Thursday, April 8, 2010

Type 1 vs. Type 2 Herpes, does it matter?

Hello all,

Looks like a few people are reading this blog, so I will continue undaunted.
I test for type 1 and type 2 herpes, at least in the blood work. It is important, because type 1 alhtough ususally found in cold sores ( mouth ) and type 2, usually found in genital herpes, can be mixed.
Their natural history is different with type 1 having a more benign course, and where each one is detected.

Each type has an anatomical preference.Funny little bugs? If you find them outside of their preferred site, the natural history tends to be less outbreaks over time. That said, the most likely time for outbreaks is in the first two years of acquiring disease. After that it depends. Usually when the immune system is depressed. Like when you have a cold, hence the cold sore.

Anecdote: Years ago an older lady in her 70's was referred to me for "something down there", a common issue. In her age group, cancer of the vulva is a likely problem, so she was frightened. During my exam I remarked to my nurse that if she were 50 years younger, it would look like herpes to me. I thought that I did not want to put her through a biopsy if it was not necessary, and if it were cancer. It would be there next week. I tested for herpes, and gave her medication. Sure enough, that was the diagnosis. I loathed telling her, especially on the phone. I imagined a scenario like this, " Doctor kills patient with phone call. " So, I asked her to come in for a visit to discuss the results.
In those days, doctors had offices where we could sit across from a patient and counsel them, discuss important topics, and generally make us feel powerful.
She came in and I told her that we found the cause of her problem and it was not cancer. OK, so far so good. I told her it was an infection, a virus. Then I told her it was herpes. She extended her hand over the table to catch mine and said " You poor dear to have to tell me that. You know my late husband ran around an awful lot when he was young. Is that all, it's back?" Dear God, I could have kissed her.

Back then typing for 1 and 2 was not available. Didn't matter. She was a happy camper, but now in her 70's recurrence was happening due to age depression of her immune system. So drink lots of OJ, get plenty of sleep and think good thoughts.

Until next time,
Ladies Doctor

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