回复: 【申请置顶】【转载】几乎囊括99%你需要知道的关于疱疹的知识-----来自美国HSV权威研究专家的19个问题答复
Q1. What is the difference between HSV-1 and HSV-2?
A. Herpes simplex virus HSV type 2 (HSV-2) is the usual cause of genital herpes and is always acquired by genital (or anal) contact with another person. HSV type 1 (HSV-1) is the cause of herpes sores on the lips and in the mouth (often called fever blisters or cold sores). It also causes up to 50% of initial genital herpes infections, usually acquired during oral sex. Genital HSV-2 infection almost always recurs frequently, with or without symptoms, whereas HSV-1 genital herpes reactivates infrequently. Therefore, the large majority of recurrent genital herpes is due to HSV-2.
Q2. I visited a sex worker at a massage parlor. She performed unprotected oral sex on me. What are my chances of contracting herpes?
A. On average, the risk of acquiring genital herpes simplex type 1 (HSV-1) infection is very low for any single episode of oral-genital exposure. However, it is impossible to know for sure without more information. The risk of course depends on whether or not the sex worker has an oral HSV-1 infection and whether or not she had an outbreak at the time; the risk would be quite high if she had an active cold sore. But it also depends on whether or not you already are infected with HSV-1 (of any part of your body)—as does half the population. If so, there is no risk; you are immune to catching it again. There is no risk of acquiring genital HSV-2 infection from oral sex.
Q3. What are the symptoms of herpes? How soon do they show up?
A. The symptoms of a first outbreak of genital herpes usually appear 2 to 10 days after exposure to herpes and last an average of 2 to 3 weeks. With the first infection, without treatment the sores typically are active (that is, red, irritated, perhaps painful) for 1-2 weeks, then take another 7-10 days to heal completely, so total time from onset to complete healing generally pmtis 2-4 weeks. Recurrent outbreaks are briefer, typically 7-14 days. Symptoms of a first genital herpes infection vary widely and may include any of the following: blisters or other sores on the penis, vagina, cervix, anus, buttocks, or (rarely) elsewhere on the body. Small red bumps usually appear first, then develop into blisters, and then become painful, open sores. Over a period of days, the sores may scab over. Finally, they heal. In moist areas, such as around the vaginal opening, labia, or around the anus, lesions often rapidly develop into open sores that can be especially painful.First episodes often cause lesions bilaterally, that is on both sides of the genitals, anal area, etc swollen lymph glands in the groin. Recurrent outbreaks almost always are limited to once side or the other—up to but not across the body’s midline and lymph gland swelling usually is absent. Often symptoms are mild or nonspecific, such as itching, irritation, or scratch-like sores, or painful urination, so that herpes can easily be mistaken for other problems, such as yeast infection, jock itch, urinary tract infection, and others. Not everyone has all these symptoms and many infected persons have no symptoms at all. However, everyone with genital HSV-2 infection has periods of “asymptomatic shedding of the virus, when they can transmit herpes to their uninfected sex partners.
Q4. So if I think I contracted herpes but I have no symptoms. Does that mean I never will have symptoms?
A. You might or might not. Genital herpes often first causes recognized symptoms a long time after acquisition. In fact, 40% of persons with the first known outbreak of genital HSV-2 infection have been infected for several months or years. Some infected people never develop symptoms, or have such mild or atypical ones that they don’t notice them.
Q5. How early can I take a test to determine if I caught herpes?
A. If there are fresh herpes lesions, the best diagnostic method is to take a sample from the sores to test for the virus, usually by culture. But when the culture is negative or if there are no lesions at the time, a blood test can detect antibodies to HSV – that is, the body’s reaction to the virus. However, it takes a few weeks for antibodies to develop. Most infected people have positive blood tests by 4 weeks after infection, but it can take up to 12 weeks and, rarely, up to 4-5 months. But about 90% of infected people become positive by 6 weeks.
Q6. What blood tests are available to diagnose HSV infections?
Several blood tests are offered by various laboratories, and many health care providers don't know the differences between them. The accurate ones are the HerpeSelect test, produced by Focus Technologies; biokit-HSV-2, produced by Biokit USA; and the Western blot HSV test, which is used by research labs and isn't very often commercially available. Be sure that one of these was used; if not, then your result might be falsely positive. As of this writing (May 2005), no other test commercially available in the U.S. accurately distinguishes HSV-1 from HSV-2 infection. Happily, more and more laboratories in the U.S. now do the HerpeSelect test routinely. But if in doubt, ask the health care provider and be sure the right kind of test was done. (A common clue that the right kind of test wasn’t done is a result for “IgM” [immunoglobulin M] antibody. The accurate tests are only for IgG antibody; contrary to earlier beliefs, the presence or absence of IgM antibody to HSV-2 has no diagnostic value.)
