Herpes Questions answered by the Dr
Dr. H. has answered many questions since we started this feature on Herpes.Org back in 1998. Please know that he diligently responds to each question personally, and now we have accumulated much of this information for your benefit.
Please note that nothing written on this page or anywhere else on Herpes.Org should be construed as either medical advice OR establishing a physician-patient relationship. If you have any medical issues, we ask that you visit a health practitioner licensed to practice medicine in your own locality.
These questions are not in any particular order, but rather reflect the broad range of the sorts of questions that we answer.
I was wondering if you can comment on the potential dangers, if any, by combining a topical application consisting of : dimethyl sulfoxide,BHT,H202,aloe vera,glycerin,st. john’s wort extract, lemon balm extract, licorice root extract and olive leaf extract into a topical solution and applying it to the shaft and head of the penis for the treatment of hsv2.
Do you perceive there will be any adverse chemical reactions by the above combination? Based on the individual research available for each of the above ingredients it appears that a combination such as the above listed would provide synergistic treatment and alleviation of symptoms.
I do not think that anything you list there would be toxic. Peroxide we put on wounds. The tiny amount of DMSO absorbed should be harmless. The remainder don’t appear that they would be absorbed in amounts that would be anything substantial. The DMSO-peroxide routine seems to be one that is circulated by the Never an Outbreak folks, or something similar. I have seen no published results. I don’t think that it will hurt you, so you might consider it. As always, consult your local health care practitioner for final advice, though he/she may neverhave heard of it. return to faqs
Medication for Cold Sores
Can you please tell me what some of the best over the counter medicines to help cold sores?
Thanks for the question. Sorry you’re having the problem.
Well, oral cold sores (and I am assuming that you are speaking about oral lesions only) are a nuisance. They are usually caused by herpes simplex virus Type 1. They are very contagious during the blister phase and the draining ulcer phase. Once they are crusted over and dry, they are probably less contagious.
The first thing is soap and water. You want to keep them real clean because they have zillions of viruses in them. By cleaning them, you prevent “autoinoculation”, where the lesion infects the skin around it. I would say that you should break the blisters and clean them with plenty of soap and water.
Second, though painful, alcohol kills viruses very well. I encourage patients to get the alcohol swabs that you see used in hospitals, which you can buy from pharmacies. Clean the wounds frequently for the same reason.
Some people believe that Blistex helps. I believe that it only numbs up the wound slightly and offers no real value.
Acyclovir, taken in regular doses of probably 400 mg will probably help suppress the outbreak to some degree. Consult your local health care practitioner regarding this.
Some people believe that red marine algae, astragalus, copper, and echinacea may be of some value. Some have said that taking 1000 mg of lysine per day may help. return to faqs
Canker Sores Transmission
I get those white/pink crater-like ulcers in my mouth about once every 6 weeks.
Could I have transmitted this to my 2yr old nephew, whom I made non-kissing physical contact, (holding, hugging, playful head-butting)? I remember visiting him about the time my current episode was in its initial stage–(that day, or the previous day, I bit my cheek).
Apparently, he has multiple sores in his mouth and throat.
Dr. H. writes:
Good question. Probably you did not transmit anything to your little relative. What he has probably picked up is herpetic gingivostomatitis, which about 90% of children have by the time they are ten years old. It causes a pretty sick kid for a couple of days, and is essentially harmless. Again, virtually all children pick it up.
This means, of course, that 90% of humans have had a herpes infection of their mouths by the time they reach adulthood. We probably pick it up from being kissed by others, which is course what all of us do with our children.
So, don’t worry. Be sure that the little kiddie is being cared for, and relax. return to faqs
Frequent recurrent outbreaks
I contracted genital herpes about 4 years ago.
Until recently my outbreaks were becoming less frequent and shorter in duration the longer I had the virus. During the last 2 months, however, I have had what seems to be one big, long outbreak with perhaps a one-week break in between at most. In addition to genitally, I even get it on my upper outer thigh and my lower back (all on the right side of my body).
I am in otherwise basically good health. I have been tested for HIV and am negative. I do have irritable bowel syndrome which my doctor says is generally caused and exacerbated by stress. Also, I take 15 mg. Prozac daily for a “chemical imbalance” (not depression).
