The Diagnosis

As I sat in the college health center waiting to see a doctor, I watched my very short-lived social life drift by. I was thinking that I’d probably never go on another date, or get a boyfriend for that matter, and I’d certainly never have sex again.
The nurse who examined me revealed that she had herpes and said it was no big deal. She had been free of outbreaks for 12 years, and the same might be the case for me, she said.
Genital herpes is a contagious viral infection that remains permanently in the nerve cells. Many people are unaware they have it, because they don’t experience symptoms or because they attribute the symptoms to something else. During an outbreak, blisters or sores appear on or around the genital area. Some people never experience a second outbreak.
The nurse taught me how to manage the virus, but managing my personal life was another story.

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Broaching the Topic of Genital Herpes

The first date after a genital herpes diagnosis may seem a little strange, however. If you hope to be sexually intimate with your date at some point, you may feel like you’re keeping a secret. If you are one to be candid with people, you’ll want to blurt it out. Don’t. There are some things you should reveal about yourself right away — for example, that you’re married, or that you’re just in town for the week — but some things are better left for the appropriate moment.
It’s up to you to decide the right time to tell a date that you have genital herpes. Follow two rules: First, don’t wait until after having sex. Second, don’t wait until you’re just about to have sex — in which case the attraction may be too strong for either of you to think rationally and act responsibly.
If in the past you tended to start a new relationship with sex, you now might want to change your approach. It might be better to break the news about herpes to someone who has already grown attached to you. Kissing, cuddling, and fondling are safe, so you don’t have to tell before you do that. But use your best judgment as to how physically intimate you want to get before telling. One thing could lead to another, and you might find yourself in an awkward situation.

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Shingles can lead to several complications:

# Elderly people have the greatest risk for complications.
# Twenty percent of patients experience pain following shingles.
# Ten percent of patients with shingles experience pain lasting more than three months.
# The rash may become infected. Antibiotics are used to treat infections.
# Skin color may change. White patches may appear where the rash and blisters first appeared.
# A facial nerve may become infected. Symptoms include earache, deafness, dizziness and paralysis of the face.
# Ulcers and scarring may occur on the surface of the eye.
# The brain may become inflamed.
# People who have shingles are more likely to have a stroke.

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Phases of shingles

Phase one is characterized by unusual skin sensations and other symptoms. Phase two is marked by the presence of a rash and blisters. Blisters eventually rupture, releasing the virus. These eruptions occur for approximately three to five days. Patients are infectious until the lesions are dried. Phase three consists of pain or other complications after the lesions have healed. Some people continue to experience pain for months or even years after recovering from shingles.

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Viral Shedding Facts

# There is still lots of research that needs to be done on viral shedding.
# THe chance of spreading herpes due to viral shedding is very low if you avoid direct skin to skin contact with the area when there are signs or symptoms.
# If the herpes virus is actively shedding there may not necessarily be any noticeable symptoms. Some people never show any signs or symptoms of herpes but can still transmit the virus to their partner.
# THe herpes virus can cause severe blistering in one partner but be totally unnoticeable in the order, even if both parthenrs are infected with the exact same strand of the Herpes Simplex Virus.
# HSV Type 1 is less likely to shed than HSV Type 2 and women are often prone to a higher rate of shedding.
# It is possible for a person to carry the herpes virus without knowing that they have it, since up to 70% of people who are infected with HSV-2 show no signs of infection. So it is very easy for a person to a person to unwittingly transmit the infection to their partner.

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What is Viral Shedding?

When the herpes virus is not active on the surface of the skin it resides in a sleeping state the nerve cells and other tissues. At times (which cannot always be predicted), the virus will become active and travel the nerve pathways up to the surface of the skin.
It is at these times when the virus has “surfaced” to the skin that viral shedding occurs. Viral shedding is when the herpes virus is active and “shedding” at the site of infection. The herpes virus is considered contagious during this “active” time and can there fore be spread through direct contact with the infected idea.
It is possible for the virus to be actively itself at the site of infection without showing any visible or symptoms. This is referred to as “Asymptomatic Viral Shedding”.

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Where and when will Viral Shedding Occur?

Due to the fact that viral shedding can occur without any signs or symptoms, it is impossible to determine exactly when viral shedding is occuring. For this reason, there will always be a small risk of transmission.
You can however determine your high risk periods and completely avoid contact witht the infected area during these times. For people who experience active outbreaks, shedding is most likely to occur a few days before any symptoms show and as soon as there any sensations warning that an outbreak is starting.
Whenever there are noticeable symptoms, and a few days after the outbreak has healed, are also high risk times for shedding. Condoms can be used in between the high risk times and medications can be taken to further reduce the risk.