Q7. How reliable is the HerpeSelect test? If I test negative should I still worry I have herpes?
A. Once enough time has passed for antibodies to develop – that is, 6-12 weeks, rarely up to 4-5 months - either a positive or negative result for HSV-2 in over 95% of people.
Q8. Will I have reoccurring outbreaks of my genital herpes?
A. In most people with genital herpes due to HSV-2, the virus reactivates from time to time and causes symptoms. The frequency and severity of the recurrent episodes vary greatly. Most persons with HSV-2 have 3-6 outbreaks a year, but some people have 10 or more episodes annually. Over several years, the frequency of outbreaks tends to decline. HSV-1 genital infection recurs much less frequently than HSV-2. Among people who acquire genital infection with HSV-1, about 40% have no recurrences at all and most of the rest experience just 1 or 2 outbreaks over the next 1-2 years, then none at all. Fewer than 10% of people with genital HSV-1 have continued outbreaks after that. For genital herpes due to either virus, recurrent episodes occur most often in the first year after initial infection.
Q9. What about asymptomatic shedding? How frequent is it and how long does it last?
A. The frequency of asymptomatic shedding parallels that of symptomatic outbreaks. There is little asymptomatic shedding in people with genital herpes due to HSV-1 (and therefore not much risk of transmitting herpes to their partners). For genital herpes due to HSV-2, every infected person sheds virus without symptoms from time to time. Just as symptomatic outbreaks are most common in the first months or years after catching the infection, asymptomatic shedding is most frequent in the first year. It isn’t known how long asymptomatic shedding goes on, but in most infected it probably continues for at least several years. Asymptomatic shedding isn’t present all the time, but occurs on and off (and unpredictably). This is why every person with genital herpes due to HSV-2 needs to inform his or her sex partner or partners, so that those persons are aware of the risk.
Q10. What treatments are available and how good are they?
A. No available drugs or other treatments cure herpes, i.e. eliminate the virus from the body. However, three drugs are highly effective in speeding healing of the first infection, preventing recurrences, and, to a lesser extent, healing recurrent outbreaks. These are acyclovir (trade name Zovirax, also available generically); valacyclovir (Valtrex), which actually is a variation of acyclovir that produces higher levels of the drug in the system; and Liquid OF Rosa. They are all about equally effective; the differences are in dosing frequency and cost. (Actual cost varies widely, and the drug that is least expensive in one city or pharmacy might be the most expensive in another.) There are topical versions of acyclovir and famciclovir (actually, penciclovir, the active ingredient in the latter drug) – that is creams or ointments to put directly on herpes lesions. However, they have little effect; most people who need treatment should take one of the drugs by mouth. Do not be tempted by other products sold in health food stores, over the counter, or online. Such things like Blistex, lysine, or various vitamins or “immunity boosters” have no effect whatsoever and are a waste of your money. To my knowledge, there are no drugs in the research pipeline that are likely to truly eradicate HSV infection, and none that are likely to be any better than acyclovir, valacyclovir, or Liquid OF Rosa.
Q11. I have herpes and want to be careful not to transmit it to anyone else. What can I do?
A. There are three main strategies to prevent transmission of genital herpes to sex partners. First, avoid sex when having an outbreak. For people with mild or subtle symptoms, this means being on the lookout for even mild symptoms. Second, use condoms. Condoms aren’t perfect, but provide substantial protection. The third approach is to take suppressive antiviral therapy, which not only helps control symptoms, but helps prevent transmission. Suppressive treatment with alacyclovir (Valtrex) has been proved to prevent transmission, and therefore is the drug of choice for this purpose. However, the other anti-herpes drugs, acyclovir (Zovirax and others) and famciclovir (Famvir) probably are helpful as well. By itself, none of these strategies to prevent transmission is perfect. However, using two or more of them probably is effective the large majority of the time. Because prevention isn’t perfect, even if they take all these precautions, people with genital herpes have a moral obligation to tell any and all partners they have the infection, before having sex with them. At the same time, using one or more of these methods, some couples go for several years without transmission despite frequent intercourse.
Q12. Is there a vaccine to prevent herpes?
