Dear Doctor,
I have a few questions, so I hope you can help.
Yesterday I noticed an irritated/red
spotBirthmarks - pigmented
Liver spots
Measles, koplik spots - close-up
Mongolian blue spots on the under shaft on my
penisCancer - penis
Curvature of the penis
Penis care (uncircumcised)
Penis pain’s foreskin. I am circumcised, so it is in that area. It’s about the size of a pin, and it’s reddish/pink and it looks like it’s just an irritated small part of the wrinkly skin. We’re talking really small. It looks like it’s getting pinker now. I noticed this after I masturbated. Other parts of the foreskin and
headHead and face reconstruction
Head injury
Head lice
Indications of head injury
Radial head injury of the
penisCancer - penis
Curvature of the penis
Penis care (uncircumcised)
Penis pain were red after masturbation so I figured I was chafing. Although those red
spotsBirthmarks - pigmented
Liver spots
Measles, koplik spots - close-up
Mongolian blue spots are less red now.
Back to the
spotBirthmarks - pigmented
Liver spots
Measles, koplik spots - close-up
Mongolian blue spots on the foreskin: this reddish/pinkish spot does not itch, and I am not in pain from it, basically there’s no soreness or sore at all. When I rub my hand over it, it feels quite normal, and again it’s small. The thing is, I think I got this irritation or whatever you want to call it of these in the same area after I masturbated before, or when I’ve accidentally worn jeans while taking a nap, so I’m guessing I’m chafing, although being the hypochondriac that I am, I always question if it could be herpes, although there really is no reason to believe it is. I’ve had protected sex with a monogamous partner. I get really nervous because on the Internet you find sites that say a lot of people don’t know they have herpes and sometimes there aren’t any symptoms. So I’d like to ask you as a doctor if you feel what I have there is just irritation of the skin, or something else. I put some Cortaid on to stop the redness. And secondly, what are the signs symptoms of herpes because obviously all these different websites say different things. It's a little hard to know what to believe. I’d like somewhat of a definitive answer of the symtoms from a Doctor so I can stop being worried over this.
Thanks.
I don't buy it. You really should tell this guy something since you have posted on HIS posting that he paid for.
Answer him and put his mind at ease.
I have this pimple like bumpe on my left butt chik. Its very hard to sit anywhere and its been there now for about 7 days.
I tryed washing it with alchole and have been using neo sporine cream, but had no luck. When I feel it with my hand I feel a round suronding the size of 2 qurters. Can you please advise what it may be. Thanks
Thanks for trying to bring some sanity to the Herpes Scare.
You're right the CDC does not recommend general testing.
I recently read a comment by Dr. Wald in a popular magazine.
She used words like "possible" "but unlikely".
This language doesn't reflect the infamatory language used
by the people "hawking" this disease.
I wish Dr. Wald would way in and tell us exactly what her
relationship with Terri Warren is and what her thoughts are.
I can't find any definite studies that prove people with "sub clinical" and only "Sero Positive" to anitbodies can transmit
the desease.
My information is that Terri Warren is an R.N. and not
an M.D. If this is true, I don't understand how she can
lawfully give medical advice without a physican signoff. I quess it depends on the state. Also is Terri a paid consultant for any of the drug companies who market the antivirals?
In my view there is a cost/benefit for everything. For example we as a society have made the decision we will not quarantine
Aids infected people. This view is not shared by our neighbor
to the South (Cuba) for example.
The public in the U.S> has also been educated you cannot get aids from saliva or kissing etc.
So in the example of HSV, a relatively harmless virus for the vast majority of people, do we really want to socially issolate Sero positive people or but them on antivirals to reduce the risk of transmission.
And what about the risk to people diagnosed as Sero Positive, go out and have sex with only known infected people
to keep from transmitting it, and suddenly have a primary herpes breakout?? This of course means that either the orginal
diagnosis was in error or the theory of sero positive to anitibodies= HSV is flawed.
Of course I'm just a lay person, but those are my thoughts.
