem with diaper rash sometimes.  My husband is active now with an extremely mild case, and in the last day or so I noticed a little sore/lesion in her vagina area, in the midst of her diaper rash.  We have been treating the rash as we always do with A&D ointment and Baumex and the diaper rash has gone away but the little sore is still there.  I'm horrified that she could possibly have herpes and my husband doesn't think it could be, but I know that if it IS, then there is a small window that you must treat this, not unlike shingles, so that it doesn't get  more severe.  Is that correct?  We are on a family vacation and wont be home for another week so I'm thinking to take her for a test at one of your labs.  I don't know how to find a pediatrician here, and I'd like to waste no more time looking and trying to get an appt.  If it does turn out to be herpes, how do they treat an infant?  We try to be organic and tend to take a wholistic/naturopathic approach to medicine, and I do very well respect the importance of emotions in our health, but this has gotten me unravelled.  My husband can't imagine how he could have infected her and he is putting his head in the sand, saying it's not possible.  Perhaps I'm just paranoid and I am thinking the worst and its impetigo or something.  I just have this suspician it's herpes...

Hi,

   I am assuming that your husband has type 2 herpes. You did not specify that in your email. Also I do not know if you have positive antibodies for Herpes type1 or, for that matter, for Herpes type 2. I also do not know whether your husband has antibodies for herpes type 1.  If so, both of you should test for both type of antibodies to know more of your serological situation. Secondly, if anything has to be considered in the domain of herpes infection for your child I would consider a type 1 herpes blister. It is not uncommon for people with type one Herpes to auto inoculate the virus in other area of their body or to innocently pass it around to others in the family. That is how Herpes type 1 goes around in families and that is why it is so common infecting 70% of population and very frequently children. I see it all the time while performing a physical in people who are totally unaware of having the virus and small tiny blister can be present in many different areas of the body. So if that is what it is, it could be a type one herpes blister due simply to the handling of the child. If it is a type 1 infection you do not have to do anything except some education on the dynamics of herpes infections and of course transmit your knowledge to your child later on.
   I would make sure that both you and your husband have a clear view of your serological status while visiting your pediatrician and for tranquility sake, I would ask the Doctor to get a swab of the blister and request the lab to perform a Herpes 1 and 2 PCR test. This test is s DNA test and does not look for antibodies but for Herpes virus particles and it is very sensitive and specific and does not require the waiting time for antibody formation and, finally, it a test for both types of Herpes.
   If you should have problems in obtaining this test let us know by calling our phone line 1-866-478-3417 and we’ll help you.

I hope this helps you.

Dr. Gian

Dear Dr. Gian,

Thank you for taking the time to answer our questions. The prospect of having hsv2 is scary and it helps so much to have a reliable source such as yourself to turn to. 

My story is as follows:

I dated and then married a lady with hsv2. When we were dating I did get small bumps around the shaft of my penis. I went to the hospital thinking I had gotten hsv2. They said no and sent me home. I was able to pop them and squeeze out what looked like very large blackheads. After I did this, they went away and never came back. I ask this because I have always been curious what this was and because it might be important for this question? It was also kinda cool- in a weird, that came out of my body, life experience sort of way. 

About three years after having sex for the first time and two years after being married (all dates are within six months because it has been over ten years now) we participated in a hsv2 vaccine trial (~1998). At this time it was determined that I had not been exposed to hsv2 in order to participate in the study. I was either given a dead/attenuated herpes vaccine or the placebo vaccine. I believe the test was to run for three years. Every three months we had an appointment where they would ask my wife if she had any outbreaks and if I had displayed any symptoms and then take my blood sample to see if I had been exposed.

This went on for about four-five times (one year) and then one day during our appointment they came in and said the study's been canceled and see'ya. It was all very abrupt- they wouldn't say why, the wouldn't say if I had received the vaccine or placebo. We were never contacted again.

My wife and I divorced two years ago and I started dating another lady. I told her that my ex wife had hsv2 and that I should be tested. At first they said the test was inconclusive and later they said that I did have hsv2 and was negative for hsv1. I was shocked because I have never had any symptoms and I am in touch with my body so I wouldn't "miss" them.