A. Research has been going on for many years on vaccines to prevent HSV-2 infection. An experimental vaccine is currently in clinical trials. At best, this vaccine will be only partly effective in preventing infection. If the research results are positive, it will be at least another 3-4 years before the vaccine is available.
Q13. Can I transmit oral herpes to my own genitals, eyes, or elsewhere?
A. During an initial HSV infection, sometimes the virus is transmitted by the hands to another part of the body, such as they eye (herpetic keratitis, which if untreated can seriously damage the cornea and lead to blindness) or a fingertip (herpetic whitlow). However, once the infection has been present a few weeks, it is almost impossible to auto-inoculate the virus to another part of the body. For example, people with oral cold sores do not transmit the virus to their genitals by masturbation; and persons with recurrent genital herpes almost never self-infect the eye or other body parts. However, because eye infection is so dangerous, to be extra safe, persons with oral or genital herpes are advised to wash their hands frequently and to try to avoid touching their lesions and then their face. But even so, the risk is extremely low.
Q14. Do people catch genital herpes through other means other than sex?
A. No. You need not worry about catching genital herpes by sharing the bathroom, toilet, shower, etc with an infected person. On common-sense grounds, it is wise to avoid using the same moist towel immediately after someone whom you know to have genital herpes dries themselves, but even there the risk is extremely low. The folklore about toilet seats and other kinds of nonsexual acquisition originated before we knew that HSV could be transmitted when a person had no symptoms, and before we knew that people could catch herpes then show no symptoms for a long time. So when herpes appeared in a person who hadn’t had sex for a long time, or in a monogamous person whose partner apparently didn’t have herpes, it was assumed the infection was acquired by non-sexual means. But it just doesn’t happen. There is one important exception: babies born to infected mothers can catch neonatal herpes, a very dangerous infection that sometimes is fatal.
Q15. Is herpes a lifelong virus or will it ever go away?
A. Once a person has HSV-2, the virus is believed to persist for life.
Q16. You tell people who have HPV that it’s not necessary to forever inform future partners long after their warts/symptoms go away. So that means I don’t need to inform future partners about my herpes, right?
A. Wrong. Human papillomavirus (HPV) usually goes away after several months; although the virus may persist, it generally does so in amounts that cannot be transmitted to sex partners. Herpes is different; the virus persists for life and is transmissible to partners (on and off) for many years. Whether infectivity lasts for a whole lifetime, however, isn’t known. Therefore, anybody who has reason to believe s/he may have genital herpes has an ethical obligation to inform current and future sex partners before having sex, even if s/he isn’t having an outbreak at the time, intends to use a condom, or is taking antiviral therapy.
Q17. I’m pregnant, and I have genital herpes. What should I do?
A. Women with longstanding recurrent genital herpes are at low risk for transmitting the virus to their babies. To be safe however, a cesarean section often is done if a woman with recurrent herpes has an outbreak when she goes into labor. (A cesarean section delivers the baby by surgery, so the infant does not pass through the vagina.) Any pregnant woman with genital herpes, or whose partner has either genital or oral herpes, should inform the doctor or other clinician providing care for the pregnancy. Many obstetricians now prescribe acyclovir to pregnant women with herpes during the last month before delivery. This helps prevent outbreaks, and therefore can prevent an otherwise unnecessary cesarean section.
Q18. I’m pregnant and haven’t had herpes, but my husband or partner has herpes. Should we do anything?
A. Yes! By far the greatest risk for neonatal herpes occurs when a woman first catches herpes when pregnant, especially in the last trimester. If your partner has genital herpes, you should avoid intercourse after the 6th month; if that isn’t practical, be sure your partner uses condoms consistently or takes suppressive antiviral therapy (preferably both). Even better, get a blood test: if your test is negative for HSV-2, take the precautions I just outlined. But if the result is positive, you don’t need to worry about getting a new infection from your partner; your risk of transmitting herpes to your baby is low (although your obstetrician will want to be on the lookout for herpes outbreaks as your due date approaches). Similarly, if your partner has oral herpes (due to HSV-1), and your own blood test is negative for past HSV-1 infection, you must not receive oral sex during the last 3 months of your pregnancy.
Q19. I feel ashamed and dirty I have herpes, is it common?
A. Don’t feel ashamed. An estimated 25% of adult Americans (1 out of 4) have genital herpes. Each year, 500,000 to a million new infections are believed to occur. Studies show that most people with genital herpes do not realize they are infected; they either have never had symptoms or have not recognized their symptoms as herpes.