Is it possible my “high strung” nature keeps my outbreak from going away? Are the any foods I should eat or avoid to help? What about exercise?
Well, let’s see. Yes to the question about stress being an apparent trigger of herpes. Nobody really knows why, though I believe that adrenalin (epinephrine) may in some way have a direct cellular triggering effect, based upon some reading that I have done.
It is important, I think, to get attacks under control. I would suggest that, with the consultation of your local health care practitioner, get on suppressive therapy for awhile, using 400 mg of acyclovir once or twice a day (I assume that you are an adult). This should rapidly knock out your symptoms and let your body recover.
I have been told that herpes is an immunosuppressive virus. That is, it directly suppresses the immune system. You might say, the more you have an infection, the more likely you become to have another outbreak, until the outbreaks gradually come one after the other.
Talk to your doctor. I suggest that you go on suppression for a few months, while working on the life style stuff, including enough rest, working on stress-causing events, and so on. Lysine, red marine algae, astragalus, and echinacea all have scientific articles that may indicate some slight benefit. return to faqs
A potential partner has herpes
Someone I am considering a relationship with has discovered he has herpes. He said he is asymptomatic, and mentioned shedding. My question: is herpes avoidable when having sex (like aids safe sex) or should I just forget this guy and avoid any contact. I have HSV-1 oral, which flares up only infrequently throughout the year (1 – 3 times/year at most).
You know, I would ask you, how do you feel about this person? Is this love or just an attraction? Being pretty old fashioned, I would say, avoid sex until, if not marriage for you, at least until a firm sense of a monogamous relationship has been established. It is the right thing to do. Old fashioned, yes, but a much safer way to sort through feelings and STD issues. Everything else is dangerous and simplistic, in my opinion. This is what I think.
Let me respond specifically to your question. Generally, herpes is avoidable. You must avoid anyone having acute symptoms, including burning, blisters, irritation, or any other sign of inflammation including referred pain, pain going into the legs or groin, or similar symptoms.
If your friend has a diagnosis of herpes, he joins 1 of 5 people in America, meaning that it is very, very common. People with herpes commonly shed virus, as much as 40% of the time when not on medication. Regularly taken acyclovir really decreases virus shedding, if the person is taking it, maybe as much as 95% decrease of shedding.
Is HSV infection avoidable if careful? Definitely. Your consort should be on medication, acyclovir unless allergic to it, once or twice a day and, if you are female and he is male, he should wear a condom, preferably with a virucidal cream in the condom. He should be free of symptoms of any sort, which usually only he would know. Meeting these criteria, the chance is probably between one in several hundred to one in several thousand that you will contract the virus.
You might transmit oral HSV to him, either genitally or orally. How does that make you and him feel? You should be free of symptoms, and he should be aware of your condition also, just as you are of his.
Personally, since herpes is almost only dangerous only to newborn babies, I would say that you should weigh the above information, decide how you feel about this guy, and think about it from a “love” standpoint. Yes, there is risk to you. You have to weigh the potential consequences.
Editor’s note: please make sure that you go to visit your primary health care practitioner before taking prescription medication, and remember that giving your partner your medication, if it has not been prescribed for them, is illegal. They need their own supply. Thanks.
Herpes and gastroparesis
I had my blood tested for HSV I and HSV 2. The IgM antibody was positive for both HSV 1 and HSV 2, and the IgG antibody was positive for HSV 1. Because of the positive IgM antibodies for both types, is it probable that I contracted the two types at the same time? I am 40 years old. Since childhood my stomach has always been weak, but after I acquired the herpes infections, I began experiencing several harrowing episodes of gastroparesis (verified by a abnormal gastric emptying test). The fist few episodes were the most severe and they would last for weeks. I also had a severe headache during the first episode, and I can’t even remember having had a headache previously in my life. Do you think it is possible that one or both of the viruses disrupted the nerves that control the stomach’s peristalsis? It has been 7 months since I was infected, and the episodes of gastroparesis are less frequent now, but I was very frightened by the them, thinking that the gastroparesis would never go away, and I lost weight like crazy. If herpes can cause gastroparesis, would taking acyclovir, or some other antiviral lessen the course and severity of the stomach paralysis? Thank you for any thoughts or advice you might be able to provide me.
