Herpes Testing in NY. Herpes Symptoms, Herpes Transmission, and
Herpes Treatment are discussed here prepared by our in house expert
doctors. We are conveniently located on Queens Blvd in Queens, NY.
Specialties in Internal Medicine and Gynecology.
We attend to all your Primary Care needs for Males and Females.
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
83-06 Queens Blvd.
Elmhurst, NY 11373
Telephone: 718-672-4600
Please be advised, many, if not most doctors are not aware of how to properly test for Herpes.
Over the past few years there has been emerging data and testing methods that most doctors
don’t even know about. For example, swabs of presumed herpes lesions reveal a lot of false
negatives. That is, somebody that really has herpes may have a negative swab test. Many
doctors don’t realize that the IgM antibody test is essentially useless. Also, many are not sure as
to the proper timing necessary for the IgG test and swabbing sensitivities.
At Advanced Queens Medical Care, we are experts in the diagnosis and management of genital
and oral herpes. Importantly, we are often able to recognize lesions when they occur and can
often diagnose herpes when lesions are not present with advanced testing techniques. We are
actively involved in reviewing relevant academia on this disease.
Disclaimer:
The following has been provided for educational purposes and is not to be used in place of a
proper consultation with a doctor.
What is Genital Herpes
Herpes is caused by a virus, herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-
2). Either virus can cause the disease. Most people who have HSV-1 and/or HSV-2 infections
don’t have any symptoms that people normally attribute to herpes. That is, most infections are
asymptomatic.
Epidemiology of Herpes
Most cases of symptomatic genital herpes are caused by HSV-2. Most cases of symptomatic oral
herpes are caused by HSV-1. However, either strain can cause disease in either location;
symptomatic or not. For genital herpes, approximately 80% of cases are due to HSV-2 with the
remainder due to HSV-1.
One study suggests that approximately 56 % of adults have HSV-1, 23 % of adults have HSV-2,
and 12 % have both HSV-1 and 2. Since the late 1970’s, blood tests have revealed that there
has been a 30 % rise in people with HSV-2. Actually, 1 in 4 adults over the age of 30 in the U.S.
have HSV-2, most are not even aware of their infections.
Types of Herpes Infection
Initial
There are 2 types of initial infection:
Primary
A Primary outbreak implies no prior disease with the herpes simplex virus. This means that an
affected person has never had either HSV-1 or HSV-2 prior to the current event.
The great majority of people experiencing a true primary outbreak either have no symptoms,or
just very minimal ones that are not easily recognizable as different from every day life.
Sometimes, however, symptoms of a true primary outbreak are the most severe compared to
other types of outbreak.
Non-primary
A Non-primary outbreak is an initial episode where a person has been infected with HSV-1 and
newly acquires HSV 2, or vice versa. The existing antibody to one strain of the herpes virus
keeps the new strain’s infection under some control. Symptoms of the new strain may be missed
completely.
However, the antibodies to one herpes’ strain does not prevent infection to the other herpes’
strain. So a person could have a history of cold sores caused by HSV 1, or more commonly have
been infected without knowing and still get genital herpes caused by
HSV-2.
When symptoms occur, they are less severe than Primary infections.
Most are asymptomatic.
Recurrent
A Recurrent infection occurs in people who have had a previous Initial HSV infection at or
near the same site on the body. Typically, another outbreak can appear weeks or months after
the first, but it almost always is less severe and shorter in duration than the first outbreak.
Although the infection can stay in the body indefinitely, the number of outbreaks tends to
decrease over a period of years.
Between outbreaks, the viral DNA remains latent in nerve ganglia.
Within 12 months of HSV-2 diagnosis, 90 percent of patients will have at least 1 recurrence,
38% will have greater than 6 recurrences, and 20% will have 10 or more recurrences. However,
over time, recurrences become less frequent. HSV-1 recurrences are less common than HSV-2.
Herpes Symptoms
Primary Herpes Infections
The average incubation period for both herpes strains is 4 days. The range is typically 2 to
12 days. However, remember, most people who are infected do not even get symptoms, but if
they do they usually occur during that time frame.
Systemic Herpes symptoms (whole body involvement): headache, body aches,
joint aches, tiredness, fever, and flu-like symptoms.
Local herpes symptoms: genital sores, painful urination, itching, and a discharge from the
penis or vagina. The “classic” presentation of herpes is flat or small pimple like lesions, which
become painful, blistering vesicles and pustules. Vesicles are typically 1-10mm. They then
ulcerate and crust. Most people do not present in this “classic” fashion. Lesions on the inner
labia do not form crustsThe lymph nodes in the groin are often enlarged and tender and may
feel like peas under the surface of the skin. The typical primary outbreak lasts from 2-3 weeks in
those people who recognize symptoms. Frequently, a new crop of herpes lesions will appear 5-7
days after the first batch is seen. Lesions are often clustered in a linear or serpiginous
arrangement. When they ulcerate they are often shallow ulcers which are painful. Some women
with primary herpes infections also get a yeast infection in the vagina, making the itching and
discharge more bothersomeUncommonly, aseptic meningitis may occur.
