Herpes Life Line

SmartBrief

Treating genital herpes soon as possible upon diagnosis, rather than waiting for a breakout patterns to emerge, equates to  better suppression of the virus, a study of 384 patients found. Nearly 71% of newly diagnosed patients who were given valacyclovir for 24 weeks were recurrence-free, compared with 43% who were given a placebo.

NEW YORK (Reuters Health) – Treatment to suppress outbreaks of genital herpes simplex virus type 2 (HSV-2) infection is typically begun once a recurrence pattern is established, but new research suggests that treatment started shortly after diagnosis can better suppress recurrent outbreaks.

The findings, which appear in the current issue of Sexually Transmitted Diseases, are based on a study of 384 patients with newly diagnosed genital herpes infection who were randomly assigned receive valacyclovir, also known by the trade name Valtrex, at 1 gram per day, or placebo for 24 weeks. Self-reported outbreaks were confirmed at clinic follow-up visits.

Valacyclovir was effective in preventing disease recurrences, Dr. Kenneth H. Fife, from Indiana University School of Medicine in Indianapolis, and colleagues report. After 24 weeks, 71 percent of the valacyclovir-treated subjects were recurrence-free compared with 43 percent of the placebo-treated subjects, a statistically significant difference.

Active treatment also reduced the number of monthly recurrences. On average, 0.11 monthly recurrences occurred with valacyclovir treatment, while 0.48 occurred with placebo.

Valacyclovir therapy was also well tolerated by the patients and a comparable number of adverse effects were reported by both the active-treatment and placebo groups.

Up until now, there were limited data available to guide physicians in how to treat their herpes-infected patients who had no established recurrence history, the investigators note.

They advise physicians to “consider suppressive therapy as another treatment option in newly diagnosed patients, especially in adolescents, those with difficult psychological adjustments, or those who have an uninfected partner and are concerned about transmission.”

Be careful when dating — that cougar (or that sugar daddy) could give you a sexually transmitted disease: a recent health study suggests that the rate of STDs have doubled in people over the age of 45 in the last 10 years.

The study, which appeared in June the journal Sexually Transmitted Infections, said that older people have a higher case of genital warts and herpes.

In Mecklenburg County, people ages 50 or older accounted for nearly 15 percent of new HIV cases during the last five years, according to a report from the Mecklenburg County Health Department.

The fact that older people are getting sexually transmitted disease isn’t new. In 1996, the Centers for Disease Control and Prevention reported 700 cases of infection among heterosexuals age 50 or older. Within five years, that number had doubled.

Though more older people are having sex, perhaps in part due to divorce and Viagra, there is little STD education targeted at them. Metrolina AIDS Project is known throughout the city as a place to go for free HIV testing and education, but even they don’t have a specific program targeting seniors.

“Our prevention is we target high-risk folks,” said Omar Whiteside, MAP’s director of education. And those are African-American women and men who have sex with men. “The idea is to provide programs for individuals who are most at risk and hopes that by providing those programs, you can prevent the greatest risks of new infections.”

Many seniors consider HIV a “young person’s disease,” according to the National Institute on Aging. But the Institute said that 10 percent of Americans over 50 are at risk for HIV and other STDs because they often don’t practice safe sex. Since pregnancy isn’t a concern, older sexually active people are less likely to use condoms, according to the Institute.

Sounds like a need for education.

Whiteside said the CDC has a group of programs that could be used to teach seniors about safe sex, but he doesn’t know if there is a specific program just for seniors.

Statistics from the Mecklenburg County Health Department show seniors around this area aren’t at a high risk of herpes. In a report sent to Creative Loafing showing data from 2004 and 2006, syphilis cases rose in people between the ages of 40-49 from 15 cases in 2004 to 49 cases in 2006. For people over 50, those cases rose from eight in 2004 to 19 in 2006.

Rick Christenbury, spokesman for the health department, said that genital warts isn’t a reportable disease in North Carolina.

HIV rates in seniors are low in Mecklenburg County, according to the health department’s stats. The number of new cases reported in 2004 for people between the ages of 40-49 were 111. In 2006 those cases dropped to 96. For people over 50, the number of new cases were 50 and in 2006 the new cases reported were 49.