I had another test at a different lab and the results came back as positive for exposure to hsv2 and again negative for hsv1. The word exposure made me remember the vaccine trial and the unusual way it ended.

I find it hard to imagine, but not unbelievable, that the scientists developing the vaccine would not realize that the vaccine will cause an antibody response in the body it is injected into and that these antibodies will produce a positive test result.

First question- If I was given a vaccine full of hsv2 shouldn't I have antibodies for hsv2 and therefore test positive for hsv2?

Second question- Would the HSV Viral PCR "polymerase chain reaction" test be able to tell if you actually have hsv2 in your body or only have antibodies to hsv2 from the vaccine? If so could you tell me where to get the test?

Of interest, the lady I was dating when I took the test "freaked out" when I told her I was positive for hsv2. We had touched each others' genitals with our hands before the test results were in and she was afraid, and perhaps rightfully so, that she might have gotten hsv2 from this and maybe she had rubbed her eye and might go blind, ect. She had the tests herself and told me she was negative. We started dating and having sex. One day, after kissing for awhile and drinking from the same glass she mentioned she had a cold sore. She had failed to mention she had hsv1! I found this hard to believe after all the grief and crying and blame she put me and herself through when we learned I was positive for hsv2! I would much rather have a red, swollen, stinging sore in my pants than displayed on my face! I gave her a hard time about it. Well, not that hard but it is curious the stigma with hsv2.

Thanks for the help and all the good work you do,

XOXO

Hi,

Thank you for your interesting case and for contributing to our STD conversations.

First off let me say that it is possible that the “small bumps” described at the beginning of your email were due to Molluscum Contagiosum. Please go there for further info.

Now for the answers to your specific questions:

First question: Yes, you could show a positive HSV2 antibodies response following a herpes vaccination. In fact the investigational herpes vaccine does not cause HSV infection because the herpes vaccine formulation contains no live or infectious virus and it is used for their antibodies stimulating or immunogenic (immune response stimulation) effects. Usually only a particular section of a herpes virus protein is used in the vaccine to stimulate the  immune response.  We do not know the detail of the vaccine protocol and the specific type of proteins used. However it would have been a good idea if, at the end of the Vaccine Trial Fiasco, you were offered at least a couple of extra HSV2 antibodies over 3-6 months to see if you had developed antibodies at the end of the vaccine trial or, for that matter, to a more recent exposure to your wife, especially if you were on a placebo group. So that does not help you a lot.

Second question: You became serologically positive and you are puzzled as to what was the source of your antibodies production since you do not recall symptoms suggestive of a primary Herpes infection. So you ask: would a real-time Polymerase Chain Reaction (PCR) help me sort this out?  The answer is a bit tricky and technical.  Although at the present time the real-time Polymerase Chain Reaction (PCR) detection for Herpes simplex virus (HSV) types 1 and 2  is used  in spinal fluids in neonates or in people with suspected meningitis the great majority of specimen reach the Lab are from genital or other skins swabs. In fact at the present time this type of test is replacing the old fashion virus culture for the detection of HSV in clinical swab samples. The PCR can be used in other type of fluids, such as blood, but this type of use is not that common given its costs and the availability of affordable and high sensitive and specific antibodies tests.

Furthermore, since different vaccines may use different proteins coming form the live virus for their antibodies stimulating or immunogenic (immune response stimulation) effects. we would need to know the specific type of virus proteins used in the your vaccine trial formulation  and match them with the one used in the PCR test (which usually are the glycoprotein D for Herpes 1 and glycoprotein G for herpes 2). I would venture to say that if you took the test you would probably be positive on the PCR test and lighter on your wallet. So may this also does not help you very much. However if you would like to have a HSV PCR blood or skin swab test do give us a call.

Lastly, for your comment about different emotional responses to different anatomical location of Herpes 1 and 2, I would like to say that you do have a point but let’s live that one for another discussion.

In good health,

Dr. Gian 

From:
Sent:
To: drgian@stdweb.com
Subject: question about infidelity

Dear Dr:

I recently discovered that my husband of 15 years had been unfaithful to me with a worker. She has a really bad reputation. Although he says they only had one sexual encounter, I am worried and devastated with the whole situation. We are trying to work it out but I do not want to try anymore if I am not 100% certain that he did not get any disease from her, "ANY".