I doubt that you contracted both at the same time. You probably contracted type 1 as a child, since some 90% of children pick up type 1 as a child by the age of ten.
I do emergency medicine mostly, and, yes, I’ve seen horrible episodes of gastroparesis, including one guy I thought was having a heart attack. He knew better. He said that if we would just let him throw up, his pain would go away. Sure ’nuff, when he barfed, the pain was gone and he was well.
No, I don’t think you would find any evidence that there is viral involvement of the “nerves” causing stomach problems. Now, it IS remotely possible that you have had a herpes ulcer develop way down in the esophagus or even, theoretically, in the stomach. You might consult your gastroenterologist about that. You might have gastric emptying problems if you were developing a recurrence in the stomach.
Now, having said that, I have never personally seen a patient with such a problem, though New England Journal this spring published such a patient with an esophageal herpes lesion (who was, I might add, pretty sick on presentation).
I would suggest that you be “scoped” during one of the episodes to make sure that there is not some sort of ulcerative cause to the episodes. Only if you could prove that it was a herpes lesion would I consider taking acyclovir. Otherwise I don’t think that it would be of any benefit. return to faqs
Partner with herpes
My girlfriend has herpes, but hasn’t had an outbreak in 20 years, I have had sex with her numerous times. She claims she hasn’t had any problems with boyfriends in the meantime…am i at risk?
Absolutely you’re at risk, if it was in fact herpes that she was diagnosed with 20 years ago. That’s a long time ago in medicine, in the late 70’s. I don’t recall that viral cultures were readily obtainable then, so the diagnosis MAY be somewhat suspect. A blood test for Herpes simplex Type 2 IgM would be helpful on her, and on you too for that matter since one in 5 people are carriers.
Wear non-spermacidal condoms, latex preferred. Don’t have sexual relations if she’s having symptoms. Encourage her to take acyclovir 400 mg twice daily if you’re going to be having sexual relations. And, relax. That should give you a very high protection factor.
Please make sure that you go to visit your primary health care practitioner before taking prescription medication, and remember that giving your partner your medication, if it has not been prescribed for them, is illegal. They need their own supply. Thanks.) return to faqs
Had sex with infected partner
About 5-6 weeks ago, I had unprotected sex with a woman who was infected with genital herpes.
Unfortunately for me, and inconsiderately by her, she didn’t tell me until afterwards. My question is this: Will I EVER know whether or not I’m infected if I don’t show signs of an outbreak? To this point, I have had no signs of an outbreak, but the whole situation is making me terribly paranoid, and worried. At the time we had sex, she didn’t have an outbreak either (which was her justification for not informing me).
My doctor (whom I don’t particularly trust) told me that if I didn’t see any visible signs within 2-3 weeks, that I didn’t need to worry about it. For some reason, that seems like too simple of an explanation.
Hmmm, well, you know, it is a dilemma, folks that are less than honest and who put you at risk, assuming the facts your relayed are true.
Your doctor was about right. Odds are probably above 75% that if you WERE going to have a first episode herpes thing, it would have happened within two or three weeks.
Okay, that said, this is what you do. Go get type specific blood testing for Herpes Simplex types 1 and 2 done now. If these are negative, then repeat them in about ten weeks, and see if any changes occur. A change from negative to positive in either of the blood tests would be an indication that a new infection has occurred. On the other hand, if the first one is positive, you were either already infected with that virus, or have just turned positive. Depending upon how long from the exposure to the test, it may be impossible to know.
What to do? Forgive your friend. Forgiveness is always important, and, as Mark Twain said, “Anger rusts the soul.” You have a right to share your feelings with this person, of course, and it is proper to do so. Assuming you have no future problems and that your blood test did not turn positive, tell your consort in the future that you have previously had sex with a person who told you later she had had genital herpes at some time in her life. And, I recommend using latex condoms. If you ever DO show up with a positive blood test, then refer to my treatments paper on the website.
Finally, we know now that perhaps most people who contract herpes infections do so without being aware of having contracted the virus. Many of these people shed virus asymptomatically from time to time. This is a reason why testing is important.
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