Note: a definitive test would have to include statically significant numbers along with a control group. Rememember the
transmission rate from female to male defined as having unprotected sex with an infected partner (defined as someone who is not only Sero Positive to Antibodies buy has periodic breakouts) only during the period they don't have symptoms for one year is only 4 per cent. The error rate in the herpes select test I think is 4 percent under ideal conditions. So without a control group I don't see how you make any definitive statements.
following link. You can view it there.
http://bmj.bmjjournals.com/cgi/content/full/314/7074/85#R14
As he points out 55 per cent of the people in Dr. Wald's
study did not shed the virus.
Also you get click on the footnotes and get an copy of
the study.
For me, it raises a lot of questions.
One. This was done exclusively with women.
Two. Almost all if not all of these people
were symtomatic (Women they assumed were
sub-clinical turned out to have symptoms).
Even then only 45 per cent of these women had the virus
in vaginal fluids and then then only on rare occassions.
From these study, I can't get to the point that Sero-positive
without clinical symtoms == contagious or even infection vrs.
exposure.
The only thing I can get from it is that on rare occassions 45 per cent of HSV2 symtomatic women have the virus present in vaginal fluids when then are not symtomatic.
Read it and let me know what you think.
Note: an example of what Crazy is talking about is a recent study to determine the effectiveness of a certain antiviral in
perventing transmission of HSV2. A "TV DOC" got on national TV, pointed out that of all the births in the U.S. 2000 babies get genital herpes from the birthing process and 80 per cent of the mothers don't even know they have the virus.
But never fear, "ACME" drug to the rescue. This drug is effective in preventing transmission in 40 per cent of the cases.
You can imagine the phones of managed care providers were ringing off the wall from scared mothers demanding HSV2 blood
tests and this drug. With 20 per cent of white women and 45
oer cent of black women seropositive to HSV2 "ACME" sold a lot of drugs.
If you look back in the comments you will see a scared mother with a 2 year old with HSV1. Do you really want to socially
isolate a two year old in the family unit on what is at
best speculation.
Of this would be okay, as long as we're sure that people who are Sero Positive and subclinical to HSV2 either are at risk of transmission or actually have the desease.
Just having the anti-bodies may or may not = infection. For example if I take Hepatitus (hepatitis) A + B vaccine I will be positive
for Hepatitus (hepatitis) anti-bodies, but don't have or will ever have the
desease. All these depends on the disease, and to make that
determination for HSV2 a large study limited to persons who are proven to be subclinical via periodic medical examinations performed over a adequate period of time is needed. In additon, a control group woud be required. Of course, it would probably be hard to get it funded because it won't sell any drugs.
Another example of the "hyping of drugs" is the current interest
in male menopause now that testosterone is available in non-injectable versions.
If you know of a study that proves that subclinical people who are Sero Positive to HSV2= Infection or that they are in fact
contagious "post a link" I am most interested.
I've been all over the web and can't find one frankly to my surprise.
Personally I am a "lay person", HSV2 negative, 60 years old, and as a matter of practice will not get sexually involved with anyone without a blood test for STD's including HSV2. But I've seen first the trama this causes people when they find they are seropositive and told they have the disease.
I had always been told and assumed what you are saying is true.
But after the last women almost committed suicide, and several
front line Doc's said Seropositive did not mean infection, I started looking into it for myself
Therefore, I was very interested in the debate between Ms. Warren and Doctor Rockoff who until redirected by Ms. Warren didn't advise that subclinical sero-positive was meaningful.
Then searching some other sites, I found Ms. Warren was apparently not a physician. In fairness, looking at her
post again, I think she used R.N. after her name.
But I felt "had". I think Ms Warren's work may be beneficial, but do we really want nurses "counter-manding" doctors. The public has been taught only licensed persons in the professional
fields of medicine, law etc can give advice. I realize Nurse
practioners are a special case, but the last time I checked state law requires them to work under the direction of a licensed physician. But in any case, any person who perports themselves as an expert and based on that expertise countermands a licensed physician in public view should clearly
identify themselves as what they are.
