The Guide to Getting It On (111 page)

Herpes Simplex Virus 2: Genital Herpes
HSV2 is associated with genital herpes infections. About 16% of people in the US over the age of 13 show evidence of HSV2 infection when their blood is tested. Of those infected with HSV2, only about 10% know it.

Genital Herpes is classified into 3 categories:

Non-primary:
This is a first-episode infection of HSV2 or genital herpes in someone who has previously been infected with HSV1 (cold sores, etc.). Symptoms are less severe and may go unnoticed. As many as 80% to 90% of first-time genital outbreaks go unrecognized.

Primary:
This is an outbreak of genital herpes in someone who has never had HSV1 or HSV2. Primary symptoms are sometimes severe and can range from headaches, aching joints, tiredness, fever, pain in the legs, and flu-like symptoms. The lymph nodes in the groin can become enlarged and tender. Lesions and sores may appear in the throat or mouth. Genital symptoms may also include sores, painful urination as well as itching and discharge from the penis or vagina. The sores begin as blisters, then break open to form ulcers in the skin. Women may not notice sores on their labia. They will normally have lesio
ns on their cervix as well.
Men may have lesions inside their urethra. Frequently, a new crop of lesions will appear 5 to 7 days after the 1st batch.

Recurrent Infection or Flare Ups:
Flare ups occur at the same site or near it in people who have had previous HSV infections. For genital herpes, this includes having outbreaks anywhere in the “boxer shorts” area. That’s because herpes hibernates in the nerves, and a single group of nerves supplies the genitals, thighs, lower abdomen, rectum and buttocks. Herpes can move along that group of nerves and cause an outbreak anywhere on the skin where those nerves go. So while some people will have outbreaks in the same location, others might have a new outbreak on their thigh or rear end or lower abdomen. This also means you don’t need to have had anal sex for an outbreak to occur around your anus. During the first year, it is not uncommon to have four or five recurrences. The average recurrence lasts 2 to 10 days. However, the recurrences can be so mild that people are hardly aware of them.

Luck of the Draw:
While most people with herpes have symptoms that range from extremely mild to moderate, some people with herpes have symptoms that are severe. Talk to your healthcare provider about medications that can help reduce the severity of future flare ups.

Timing of Herpes Infection vs. Timing of Outbreak

A person could have herpes for thirty years, not know it and then have their first recognized occurrence. When they finally do have an outbreak that they can recognize, it can cause unwarranted suspicions of infidelity. Ouch!

Oral Herpes in the Genitals

Oral herpes (HSV1) now causes about one-third of the first-time genital herpes outbreaks. The way this happens is when someone with a cold sore or other kind of oral herpes gives a partner oral sex. So the partner can get a case of oral herpes in the neighborhood where genital herpes usually lives.

At the start, the partner is unlikely to notice much of a difference in how the oral herpes behaves. It will seem just like genital herpes. However, because it’s not genital herpes, it won’t have the same affinity for the nerves in the genitals as genital herpes would. As a result, the person whose genitals get infected with oral herpes is much less likely to have recurrences.

Other Herpes Information

Prodrome:
Prodrome
is a set of symptoms that occurs before an actual outbreak is present. Itching, tingling, a crawling under the skin feeling, pain down the leg or in the butt are some of the symptoms. About half of the people with genital herpes experience prodrome.

Triggers:
Things that can trigger a herpes outbreak include menstruation, sunlight, pregnancy, birth control pills, diet, friction (prolonged intercourse, oral sex or masturbations), stress, illness, and heat.

Tests for Diagnosis:
Visual inspection and viral cultures can be done to diagnose herpes if there are sores. The problem with viral cultures is that they give false negative results up to 76% of the time. This means that up to 76% of the time, when a viral culture comes back negative the person really does have herpes. All negative cultures should be followed up by a more accurate blood test 3 to 4 months after possible exposure. Blood tests can also be done when you are between outbreaks, although according to the CDC, the results are not always clear-cut.

Treatment:
Three antiviral medications are available to help alleviate the symptoms of herpes: Acyclovir, Valtrex and Famvir. All three drugs work equally well. Studies with these drugs have found that 80% to 90% of people who take the drugs for suppression have greatly reduced frequency of outbreaks or do not have outbreaks while taking the drug. If a woman should become pregnant while taking an antiviral medication, she should discontinue its use and inform her healthcare provider.

Transmission:
The greatest concern sexually has to do with transmitting the virus to another person. Intercourse should be avoided completely during outbreaks for maximum safety when one partner is infected and the other is not. Even though someone who has herpes has never had severe symptoms, a person they give it to could have severe symptoms.

Pregnancy:
According to the CDC, the infection of a baby with herpes from a pregnant mom is very rare. However, if a woman has active genital herpes at the time of delivery, a C-section will often be performed as a precaution. Pregnant women who are considering having sex with a new partner should be aware that contacting herpes late in the pregnancy can substantially increase the chance of transmitting herpes to the baby. The baby’s chances of dying or being developmentally disabled from neonatal herpes are much greater when the mom is first infected with herpes when she is in the third trimester of pregnancy. If the mom was infected with herpes before she got pregnant or before the third trimester of pregnancy, the chances are good her immune system will help protect the infant.”

Herpes and HIV:
Like most sexually transmitted infections, herpes can increase your chances of getting HIV and it can make people who have HIV more infectious.

Disclosure to a New Partner

It is essential to disclose your herpes status to a new sexual partner prior to having sex. Give them the chance to make an informed decision about the future of their own health. Let them know that even if you don’t have active symptoms, you can still give them herpes. If you don’t tell your partner until after sex, they have good reason to question your integrity and your ability to be trusted.

