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Sexually Transmitted Diseases - STDs

Genital Herpes

In February 2002 the British Medical Association (BMA) Science Department and Board of Science and Education published a document called 'Sexually Transmitted Infections'.

This is yet another virus, so once contracted it is a lifelong disease with no cure and is generally caused by the herpes simplex virus (HSV) type 2.  HSV type 1 is the normal cause of 'cold sores' but can also cause genital herpes.  When someone normally gets a 'cold sore' it used to just be because they have been 'run down'.  Now are we to assume that they are also possibly suffering from genital herpes having contracted the 'cold sore' through oral sex as the report states that "The acquisition of HSV-type 1 infection by oro-genital sexual contact is quite common."?

Having said that many people can be infected without symptoms, the report then says "when symptoms occur..."  Shouldn't the report say "when or if"?  It is somewhat alarming to read that the blisters that might appear rapidly break down to leave painful ulcers.  How long is rapid?  What treatment is there for this?  The report states that these blisters/ulcers may be accompanied by flu-like symptoms and pain or difficulty in passing urine.  The report goes on to say that there is a short incubation period of two to twelve days before any symptoms may develop.  Yet the person will still be contagious for life and if no symptoms occur the person may not realise that they are infecting others.  It is particularly worrying that the virus can spread through skin to skin contact.  This means that even if the couple were in their underwear, the virus could be passed on whether or not there were symptoms present.

The report states that "The virus causes a latent infection of nerve cells from which it may reactivate to cause recurring genital skin lesions.  This is more common with HSV-type 2 infections.  Recurrences are more localised than the original episode and tend to affect the same site each time.  They are usually less severe and will normally heal within seven days."  Yet it fails to say what triggers the reactivation.  It also fails to say how frequent these episodes are likely to occur.  If something is 'less severe' that it only lasts seven days, then what does this tell us about the original infection and its severity?  Over time, are the affected nerve cells likely to become more or less sensitive to the infection?

Alarmingly, the next paragraph reads "There is no curative treatment, but specific antiviral therapy is available which can decrease the severity of initial or recurrent genital herpes infections and, if taken continuously, reduce the likelihood of recurrent infections.  It may also reduce the duration of an initial attack provided the treatment is started within the first five days, but the earlier the better.  Antiviral drugs need to be taken daily in small doses to prevent herpes symptoms or can be taken in larger doses, when signs and symptoms appear."

So, there is no cure, but assuming someone knows they have Genital Herpes they need to then be on antiviral treatment continuously for the rest of their life just to try to alleviate some of the discomfort, with no guarantee that it will work.  Who pays for this daily treatment?  How much do the drug companies make from this?  What strain is there on the NHS finances and other resources in dealing with this virus?  What research is being carried out to find a cure?  Who is paying for this research?  If someone is taking antiviral drugs does the body eventually produce a resistance to the daily drugs?  What are the contra-indications or side effects of the drugs?

The next paragraph states "In long-term relationships where one partner has HSV about 10 per cent of uninfected partners will become infected per year, though not all will develop symptoms."  Does this mean that within 10 years both partners are infected?  How can anyone tell if they are infected, and therefore need to take antiviral drugs, if there are no symptoms?  Is there a system for regular checks?  Who pays for these?  How would they become infected - through skin contact or intercourse?  Where does the figure of 10 per cent come from?  What studies were done to reach this figure?

The last paragraph on Genital Herpes says "A first episode of herpes during late pregnancy is potentially dangerous to the baby and requires specialist advice".  The report doesn't say what the dangers are or how to alleviate the problems.  It does go on to say that utero infection with HSV is extremely rare and that the Association for Genitourinary Medicine has produced the national guideline for the management of genital herpes, which includes the management of herpes in pregnancy.  But if general cases of genital herpes are becoming more common then surely there is the likelihood that a first episode during late pregnancy would also be more likely, especially as a condom would probably not be used unless it was to try to prevent any infections including HIV from being contracted.  Even more so if there are no symptoms and also bearing in mind that skin contact alone can spread the disease.

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