Frankly, I am still curious as the whether Ms. Warren has done
any consulting work or affiliated with any drug companys. There's nothing wrong with. A lot of Doctors are paid consultants. But it's still a fair question.
Sorry you have contracted HSV2.
Thanks for your comment to my post.
I also think we might be looking at two different Anna Wald studies - the one I looked at definitely had men in it and 52 out of 53 asymptomatic folks who enrolled either recognized an outbreak or shed the virus during the study time.
Thanks, Can you provide a link to the Dr. Wald study
you reference that has men. I looked at a lot of them
but so far haven't found any that definitely shows
confirmed sub-clinical sero positive persons have or
shred the virus.
But am open minded and looking. Did you read the article from
my link?
Crazy, I think you are right.
Still, I don't understand what Ms. Warren as a nurse adds to a team of PHD's who are medical doctors, and experts in viral
research. Why would they elevate her to their status? Don't they have on staff nurses?
Is she involved somehow in the funding of this research?
I just think these are fair questions so we know where everyone
is coming from?
No blood tests are 100% accurate. Laboratory data has to be taken in context with the history and clinical findings. Sensitivity of 96% is considered very good.
About the number of people who shed -
The percentage of people found to shed without symptoms is proportional to the length of the study. The longer you look, the more you'll find.
Question for t1234 - Who's saying that seropositive for HSV doesn't mean that you're infected? I realize that may be the case for hepatitis and other viruses, but herpesviruses establish permanent latency in sensory ganglia. It only takes a few hours for the virus to find its way there upon inoculation.
Here's an early case study that documents an asymptomatic transmission. The source partner was enrolled in a study of acyclovir therapy and was examined by a clinician the day before and the day after the transmission occurred.
Acquisition of genital herpes from an asymptomatic sexual partner.
Rooney JF, Felser JM, Ostrove JM, Straus SE.
N Engl J Med. 1986 Jun 12;314(24):1561-4.
And here's a study of source partners that documents transmission from those with no history of symptoms (23 out of the 66 source partners.)
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2988143&dopt=Abstract
Sex Transm Dis. 1985 Jan-Mar;12(1):33-9.
Frequency of acquisition of first-episode genital infection with herpes simplex virus from symptomatic and asymptomatic source contacts.
Mertz GJ, Schmidt O, Jourden JL, Guinan ME, Remington ML, Fahnlander A, Winter C, Holmes KK, Corey L.
Here are some studies on shedding in men. These were published later than the Patel article, I think.
Herpes Simplex Virus Type 2 Shedding in Human Immunodeficiency
Virus-Negative Men Who Have Sex with Men: Frequency, Patterns,
and Risk Factors
Krone, Wald, et. al.
Clin. Infect. Dis. 2000;30 (February)
Genital Shedding of Herpes Simplex Virus among Men
Anna Wald, Judith Zeh, Stacy Selke, Terri Warren, Rhoda Ashley, and Lawrence Corey
JID 2002;186 (Suppl 1)
Frequency of Symptomatic and Asymptomatic Herpes Simplex Virus Type 2 Reactivations among Human Immunodeficiency Virus Infected Men
Timothy Schacker, Judith Zeh, Hui-lin Hu, Edgar Hill, and Lawrence Corey
The Journal of Infectious Diseases 1998;178:1616-1622
You can find the abstracts for these (and maybe full-text) at PubMed. Just put a few keywords in, like the author's name and the word herpes and they should come up.
windy
Thanks, I'll look at them. In fact I think I've already
seen some of them, but will look again.
I think I mis-stated my question.
The studies I've seen were done with persons who are
sero-positive and with or had had clinical symptoms. As you know most people who are sero-positive have no clinical symptoms.
I would define non-clinical as no past outbreaks of ulcerated
sores confirmed by periodic psychical exmaninations by a physican during the study for a period of more than 1 year.
