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The burden of a microorganism in the body is not necessarily related to the likelihood of transmission of that organism (with the exception of helminths). 90% of you answered this question correctly, so clearly you got it. But there were a few of you who aptly wondered… What about viruses like HIV? HIV viral load is related to infectiousness. Wouldn’t the load of other viruses be related to infectiousness as well?

Intuitively, it makes sense - someone who is infected with more microorganisms would be more likely to transmit that infection to others. But practically it is usually not true. Let’s look at viruses.

* First of all, the amount of virus infecting an individual does not necessarily correspond to amount of viral shedding.

* Secondly, while we can often detect the level of virus shedding, we do not necessarily know if there is a difference between virus that is shed, and virus that is shed that is transmissible.

* Finally, if there is a difference in shed virus that is transmissible, we don’t necessarily know how to differentiate it from non-transmissible virus.

This week’s disease of the week, Herpes simplex virus, is an illustration of this line of thinking. HSV-2 is one of the most common causes of genital ulcer disease worldwide, and most infections are asymptomatic. It is known that detectable viral shedding is related to transmission, but it is not clear whether viral shedding is related to viral load. To top it off, there is a lack of evidence that virus detected when measuring viral shedding is the same virus that is transmissible.

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If Ted Kennedy’s cancerous lesion is a glioblastoma multiforme, the most common kind of brain tumor, it may have been caused by a virus from the herpes family.

Last year, Duane Mitchell and his colleagues at Duke University learned that cytomegalovirus is present at elevated levels in more than 90 percent of glioblstoma multiforme tumors. Armed with that knowledge, they are testing a vaccine that fights the common virus as a brain-cancer remedy.

Their patients also receive standard cancer treatments a staple in the treatment of some gliomas, that may also enhance the effects of the vaccine.

Mitchell is testing daclizumab, an antibody that can suppress the immune system, in combination with the vaccine. When the natural defenses bounce back after being knocked down by the drug, they may more vigorously attack the cancer-causing virus.

Brain tumors are not the only type of cancer that can be caused by a virus. Most cases of cervical cancer can be prevented by taking the vaccine Gardasil, which wards off human papillomavirus.

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New research suggests that having a family history of shingles increases your risk of developing the disease.

According to the case-controlled study published in the Archives of Dermatology (144: 603-608), patients with herpes zoster were almost four times more likely to have a blood relative who had also experienced the disease than those patients with no such family history.

While it is known that herpes zoster is more likely with increasing age and in patients with cell-mediated immunosuppressive disorders such as AIDS and cancer, it has only recently been suggested that there could be a genetic predisposition to the disease.

US researchers interviewed over 500 patients with herpes zoster and a similar number of controls. A significantly higher proportion of cases reported having a family history of herpes zoster (39.3% vs 10.5%).

The findings add to the increasing amount of evidence that infectious and dermatological diseases have genetic associations, the researchers said, and are particularly important in light of the new preventative herpes zoster vaccine now available.

“Such patients [with a family history of herpes zoster] represent a population that may be at increased risk of developing herpes zoster and therefore have a greater need for vaccination,” the study authors concluded.

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* Genital herpes has a phase called prodrome. During this phase, you get sensations such as tingling, itching or some pain, etc. You then know that the herpes will break out in a few days - a day or two or more.

* Genital herpes can easily spread during this prodrome period or during active outbreak. It may also spread when no outward signs are present, because the virus remains active on the skin.

* Genital herpes commonly gets transferred through skin cuts or mucous membranes. Oral cavity, vagina, anus and glans penis are all covered with mucous membrane.

* Genital herpes does not cause serious health problems, but a person suffering from it is more susceptible to get HIV.

* Asymptomatic reactivation or asymptomatic shedding is the phase during which herpes can spread without any outward sign.

* Anti-viral therapy can reduce the probability of spread. Your doctor will tell you about it.

* Herpes is diagnosed with viral culture during active outbreaks. During dormancy (no visible signs), a blood test can be done. But these tests are not very accurate.

* If a person has cold sores and performs oral sex, his/her partner may get genital herpes with virus type 1.

* The herpes virus cannot live long on dead surfaces such as toilet seats, towels, etc. It is rare to contact herpes from these objects.

* Herpes is caused by viruses HSV1 and HSV2. HSV1 commonly causes oral herpes or cold sores and HSV2 normally causes genital herpes. However both these viruses can be found in oral cavity or near/on genitals.

* HSV2, which commonly causes genital herpes, may be present in the mouth but it rarely affects the mouth.

* Use of ointments or creams on genital herpes may slow down treatment. Speak to your doctor about this before using any thing.

* It is difficult for a mother to pass on herpes to her newborn unless she has contacted herpes during the last three months of pregnancy or if she has active herpes during delivery. In that case, doctors recommend cesarean section.

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Genital herpes is treated with oral anti-viral medications. Your doctor may adopt episodic or suppressive therapy. In episodic therapy, your doctor will give you medicine whenever you have an episode of genital herpes. It is best to begin the medication when you find signs of the prodrome. In suppressive therapy, anti-viral medication is continued to suppress any outbreak of herpes. Anti-virals don’t cure herpes but reduce the time period and the severity of the outbreak. Regular medication may also reduce the shedding of virus when no outward signs are present.