I am not 100% sure that it only happened one time (I cannot trust what he says anymore), and not even sure of the time, but my guess is that it was going on 4 or 5 months ago and lasted for couple months.

What are all the necessary tests he has to take? How often and for how many times does he need those tests? How long until I am sure he is clean? I've read some of the questions and answers and see that some tests need to be done again after so many months. Please guide me in all this disturbing process.

I do not know of symptoms, but we are not that close to talk about those things at this time, so I want to assume the worst and start from there.

Hi, 

In situations like this there are of course many issues at stake such as Health, Certainty, Trust, Responsibility, Communication and Workability.  Of course a blood or urine test may or may not handle all of them.  In the health area the recommendation is to perform the comprehensive remote panel since the time of exposure you say is 4-5 months (use 4 months as time zero from exposure for the panel).  If the results are all negative you may consider at least the STD health issue closed. Nothing is 100% certain in human affairs; the only thing we are certain is of…uncertainty, a sort of double–bind situation. So let go a little bit on that issue. For all the other issues, escape the suffering by holding the judgments for sometime, by learning more about yourself and each other and by making new commitments.

In good health

Dr. Gian

Doctor Gian,

Excuse me for not including my name in my last email. You are the medical communication director at Infomed, from what I understand, and perhaps you can help me.

As I have explained my situation, a feedback from you will make all the difference in my forming a plan in my course of action. My warts have never itched, had any redness, or caused pain. I took a blood test, and the results were negative. Would I expect a treatment plan to be a surgical procedure for removal, or is there an alternative? It has been a year now, and the warts have been in the same place and relatively the same size. Should take another test provided by Stdweb? Why?

Thank you for your valuable time.


Hi,

it looks like you have genital warts which are increasing in number, These can be  easily treated and make you wart-free. However even if left untreated, occasionally visible genital warts may resolve on their own.
No one of the available treatments is superior to any other and no single treatment is ideal for everybody or all warts. There are several factors that influence selection of treatment and they include wart size, wart number, anatomic site of wart, wart shape and form, your preference, cost of treatment, convenience, adverse effects, and your Doctor's experience. Treatment regimens are classified into self-applied and Doctor-applied modalities.  Self applied treatment is with Aldara Cream or Condylox solution and Doctor-applied treatment is done with liquid nitrogen  
The currently available therapies for genital warts might reduce, but probably will not eliminate the presence of HPV and it is not clear whether the reduction in HPV viral DNA, resulting from treatment, impacts future transmission of the virus.

In good health,

Dr. Gian
 

I am 19 year old male, who ended his first relationship with a woman about 9 months ago. During our relationship, we were sexually active and I was constantly sick with bladder problems, infections and inflammation on my prostate.  She usually had yeast infections so we both got tested several times for HIV, Gonorrea ans Syphilis, but the results where negative in both cases. Since the break up 9 months ago, I haven't been sexually active and I have had a rash in my right thigh for the past months, as well as some recurrent sores in my mouth for the past 5-6 months. I am really confused and scared, and doctors haven't been helpful so far. Could you point me in the right direction, in order to know if any STD fits those symptoms correctly?

Hi,

You do not mention if you were tested for Herpes. However, given your partner history of yeast infections I think that could be the nature of your rash. If you continue to have doubts or concerns see your Doctor and get tested for herpes type specific antibodies and try an antifungal cream.

Be Well 

Dr. Gian
 

Hello.

I am a 39-year old single woman with no children and no husband. I too (just recently for the first time in my life) have been having this pimple (one at a time) recurring now three times (once a month: Nov, Jan, and Feb) in the last three months in one fold of my labia minora. It first appears as a flesh-colored bump, then the following day a whitehead appears, and then it pops/bursts like a pimple, bleeds briefly, and then immediately heals and goes away. Since it doesn't last very long I never have it long enough for a doctor to diagnose, do a culture/biopsy of it, even though I have tried and gone to see a couple nurse practioners the day after (too late) who claim it is nothing. Could this be a folluculitis? If so, how do I prevent this from recurring? This is not a hygiene issue. I do not shave or wax. So what causes it? Do I need to notify any potential future sex partners about this?