In an e-mail, Christenbury writes: “The majority of chlamydia and gonorrhea reports are among young adults with less than two percent of reports occur among individuals 50 and over. This may reflect our screening and testing methods for these particular diseases, i.e., young adults tend to be at higher risk for chlamydia and gonorrhea and therefore are more likely to be tested.”

Cold sores are icky. And they’re insidious. The raw, ugly blisters show up without notice and are unpreventable. Worse yet, once you’re infected with the virus that causes them, you’re stuck with it for good. But landmark research reported today by microbiologists at Duke University may offer the potential for a cure.

By age 40, nearly 90% of adults have been exposed to the herpes simplex virus-1 (HSV-1), which causes cold sores. People are usually infected as children, but many never have symptoms. For those who do, however, cold sores are a painful and permanent nuisance, always erupting in the same location, at the original site of infection on the lips or mouth. Once HSV-1 enters the body it hunkers down for life, most of the time hiding dormant in the cranial nerves near the spine. The virus can be triggered by outside stress, such as exposure to sunlight, a fever or emotional distress. After it’s active and a cold sore appears, it’s treatable with the drug acyclovir, marketed under the name Zovirax, which kills replicating HSV-1. But the mystery has been how to eliminate the virus while it’s hiding, before it produces unsightly symptoms.

Until now, research has generally concentrated on keeping HSV1 inactive — and preventing cold sores from ever showing up. But the Duke researchers took the opposite tack: figuring out precisely how to switch the virus from latency to its active stage. That’s important, says lead author Dr. Bryan Cullen, professor of molecular genetics and microbiology at Duke, “because unless you activate the virus, you can’t kill it.”

Cullen and his team were able to replicate the intricate process using lab mice. They started by identifying the tiniest components of the HSV-1 strain. In its latent stage, HSV-1 produces a single molecular product, called latency-associated transcript RNA, or LAT RNA. Unlike most messenger RNA, LAT RNA doesn’t produce proteins, so scientists have never been able to determine LAT RNA’s exact function. But by inserting the LAT RNA into mice, Cullen found that it breaks down into even smaller strands called microRNA. Researchers then discovered that it was the microRNA that blocked production of the protein that activates HSV-1. “So if there was a sufficient supply of microRNA, then the virus stayed latent,” Cullen says. “But under a high level of stress, the microRNA’s blocking mechanisms break down, thus triggering a cold sore.” The study, funded by the National Institutes of Health, will be published in the journal Nature this week.

Understanding how to override the microRNA could allow scientists to activate the virus and then kill it using acyclovir. “Once the virus sticks its head up over the fence, you whack it off for good,” Cullen says. “Yes, the person has to have one last cold sore, but it’d be worth it to most people to cure them forever.”

The theory is that by activating the virus, then preventing it from returning to hibernation, which is when researchers think it gains strength, it can be completely eradicated. Cullen believes that a drug could be developed to block the microRNA that suppress HSV-1 into latency; once it’s active, acyclovir can be used to destroy the virus permanently. Cullen suggests that this new research may also eventually be applied to other latent viruses, such as herpes simplex virus-2 (HSV-2), which causes genital herpes, or the chicken pox virus, which causes shingles in adults. Cullen warns that some patients, especially those suffering genital herpes, may have to take acyclovir on a regular basis (HSV-2 is a hardier virus), but for people with HSV-1, the virus could be eradicated with just one dose.

Cullen and his colleagues, as well as several biotech firms, are already investigating such treatments and how best to deliver them. “Are any of these viruses fatal?” Cullen says. “No. But there are a lot of people who’d be thrilled never to have a cold sore again.”

July 3, 2008

Jill Barrs knew something had to change after one too many dates with a dude calling himself a neo-hippie.

So she created a profile at conservativematch.com (“sweethearts, not bleeding hearts”), hoping to meet a man with similar values.

“I was tired of dating liberals,” Barrs said. “I’m not trying to be insensitive to other political views, but I was tired of dating apathetic people who didn’t hold the same interest in politics.”

An electronic smile from Edward Wildermuth, a dashing accountant, sparked her interest. His passion for domestic policy fueled her fire.

The Web site didn’t make it – conservativematch.com is no more, though conservativedates.com thrives — but Barrs and Wildermuth did. On March 29, nearly three years after meeting online, the Glen Ellyn couple were wed. And now politics is part of the daily discussion in the home of these blissful newlyweds.