If you are having casual sex, keep in mind that people who have herpes seldom inform casual-sex partners about it.

Herpes Resources

By far, the best online resource for herpes is the Westover Heights Clinic:
http://westoverheights.com/handbook.html
. You can download the
Updated Herpes Handbook
for free. It is updated frequently by its authors, Terri and Ricks Warren. For more information, you can also phone the National Herpes Hotline at (919) 361-8488 or the National STD Hotline at (800)227-8922.

Hepatitis A, B, or C

Hepatitis refers to a chronic inflammation of the liver. While you can have hepatitis without ever knowing it, hepatitis can also lead to liver failure and to cancer of the liver. So hepatitis has many forms, from a silent infection that your body clears without needing treatment, to a disease that can easily kill you.

Hepatitis is usually caused by one of six viruses that are not related to each other. Hepatitis can also be caused by heavy alcohol use as well as medications, toxic chemicals, and certain illnesses.

The word “hepatitis” simply refers to a liver that is damaged, as opposed to what is causing the damage. This is different from STIs like herpes, HPV, and HIV, which are named after the specific microorganism that causes them. Also keep in mind that while alcohol abuse can cause hepatitis all on its own, a hepatitis virus can damage your liver without you ever having had a drink.

The reason why hepatitis can be so devastating is because we rely on the liver to filter out toxins in the body and to produce bile to help break down fat. There is no living without a liver.

The six viruses that cause hepatitis are often lumped together in discussions like this one because they all impact the liver. But they are by no means the same. This is why reading about hepatitis can be confusing. Just trying to understand the different ways the viruses are spread can cause your liver to ache. One of the hepatitis viruses is spread by fecal contamination and by oral-anal contact. One is spread by regular sex and kissing or sharing a toothbrush. Another is only spread by contact with infected blood. Three of the viruses are common in North America (hepatitis A, B, and C) while the others are more common in other parts of the world. There are vaccines that help prevent two of the viruses, but not for the other four.

Hepatitis A is primarily spread through fecal contamination, so beware rimming or having anal-oral contact with strangers or casual sex partners. You can also get hepatitis A by eating food and drinking water that is contaminated with microscopic pieces of poop.

Hepatitis B is found in infected blood, semen, saliva and vaginal secretions. So it is spread through sexual contact including kissing, and it can be spread by contact with the blood of an infected person. This would include intravenous drug use, sharing needles, sharing razors for shaving and even through sharing a toothbrush.

Hepatitis C is the most common blood borne infection there is. It is primarily transmitted through injection of blood (blood transfusions, drug use and accidental needle sticks in healthcare settings). It is possible that hepatitis C can be spread through sex and through sharing razors or a toothbrush, but these are not very efficient ways of transmitting hepatitis C.

A lot of people who have hepatitis don’t experience symptoms, but others do. These are the same kinds of symptoms that people have when their liver is failing or not functioning correctly. They can include abdominal pain, dark urine and clay-colored poop, jaundice or yellowing of the skin and whites of the eyes, fever, fatigue, loss of appetite, nausea, vomiting and joint pain.

Symptoms can last from weeks to months or longer. Some kinds of hepatitis infections will clear up on their own, others won’t. People who have no symptoms can still be carriers of one of the viruses.

Getting vaccinated for hepatitis A and B viruses is a really good thing to do even if you are a total virgin. It can be even more important if your sexual boundaries are a bit porous or you enjoy barebacking and rimming. Condom use might help decrease the spread of hepatitis B, but condoms are of only limited help in preventing other hepatitis viruses.

Syphilis

Syphilis is caused by a bacteria. It is transmitted when you make contact with a syphilis sore that is on a partner’s genitals, vagina, anus, rectum, mouth or lips. A lot of people with syphilis don’t have symptoms but are at risk for serious harm if the syphilis is left untreated. Syphilis can also increase the chances of getting HIV by two to five times.

Syphilis is one of the most famous sexually transmitted diseases in history. At one time, when there was no treatment for syphilis, half of the hospital beds in the world were filled with patients who had syphilis. (See the history of syphilis at the end of this chapter.)

Syphilis infections occur in stages. The first stage is a painless open sore or sores on the genitals, rectum or mouth. These are called chancres. They disappear in a few weeks. The second stage starts as the chancres are disappearing or have disappeared. During this stage, people often develop a rash, especially on the hands and feet. However, the symptoms can mimic those of so many other diseases that syphilis is sometimes called the great imitator.

If left untreated, syphilis goes into a hidden or latent stage for 3 to 40 years. Then, people can get
late stage
or
tertiary syphilis.
This can result in severe damage to the heart, brain, nerves, bones, eyes, organs and muscles.

Syphilis is easy to detect by blood test and sometimes with direct observation. Syphilis is also easy to treat during its early stages with penicillin. Condoms are not very effective in stopping the spread of syphilis.

While not many people get syphilis today, this disease can be so devastating in its late stages that it is important to get tested for it every year if you are sexually active and not in a monogamous relationship. Pregnant women should always get tested for syphilis, because it can be passed on to the baby with devastating results.

Bacterial Vaginosis (BV)

Bacterial vaginosis is a puzzling condition. While it is the most prevalent vaginal infection in women of reproductive age, the latest research is indicating that it may be overly diagnosed.

Researchers are not yet certain whether BV is a sexually transmitted infection, although the evidence does stack up in that direction. Symptoms for BV can range from little or no symptoms at all to a creamy discharge, a fishy smell after intercourse, itching and painful peeing.