It may follow that sero-positive people have the virus (maybe) or were exposed to it. But it doesn't automaticly mean that they represent any health risk to their partners. In fact the study Dr. Patel referrs to tends to show they do not if you want to view it from a different bias (55 per cent never shed inspite of the fact nearly all of this group had clinical symptoms). You can make another assumptions if you were biased in the opposite direction. Since only people with clinical symptoms rarely shed then people that were sub-clinical would never shed. See what I mean.
Assuming that if the test had been continued for another six months more people would have shed is not a valid assumption or is based on facts not in evidence.
This is the problem assuming results from this tests that they just don't factually show. We don't know if more people would have shed by continuing the test unless we in fact continue the test.
Also my understanding is that HSV1 and HSV2 are not the only virus in the herpes family that are sexually transmitted or widely distributed in the population. They are just considered not a health risk except in very rare cases. At one time HSV1 was not considered a health risk either. At least until oral antivirals became widely available.
Also, just because a virus is present don't mean the viral load is a the level that's transferrable. Otherwise we'd all have Aids.
Will the above in mind I will look at the studies.
Thanks again.
96 PER CENT IN PRACTICE. BLOOD IS SENT FROM THE CLINIC TO THE LAB AND MAY BE TEMPERATURE SENSITIVE. ALSO THE TESTING EQUIPMENT HAS TO BE CALIBRATED.
Some labs use their own versions which are non FDA approved.
ANYONE WHO TESTS POSITIVE WITHOUT A HISTORY OF SYMPTOMS SHOULD HAVE IT CONFIRMED BY ANOTHER TEST AT ANOTHER LAB.
YOU WOULDN'T BELIEVE THE "HORROR STORIES" OF FALSE POSITIVES.
You make some good points. By your argument, we can't say that some percentage never shed, we can only say that they didn't shed during the study. If you look at several studies, you'll see the trend. Shorter studies find fewer shedders than longer studies. I don't recall how long the longest shedding study is. It might be about three months. BTW, the reference below cites another study that found 100% to shed when they looked for longer than 100 days. I haven't read that one, so I don't know the details.
I think I understood what you were asking for, and Mertz' study was the closest thing I could find. Proving that someone never has symptoms rather than misses their symptoms would be a difficult thing to do. Likewise, sampling for viral shedding on a daily basis for a year or two is impractical.
Most people who are seropositive DO have symptoms, but they don't have classic outbreaks that are unmistakeably herpes. And those minimal symptoms correlate with documented episodes of shedding. Once they know what to look for, they can identify their outbreaks, but even then, they still have some episodes of shedding that neither they nor the clinician can identify.
We do know from animal studies that frequency and severity of symptoms is related to the total amount of viral dna latent in the ganglia, so in theory, it might be possible to become infected with a small enough dose of virus to seroconvert but not enough to cause recurrences. That's a really hard one to prove.
Here's a good review of shedding studies. Very readable. And it contains a reference to another study on shedding in women who are unaware of their herpes status, but it probably doesn't adequately answer your question. It has some good discussion about definitions of asymptomatic/subclinical shedding and some of the practical problems related to applying these definitions.
Herpes simplex virus: the importance of asymptomatic shedding
Koelle and Wald
J Antimicrobial Chemo (200) 45, Topic T3, 1-8
I don't know how long we're gonna be allowed to keep this up on this board. If you want, you can email me at windyh99 at yahoo .
I appreciate your help.
I'm interested to hear if you got any answers to your problem. I have an identical problem which is has been very stressful.
The area on my penis just below the head (just below the 'hole') has a reddened area. When my penis is flaccid, it's less noticeable, However, during an erection it is more prominent and after masturbation it becomes very red. I take extra care to make sure I do not touch this area during masturbation to see if it still becomes red and it does. I had a handjob and anal massage from a massage parlor several weeks back and am wondering if this could be herpes as well? ANY HELP is welcome!
I had a full STD and Herpes test at 1 week but that only presents past incidents. I made an appt. to have another test at 5 weeks but this is practically driving me crazy. Among other things, unrelated or so, my nail beds have developed redness towards the tops.