Forget eHarmony, Match.com or Yahoo personals. Singles increasingly are turning to niche online dating sites promising to match couples with similar interests, backgrounds or religions.

Mark Brooks, whose blog Online Personals Watch chronicles the Internet dating industry, estimates that niche sites now occupy approximately 43 percent of total market share. Brooks writes that while mainstream sites are stagnating, niche sites continue to grow.

While the most popular niche sites offer the chance to meet people of similar race, religion or sexual orientation, there are sites for every conceivable taste and interest.

People looking to meet Trekkies or truckers can turn to the Passions Network, which offers 110 individual online niches for daters to meet and mingle. The site includes space for those interested in mullets and mustaches, pirates and redheads.

“The marketplace as a whole seems to be moving toward niche community development,” said Michael Carter, president of Passions Network Inc. “The idea is to break the ice with people” over a common interest.

If there’s someone for everyone, there’s a Web site to help. Here’s a look at a few niche sites:

Calling itself a “reason for hope,” Ave Maria Singles offers a service for hard-line Catholics interested in sacramental marriage.

This dating Web site takes the unorthodox approach of featuring a bald, bearded monk’s endorsement on its home page. Ave Maria Singles also offers singles trips, like an upcoming excursion to the Holy Land or a singles cruise where daily mass is included in the cost.

Who you’ll meet: Guys like Bill, 24, from New Jersey, who spent one “grace-filled” year as a seminarian before realizing God didn’t want him to be a priest. He wanted him to be a husband.

“Half of my friends don’t understand why I pray the rosary, read encyclicals or visit the adoration chapel,” he writes. He’s looking for a “chaste” woman and it won’t hurt if you look the part.

“I get weak in the knees anytime I see a woman with a dress,” he writes. “When I see a veil on her head, I faint.”

This is the site for people staying positive though they’ve tested positive — for sexually transmitted diseases.

Registering for positivesingles.com involves identifying your STD (Herpes Type 1, syphilis and thrush are options) and checking a box for the disease you are looking for in your match (no preference is OK, too).

Beyond the personals, the site offers helpful forums, blogs and a live chat with an STD doctor.

Success story: “I just wanted to say that anything is possible, like finding the love of your life on Positive Singles,” wrote Spidersyren and jaxvilman. “We are engaged, I am pregnant and moving to Florida. And to think I thought life was over when I found out I had herpes!”

Billing itself as the “most popular Armenian singles sites on the Web,” Hye Singles is designed to connect singles to their “Armo soul mate.”

Who you’ll meet: Armenians and those who love them. Max_K, a 30-year-old from Buenos Aires, describes himself as “an Armenian guy, full of Armenian blood.” He’s prepared to do some traveling, “looking for Armenian girls all over the world.”

There’s a special “Ask Dr. Nuneh” section where the good doctor answers questions like “Sticking to Armenian?,” “Are Armenian women too materialistic?” and the more generic “Do we need more than love?”

July 1,2008

A collaborative study which included researchers from the Health Protection Agency (HPA) West Midlands and is published in the journal Sexually Transmitted Infections (STI), shows an increasing rate of sexual infections in people over 45 years in the West Midlands.

The study examined episodes of infection between 1996 and 2003 and found an upwards trend in the number of visits by over 45s attending Genitourinary Medicine (GUM) clinics for Sexually Transmitted Infections (STIs) in the West Midlands. In 1996, this age group comprised 3.9% of all clinic visits; by 2003, this had risen to 4.5%.

The study looked at regional data for the period 1996-2003 and focused on five STIs – chlamydia, genital herpes, genital warts, gonorrhoea and syphilis. 4445 STI episodes were reported among over 45s in this period. Overall, males and those aged 55-59 were significantly more likely to be affected.

Rates for all five STIs were significantly higher in 2003 compared to 1996, and the cumulative rate of infection more than doubled from 16.7 per 100, 000 of the population in 1996 to 36.3 per 100,000 of the population in 2003.

The most commonly diagnosed infection among over 45s was genital warts, accounting for almost half (45%) of the cases. Herpes was the next most common, affecting almost one in five (19%).

“Despite the increased political, public and professional recognition of the public health importance of STIs, and the documented increase in the number of visits to GUM clinics by over 45s, there have only been a few small scale studies addressing STIs in older age groups,” Dr Babatunde, Consultant Regional Epidemiologist with the Health Protection Agency West Midlands.