NonPrimary Herpes Infection
The symptoms that occur with Nonprimary herpes infection are the same as Primary
infections. Differences include, a smaller area that is affected, systemic symptoms are more
likely to be absent, there is a quicker recovery time. Up to 90% of outbreaks are
unrecognized and completely asymptomatic.
Recurrent Herpes Infection
During recurrent outbreaks, most people do not experience systemic symptoms. The
lesions cover a still smaller area and many people do not experience pain with their
outbreaks. The average recurrence lasts about 2-10 days. Although unlikely, a person
could have genital herpes unrecognized and then have their first outbreak 50 years later.
The same group of nerves supplies the genitals, thighs, lower abdomen, rectum and
buttocks. Some times outbreaks occur in just the same place every time they appear.
Other occasions an outbreak may go to a different area. In fact, a person may have
herpetic lesions on their buttocks even if their primary lesion was on the genitals.
Prodromal symptoms are symptoms that one may feel before the herpetic lesions emerge.
About 50% of patients experience a prodrome such as tingling sensations or shooting
pain. These may occur anywhere from 30 minutes to 5 days before an eruption. A
potential of a prodrome is that it helps in the treatment of some patients. That is they can take
pills that will lesion the symptoms and duration when the eruption occurs more than if taken
during the eruption.
Triggers of recurrences may include menstruation, sunlight, pregnancy, birth control pills, diet,
friction stress, illness, and heat.
Transmission (Spread) of Herpes
The great majority of cases are transmitted when a partner does not have any visible lesions.
Although it is easier to transmit herpes when there are visible lesions, “asymptomatic viral
shedding” accounts for most transmissions from one person to another. That is, a person does
not have to have any symptoms or lesions that are visible to transmit the disease from one
person to the next. In fact, direct contact other than sexual intercourse can and does result in
viral transmission. One study found that women who had HSV-2 had asymptomatic viral
shedding on 28% of days.
A Word or Two about Oral herpes
Common names are “Cold Sore” “Fever Blister.
The same viruses that cause gential herpes cause oral herpes. The main difference is that HSV-
1 is more common. The symptoms, diagnosis, and treatment are the same. However, it should
be noted that the vast majority of oral infections are not sexually transmitted. Oral herpes is
often acquired in childhood, and is frequently the result of an adult with a cold sore or
asymptomatic shedding kissing a child. Many acquisitions are totally without symptoms. Adults
who get an oral first infection can have symptoms that are both dramatic and painful.
Menstruation, sunlight, pregnancy, birth control pills, diet, friction (which includes prolonged or
vigorous intercourse, oral sex or masturbation), stress, illness, and heat have all been identified
as possible triggering mechanisms.
Herpes Testing
The method of testing depends on the individuality of the patient. Some may get a swab for a
culture, a swab for a PCR sample, or a blood test. Please keep in mind, many doctors are not
aware of the proper time frames, false positives, and false negatives of each test. Many are not
even aware of which tests exist. Each test has limitations. Each test may require different timing
in relation to disease onset. Each testing procedure generally causes little if any pain when done
by an experienced doctor. At Advanced Queens Medical Care, we are experts in diagnosing
lesions, whether it be by inspection, culture, PCR, or blood testing.
Who should test for Herpes?
1. Anyone who has had a sexual partner in the past and wonders if they got herpes without
developing symptoms.
2. Someone who has been diagnosed with herpes by visual exam alone and wants confirmation
of the diagnosis or wants his or her virus typed.
3. Someone who has had repeatedly (or singly) negative herpes cultures from suspicious skin
changes.
4. Someone who has had repeated urinary tract infections but never grows out a bacteria on a
urine culture. They may have herpes lesions in the urethra.
5. Anyone who wants to get screened for sexually transmitted diseases. STD screens may not
always include a herpes test. You should ask specifically for a herpes test.
6. Pregnant women.
Treatment of Herpes
Treatment of herpes is perhaps the easiest part of the disease. Treatment is not perfect. There
are options to make recurrences less likely to occur and options to treat recurrences when the
occur. Each treatment is tailored to the individual patient. At Advanced Queens Medical Care,
we also understand that there are many psychological effects of genital herpes and we
emphasize and try to work as a team to resolve these issues
Advanced Queens Medical Care
We are Board Certified and Diplomates in our respective fields. We are experts in the diagnosis and treatment
of herpes. Please call 718-672-4600 during office hours to make an appointment for consultation. We are a
private medical office accepting most health insurances. We have reasonable rates for uninsured.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|