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Genital herpes is caused by herpes virus- HSV. HSV are of two types- HSV1 and HSV2. HSV1 causes more of oral herpes and HSV 2 causes more of genital herpes. But HSV1 can also affect the genital area and cause herpes. Genital herpes is contacted by sexual contact. Anybody who has genital herpes can pass on the virus to his/her partner through a cut in the skin or mucous membrane. If somebody has cold sores and performs oral sex, he/she can also transmit the virus and cause genital herpes in partner.

Once the virus enters the body, it multiplies rapidly. The herpes virus remains in the body and may either be active or inactive. During the active period, the virus travels to the genital area and causes sores. During inactive period, it remains dormant in the body. When genital herpes is contacted, virus shows up in the first episode of herpes and after that goes in to sleeping mode to recur again.

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Genital herpes shows different symptoms in different people. Some may have severe problems while others may get the symptoms so mildly that they may miss it for something else.

Genital herpes begins its first episode within a fortnight of contact. Some people get severe symptoms of herpes in this episode while others may get very mild symptoms of herpes during the first episode. The main symptom is appearance of lesions. These may be pimples or blisters which will crust and heal within a month. Painful urination and headache may occur during the first episode. Some people also show flu-like symptoms during the first episode. Some other people may get very mild symptoms and take them as insect bites, rashes, ringworm, etc. As these symptoms resolve soon, people are left unaware of the fact that they have herpes. Then, blisters appear on the genitals and near genitals. The common areas are: on the vulva, penis, near anus, thighs, and inside vagina.

In the next episodes, the symptoms of genital herpes may appear like: ingrown hair, insect bites, pimples, spots, etc. If blisters form, they crust over in few days and resolve. Most of the following episodes resolve much quickly than the first episode. Symptoms mimicking hemorrhoids may also appear on the anus. If you get repeated fissures or any other symptoms near or on the genitals, you should get screened for genital herpes. On average, a person having genital herpes from HSV2 may have three to four episodes of recurrence every year. Many times, despite the virus being active near the genitals, one may show no symptoms. That is called asymptomatic shedding . Many people feel some pain, tingling or itching before active onset of genital herpes. Within a day or two, lesions appear on the affected area.

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Just to be clear, HPV and herpes are not the same. Herpes Simplex Virus has two different types - I and II. Type I is typically oral and II is typically genital, but there’s a great deal of crossover.

HPV (Human Papilloma Virus) has scores of types. While the herpes virus (it seems) is a ‘forever’ type of thing, HPV sometimes disappears. Also, it is HSV (herpes) that creates cold sores, and HPV that can create warts or cancer, but these two viruses are distinct and do NOT cause the same complications.

Trusting partners can be very difficult when negotiating safer sex, particularly as everyone has different definitions of “safe.” Additionally, not everyone gets tested for the same infections (for example, it is not in a standard screening to test for herpes) so saying “I’ve been tested and I’m fine” can mean one thing for one person and another for another.

Really, this just emphasizes the importance of having really clear communication, particularly about something as emotional and body-related as sexual health. What have you been tested for? How long ago was that? When was the last time you had protected sex prior to that? Have you had sex after that? What does “protected” mean to you - does that include oral sex? What are the sexual practices of your current partners, and what are your safer sex practices with them? It can be a pretty in-depth and intense conversation, but it can be much better to go through that and get everyone on the same page than to risk disastrous miscommunication.

One last note on transmissibility: One can, in fact, have used latex barriers for every genital-genital and genital-oral contact and still become infected with either HPV or HSV. HPV is tricky because it can manifest outside of areas covered by condoms, as can HSV. Additionally, HSV most commonly infects the mouth, and how many people think to ask if someone has ever had a cold sore before kissing them? One must also note that someone can be infected with HSV or HPV and never ever have experienced symptoms (as is true with many sexually transmitted infections), so a partner might be entirely unaware of infection status, PARTICULARLY as these viruses are not typically tested for in a standard STI screening (which usually includes chlamydia, gonorrhea, HIV, and usually syphilis, though different communities have different trends and standards).

Bottom line: Talk with your partners, get all yerselves tested, and make sure everyone is on the same page regarding safer sex practices. If you feel you can’t trust a partner (or a partner’s partner) to keep to safer sex agreements, it might be a good indicator that you should reevaluate your relationships.

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The outbreak of active herpes can be controlled by anti-viral medications. It is easier to manage the outbreaks if you identify factors that trigger active herpes. What triggers the virus to cause active herpes again? It is believed that everyone has his/her own triggers. Over time, most of the herpes patients find out what triggers their herpes. The common triggers that you will be looking for are: stress (both physical and emotional), illness, steroids, sun exposure, poor diet, friction in the genital area because of obesity, tight clothing, etc.

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How long will it take to show symptoms of an STD after having oral sex?

Giving head can put you at risk for chlamydia, gonorrhea, herpes, syphilis and possibly HPV. Going down on a woman can put you at risk for herpes and possible HPV. While that sounds like a lot, STDs in the back of the throat often have no symptoms and some clear on their own. An easy throat swab for gonorrhea or chlamydia or blood test for syphilis or herpes can tell if you have an infection.

Because most STDs have no symptoms, the only way to know for sure is to get tested.

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