“The results of this study can be used by public health policy makers to improve sexual health programmes for older people,” he said. “Sexual health strategies have rightly focused on the under 25s but our results indicate that sexual risk-taking behaviour is not confined to young persons but is also an increasing trend in the over 45s” said Dr Olowokure. ”

Dr Olowokure added: “Older people are increasingly likely to be single or undergoing relationship changes and are less likely to consistently use condoms, perhaps because the risk of pregnancy no longer exists. Increased international travel, internet dating, new drugs to counter erectile dysfunction and overlapping sexual networks may also be factors. .These issues all warrant further exploration.

“Attitudes to sexual relationships are changing across the generations, and the increasing rate of infection seen in older age groups would indicate that they remain sexually active and at risk of sexually transmitted infections. It’s very important that health services and others recognize this and ensure that older age groups are not missing key ‘safer sex’ messages.”

The HPA now plans to work with its partners to investigate the social and behavioural patterns that may lie behind these findings.

HPA Expert: Consultant Epidemiologist Dr Babatunde Olowokure is available for comment for both print and broadcast journalists

Notes

Summary of the findings of this study:

- This study provides evidence of significant increases in attendance at GUM clinics by older persons
- Current public health policy and sexual health progammes do not adequately cater for older persons
- Results indicate that sexual risk-taking behaviour is not confined to young persons but also occurs among older persons.
- There is a need for good quality qualitative and quantitative research to support effective planning and implementation of sexual health strategies aimed specifically at older persons.

You’re never too old to get an STD

By Judy Rupp, commentary

Maria was offended when her daughter started to lecture her about safe sex. At age 78, she had been a widow for 11 years, and her relationship with Edward was filling an important need in her life.

“We are not going to get married,” she told her daughter, “because that would complicate matters with our property and our children. And I’m too old to get pregnant. So what is it that you’re so worried about?”

“STDs,” her daughter answered. “Sexually transmitted diseases.”

An AARP survey in 2007 found 85 percent of Americans 65 and older had some kind of intimate experience at least once a week; less than 5 percent considered themselves “too old” for sex. And sexually transmitted diseases are spreading rather rapidly among the senior set. According to Centers for Disease Control, at least 10 percent of new AIDS cases every year occur among persons age 50 and older.

One reason for the change in attitude among seniors regarding sex — if there has indeed been a change — may be the introduction of erectile dysfunction (ED) drugs Viagra, Cialis and Levitra. ED affects at least 25 percent of males by age 65, and that percentage increases with each passing year.

For many of the erectile problems facing older males, these drugs have a high rate of effectiveness. But they do not protect against sexually transmitted diseases.

Unlike the younger generations, most older Americans did not have the benefit of sex education in school. And after several decades of a monogamous relationship, they may not have bothered to inform themselves about STDs. One survey found 47 percent of women older than 50 knew little or nothing about AIDS.

The most reliable protection against STDs is the use of condoms. Women past child-bearing age do not think readily of condoms. And even with the help of Viagra, many older men may find them tricky to use effectively.

AIDS: There are more than 20 sexually transmitted diseases, and, while many of them can be cured easily with antibiotics, they often go undetected. And nearly all of them increase the risk of AIDS.

With a weakened immune system and thinning of vaginal walls, an older person may be more vulnerable than a younger person to HIV, and early symptoms are sometimes difficult to distinguish from changes associated with aging or with chronic medical conditions. Dementia, ordinarily a very late symptom of AIDS, is the presenting symptom for as many as 10 percent of cases in persons older than 60.

In addition to ignorance, seniors are hampered often by denial. A married man who is having extramarital gay sex or sex with a prostitute is not going to want to admit it to his family or even to his doctor. A widowed or divorced male who is dating regularly likewise may be reluctant to admit he is having sex with multiple partners.

Major risk factors for STDs, in addition to failure to use condoms, are: 1) sex with multiple partners and 2) sex with someone who is having sex with multiple partners. Both of these scenarios are becoming increasingly common among seniors in the community and even those in nursing homes and assisted living facilities. As Maria’s daughter reminded her, the rules of safe sex — including mutual monogamy — hold regardless of age.

SYPHILIS: Once the most feared of STDs, syphilis still is around and still highly contagious, although treatable with antibiotics. Left untreated, syphilis can lead to severe neurophysical impairments such as complete or partial paralysis, progressive dementia, blindness or deafness.