Hi, 

I do not think what you describe is a folliculitis and/or and hygiene issue. It seems that you are having symptoms suggestive of Herpes Genitalis virus infection. You should see a Physician and have a culture taken when you have the next flare up.  The culture distinguishes type 1 form type 2 Herpes but may yield a significant percentage of false negatives.  In the meantime learn as much as you can about the infection and, yes, discuss it with your past, present and future partner(s). Another approach would be to do a Herpes IgG type 1 and type 2 antibodies test with the understanding that antibodies formation may range from a couple of weeks to 3-4 months from exposure to the virus.

You can prevent recurrences maintaining a healthy immune system and considering a suppressive therapy with medications.

 I hope this helps you. 

Dr. Gian

From:
Sent:
To: drgian@stdweb.com
Subject: what are the odds
 

Dr Gian,

I was married for 24 years, had a very active sex life and then got divorced. I was faithful to my husband as he was to me. I have been sexually active with only one man for the past year and a half and regretfully had unprotected sex. I had a serious outbreak of Herpes for the first time in my life. My x husband tested negative but I tested positive for 1 and 2. I believe I contracted the HSV from my new partner. I have not spoken to him yet because I wanted to make sure my x did not pass it to me. If I was harboring the virus for 25 years my x would have gotten it..correct? I need some insight. My IgG was done twice but was much lower the second time. My Dr believed it peaked two weeks prior.

Thanks

Hi,

I would need a little more info about your case to give you a better answer. It seems to me that what you seem to hint in your concern is probably valid and you are probably right. However, I want to caution people that trying to point a finger and put logic at use in tracing a herpes infection may be at times an exercise in futility. This because the range of immune response in different people, the time when testing is done,  the difficulty to establish a time zero in the dynamic of infection, the use of only one test to make conclusions and, at times, the test itself. As far as the index ratio of the IgG it is advisable not to attach any clinical significance.

Stay well

Dr. Gian

Dr. Gian,
   I'm writing because I'm really confused on what's going on with me. I recently got tested for all STDs and HIV about 3 weeks ago because after some rough sex I had developed some cut like tears on the top of my vagina near the hood of the clitoris, and a tear near the lower wall of one of my vaginal lips near the opening. I immediately stopped having sex and told the guy I've been seeing why and went and got tested, but everything came back negative from the cultures, blood work, and urine sample. They figured it was either a yeast infection or just some vaginal tearing from rough sex or wiping too hard after using the bathroom. Everything healed just fine a couple days later once I "left it alone" (because i would literally look in the mirror at the tears 8 times a day because they freaked me out). I started having sex again because i knew it was safe (with the same partner that I have been the last 8 months), and just this morning I noticed a cluster of red spots/sores near the opening of my vagina on the wall of the lip. They hurt when I urinate and they're sore (possibly from looking at them over and over all day, which I fear might be irritating it more), but I'm really confused. On a side note, I typically don't use any lubrication because I usually work enough up on my own and I tend to have sex multiple times in a day with my partner within a small time frame of hours. I did a yeast infection screening kit and it came back at the lowest pH, suggesting that I don't have any vaginal infection. Should I go get retested again even though I literally just got tested? Any suggestion or ideas on what could be going on with me would be much, much appreciated. Thanks for all your help and what you do on this site.

Hi Dr Gian. 

I have had several encounters with prostitutes over the last 18 months. 8 to be exact. I know this was not the best idea and i do regret it after the encounters but drink has made me think its a good idea at the time! I now see sence and do not wont to go down that road again! I just want to put it behind me and to relax my mind that i havent caught an STI off one. I used a condom on every ocassion and i dont see any symptoms. My genitals do ach but i thought that was just through the sex i had recently with one. but i just wanted to know is there a high risk of me getting an STI? I hear that prostitues are very careful and are checked out regualry to be safe.

Hi,

Sex with sexual workers exposes you to a high risk of contracting a sexually transmitted disease and leaves you emotionally empty because of lack of intimacy. You do not seem to have symptoms and I hear a concern and a desire to make changes. So my advice is to get a panel of STD after you allow enough time from last exposure (so that you do not have to repeat some of the test) and before you act next time stop and observe what is that triggers your unwanted behavior, usually an unrecognized emotional state. If you do so you may find out that you do have a choice.

Stay well

Dr. Gian