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Saturday 28 May 2011

Genital herpes, your girlfriend's or mine


Genital Herpes, is this STD mine or your girlfriends’





Genital herpes is as much a medical problem as is social. That is, the social implications are more likely to have far reaching impact compared to the medical. Rarely do you get aseptic meningitis and neuritis we so often fear as doctors. If any sexually transmitted disease is unfairly going to compromise one spouse against the other because of ignorance, this is.

First, the likelihood that the partner is only getting infected when the patient comes for presentation is very low. Even in fairly western countries like Australia, more than 75% of adults have the HSV1 disease. The patient probably had the infection for a long time before this immunosuppressive episode that lands him or her on your examination couch. The asymptomatic spouse will probably have had the infection latent for some time before this squabble. The infecting parties may have contracted the disease during early teens like most of us do (College kissing disease in HSV1) or more diagnostically correct HSV2 infection of early sexual contact. It is very difficult to clinically differentiate the two and it is likely not to be from the girlfriend.  That the spouses don’t or didn’t have the symptoms says relatively nothing as the disease can be latent for long time. If the patient immunosuppressive cause is HIV, the stakes get even higher and treatment with acyclovir might then become important as they are more likely to complicate and spread further.

We get informed by studies that the acute treatment with acyclovir reduces the length and severity of the present episode as well as prevent recurrences. In normal immune spouses with no social issues before the disease, management will probably be easy with few presentations really justifying anti viral therapy. What will happen when the couple leaves your room is probably of more relevance, therefore religious counseling to at least let informed decision making guide the mud slinging is more important than what they have scripted to the pharmacist. It is unfortunate that pathologists have to force us to be correct and call this sexually transmitted disease. For your sake and mine as the doctor who couldn’t give you enough information in that heated and confrontational state you presented in, cool off before you make a rash decision, read about it from blogs such as these written by pathologists with a heart. A lot of babies get the HSV1 from adults innocently kissing the children. It is even more traumatic because then the children refuse to feed, the lesions on the lips are as painful when they suckle as it is during sex. The worst is that they probably are going to suffer the emotional pain in adult life as well as they get may get accused of keeping a girlfriend when recurrence surface. The very same boyfriend who infected you when you were eight months old kissing you if you understand what I mean.
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