GONORRHEA, CHLAMYDIA: Gonorrhea often is detected by painful urination or discharge from the penis or vagina. More than a million infections occur each year in the United States, and about 60 percent of patients with gonorrhea also have a chlamydia infection. Chlamydia, the most commonly reported STD in the United States, can increase the risk of sterility, pelvic inflammatory disease and ovarian cancer as well as HIV.

HERPES: About 45 million Americans are infected with a herpes virus. Herpes simplex type 1 (HSV-1) usually causes cold sores and fever blisters around the mouth. Herpes simplex type 2 (HSV-2), is genital herpes.

It once was believed HSV-1 was transmitted primarily above the waist. A recent study found women who received oral sex were nine times more likely than abstinent women to become infected with HSV-1. Vaginal sex increased the risk six-fold. The study could not prove kissing was not the means of transmission.

HPV or human papillomavirus can be spread by intimate skin-to-skin contact that does not necessarily include sexual intercourse. That’s a type of intimacy probably relatively common among older adults. And it is not necessarily prevented by use of condoms.

Although usually manifested in genital or anal warts, HPV often exists with no symptoms or with warts that disappear after a few years. As a result, many individuals are infected without knowing it. On the other hand, only a few of the many strains of warts that can occur in the genital region or elsewhere on the skin are precursors of cervical cancer.

The important thing for health care professionals and adult children to keep in mind is sex is a drive that does not stop at a certain age, at least for most adults. Nor should it stop. Sexual intimacy provides pleasure and a sense of self fulfillment; and research has found regular sex helps prolong life.

Whatever message Maria gave to her daughter years ago, the message her daughter is giving back today is not abstinence but “keep yourself safe.”

Rupp is information and assistance case manager with the Northern Oklahoma Development Authority Area Agency on Aging.

Genital Herpes: A Common Infection
Women’s HealthBy Dr. Kenneth Noller, MD

Genital herpes is a sexually trans-mitted disease (STD) that affects approximately 50 million Americans. One in four US women has genital herpes, and up to 90% don’t know it. An outbreak of herpes sores is the most tell-tale sign of infection, but while some women will have several outbreaks a year, others will only have a few outbreaks in their lifetime, and many will have no symptoms at all.

The first outbreak usually occurs within 2–10 days of exposure to the herpes virus and is often longer and more severe than any that will follow. You may experience flu-like symptoms, such as swollen glands, fever, muscle aches, and chills. A painful cluster of small blisters—which turn into sores and heal without scarring—may form on the genitals, buttocks, or other areas, near the original place where the virus entered your body.

Herpes is most accurately diagnosed during an outbreak when a sample from a sore can be taken for lab analysis. If you notice herpes-related symptoms, contact your doctor right away. A blood test can also be used to detect the presence of herpes-fighting antibodies.

Outbreaks can be triggered by emotional or physical stress or when your immune system is worn down, such as after a cold or illness. Try to get plenty of rest, eat a balanced diet, and learn how to cope with stress to help you minimize flare-ups.

During an outbreak, try to keep sores clean and dry. A hair dryer on a low setting can dry sensitive or hard to reach areas. Wear loose-fitting cotton underwear and take aspirin or acetaminophen for pain.

Remember that you can spread herpes even when you’re not having an outbreak. Condoms may help prevent you from giving or getting herpes, but the virus can still be passed if a sore—or even a cold sore—comes in contact with skin on the genitals that is not covered by a condom.

Many people who have herpes experience a recurring group of symptoms, or a “prodrome,” a few hours before blisters appear. You may feel a tingling, itching, or burning sensation in the area where your outbreaks occur, or pain in your lower back, buttocks, and legs. It’s best to avoid sex if you notice prodromal symptoms.

Herpes infections in infants can cause serious problems, such as brain damage or eye problems. An infant can contract herpes if it is delivered vaginally while the mother is having an outbreak. Women may be prescribed medication to control outbreaks toward the end of pregnancy. Cesarean delivery may also be an option for women who have an active outbreak.

Genital herpes is a common and manageable disease, but there is no cure. Outbreaks and discomfort can be reduced with oral medications. Online or in-person support groups may help you cope with the disease.

April is STD Awareness Month. To learn more about herpes and other STDs, visit the American Social Health Association at http://www.ashastd.org.