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Condoms not effective against HPV or herpes

(06-21) 15:39 PDT SAN FRANCISCO — Since the AIDS epidemic, awareness of sexually transmitted diseases seems embedded as a Bay Area cultural norm. Yet most people don’t know about how common viral STDs actually are.
Experts say being exposed to at least one STD virus is virtually inevitable. Viral STDs make up the modern “4-H club.” Herpes simplex virus (HSV), human papilloma virus (HPV), hepatitis (B and C), and HIV are the most common STDs, causing pain, cancer, liver disease and AIDS, respectively.
Condoms significantly decrease transmission rates of the most life-threatening viruses, HIV and hep B and C. But it’s not foolproof – statistics on liver disease show that 60 percent of hepatitis carriers acquired the virus by means other than sexual intercourse, such as recreational IV drug use or by receiving a tainted blood transfusion.
But for those 40 percent, a latex condom would have prevented transmission. As long as there is no breakage or leakage, using latex condoms for all sexual penetration prevents transmission of both hepatitis and HIV because those viruses are transmitted through body fluids. Condoms also prevent female-to-male transmission of those viruses.
To be considered safe sex, disease prevention needs to be at the 99 percent level. With the correct use of an intact condom, this is possible for HIV and hepatitis viruses.
Unfortunately, condoms do not do an adequate job of protecting against human papilloma or herpes simplex virus infections. Women diagnosed with HPV are often mystified and frustrated, having been “super careful,” or picky, in choosing intimate partners and faithfully using condoms for all intercourse.
But UCSF researchers have shown these viruses to be present on genital skin with no symptoms that might prompt diagnosis and treatment. That means HPV and HSV can be deposited on the condom’s outer surface from viral particles living on the scrotum, penile shaft not covered by the condom or vaginal/vulvar tissues.
Women become aware they have HPV because they see some wart-like bumps in the vaginal area or it is found during annual exams. Screening with Pap smears, including newer viral DNA testing, allows for more accurate and sensitive identification of those women who are at significantly elevated risk for cancer because of having acquired high-risk subtypes of HPV.
Unless men identify a genital wart, they are not aware of harboring HPV, as we don’t do Pap smears on men. Outside of research trials, we don’t detect male high-risk HPV carriers.
Passing a virus without having any symptoms is why these viruses get spread far and wide. Like bees sharing pollen flower to flower, men regularly transmit HPV and HSV without knowing it.
Women can also pass viruses without having any symptoms. But female-to-male infectivity is estimated at less than 5 percent of the rates of male-to-female transmission.
In 2011, a panel of the Centers for Disease Control and Prevention recommended boys, as well as girls, be immunized for HPV. (To prevent cervical cancer, HPV immunization is recommended for all girls before becoming sexually active, ages 10 to 26, for several years now.)
Lowering the risks of human papilloma virus through immunization and preventive measures will thwart thousands of cervical, anal and oral cancers. Herpes simplex virus, as unpleasant and complex as it can be, does not cause cancer, and there are good antiviral medications to shorten painful episodes and prevent recurrences.
HIV and hepatitis B and C are well controlled with condom use. Yet if we acquire a lifelong viral “souvenir” through sex, may it be from a person who is important forever. It’s a minimal-regrets way to assess the value of a relationship before risking exposure. When it comes to viral STDs, the devil is in the details.

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Facts about using condoms to prevent herpes transmission

# The herpes virus does not pass through latex condoms.
# When properly used latex condoms are likely to reduce your risk of spreading or getting herpes, however even the best condoms do not guarantee total safety.
# When herpes sores occure in places not covered by a condom the condomis of little help, if any.
# COndoms and foams should not be relied upon when herpes sores or symptoms are present.
# Condoms do not provide 100 percent protection because a lesion may be found which the condom did not cover. Used consistently, however, condoms are one of the best available forms of prevention.

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Can I protect myself from herpes by always using a condom?

You cannot entirely prevent herpes transmission by using a condom, but you can reduce it. Unlike many other sexually transmitted diseases, herpes spreads by skin-to-skin contact instead of through bodily fluids. Since condoms don’t cover all potentially infectious skin, they can not completely stop herpes spread.
Still, condoms should unquestionably be a part of your arsenal in protecting yourself from a herpes genital infection. Although the amount of protection from simply using a condom will be less than for a disease like HIV that can be prevented by blocking secretions, that doesn’t mean the reduction is insignificant. A 2009 meta-analysis of six pre-existing studies — that all peripherally addressed the question of how condoms affect herpes transmission — found that consistent condom users saw a 30 percent reduction in their risk of getting herpes from their partners. However, condom use has to be consistent. The study also found that every unprotected sex act increased the risk of herpes transmission.
There are other ways of reducing the risk of herpes transmission including suppressive therapy to reduce both symptoms and the amount of viral shedding and not having sex during or right before an outbreak; however, condoms should also play an important role in reducing the spread of the herpes virus. For maximum benefit, you should use them or other barriers every time you have sex, since herpes can be spread even when a person has no symptoms. Barriers should also be used for oral sex, since genital herpes can be spread to the mouth and cold sores can also infect the genitals.

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