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张唯一
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- 2009-10-14
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发表于 2009-10-14 13:12
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Steven.H教授关于常见生殖器疱疹问题的汇总-可解答99%的问题 生殖器疱疹, 疱疹, hsv, herpeslect看完疱疹战友吧翻译的这篇文章就知道,国内绝大部分医生和国内网站上刊登的生殖器疱疹常识都是错误的,中国对生殖器疱疹的研究和国外差距已经越来越远,仍停留在七、八十年代的认知上,希望能让更多人了解生殖器疱疹的真相，也希望引起有关部门的重视。
以下为美国HSV 权威研究专家Steven.H教授关于HSV疱疹病毒常见问题的汇总，Steven是我的导师，有几十年的美国知名STD（性传播疾病）诊所临床经验并对HSV进行过深入的研究，该问题解答汇总发表于他的医患交流留言版，经允许由本人翻译并在生殖器疱疹战友吧发表，希望其他网站转载能注重版权，尊重作者和本人的劳动。——written by Prof Steven.H，生殖器疱疹战友吧(paozhen8.com)站长医师郭晋军翻译整理
注:翻译作品为本人导师原创,谢绝转载,如发现转载或篡改,本人将采取法律手段.
问题1：HSV-1和HSV-2两种疱疹病毒有何区别？
回答：HSV-2病毒是引起生殖器疱疹的主要病毒，并且它总是通过与其他人的生殖器（或者肛门）接触而感染；HSV-1病毒是引起口腔和唇部疱疹（通常表现为水泡或溃疡）的病毒。同时还通常通过病毒感染者为他人提供口交的途径，引发被感染者的生殖器感染HSV-1病毒而患生殖器疱疹，这种感染占原发性生殖器疱疹感染的50%。感染HSV-2型的生殖器疱疹经常会复发，尽管有时会没有症状，而感染HSV-1型的生殖器疱疹很少复发。因此，绝大多数复发性生殖器疱疹是由于感染HSV-2型病毒感染的。
Q1. What is the difference between HSV-1 and HSV-2?
A. Herpes simplex virus HSV type 2 (HSV-2) is the usual cause of genital herpes and is always acquired by genital (or anal) contact with another person. HSV type 1 (HSV-1) is the cause of herpes sores on the lips and in the mouth (often called fever blisters or cold sores). It also causes up to 50% of initial genital herpes infections, usually acquired during oral sex. Genital HSV-2 infection almost always recurs frequently, with or without symptoms, whereas HSV-1 genital herpes reactivates infrequently. Therefore, the large majority of recurrent genital herpes is due to HSV-2.
问题2：我去找了一家按摩房的性服务提供者，她为我提供了无保护措施的口交服务，我感染生殖器疱疹的机会是多大？
回答：一般来说，通过任何单单一次的口腔-生殖器的接触，感染HSV-1型生殖器疱疹的几率非常低。然而在没有更多详细资料的情况下，不可能知道准确的概率。感染几率的大小取决于性服务提供者是否患有口腔和唇部疱疹，以及口腔和唇部疱疹病毒（HSV-1）当时是否在发作期；如果她当时有正在发作期的口腔和唇部疱疹溃疡或水泡，那么感染生殖器疱疹的概率会相当大。但是这仍取决于你是否和这个世界上近一半的人一样，以前身体的任何部位早已经感染过了HSV-1型病毒，（因为近一半的人儿童时代或成年后都感染过HSV-1型的口腔和唇部疱疹），如果你以前已经感染过，那么通过接受这次口交而感染生殖器疱疹的几率就为零，因为你的身体对再次感染已经产生免疫。另外，通过口交不会感染HSV-2型生殖器疱疹。
Q2. I visited a sex worker at a massage parlor. She performed unprotected oral sex on me. What are my chances of contracting herpes?
A. On average, the risk of acquiring genital herpes simplex type 1 (HSV-1) infection is very low for any single episode of oral-genital exposure. However, it is impossible to know for sure without more information. The risk of course depends on whether or not the sex worker has an oral HSV-1 infection and whether or not she had an outbreak at the time; the risk would be quite high if she had an active cold sore. But it also depends on whether or not you already are infected with HSV-1 (of any part of your body)—as does half the population. If so, there is no risk; you are immune to catching it again. There is no risk of acquiring genital HSV-2 infection from oral sex.
问题3：生殖器疱疹的症状是什么？什么时候出现？
回答：生殖器疱疹症状的初次发作，通常发生在感染后2-10天内，症状一般持续2-3周。初次发作时，如果不经过治疗，患处一般会发作（即发红、刺痒、也可能疼痛）1-2周，然后再经过7-10天会完全愈合，所以从发作到愈合的整个过程一般在2-4周。复发症状的周期会更短，典型的一般在7-14天。初发的症状有非常多种形式，包括:发生在阴茎、阴道、宫颈、肛门、臀部或者极少数情况下身体的其他任何部位上的水泡或溃疡。经常是首先出现一个小的红色的丘疹，然后发展成为水泡，继而变得疼痛，发生溃疡。经过几天后，溃疡会结痂，最后直至愈合。在比较潮湿的区域，如阴道口、阴唇或肛周附近，痛处会发展得较快并且很快发展成感觉很疼痛的表面溃疡。初次发作通常也会引起双侧的症状，即在生殖器官、肛周地区等两侧都都有症状，并且腹股沟附近两侧的淋巴管可能会肿胀。而复发则一般都只发生在一侧，并且通常不会发生淋巴肿胀的现象。通常症状非常轻微或者没有特别的感觉，比如发痒、疼痛、象类似轻微擦伤的皮损，或排尿时疼痛，因此疱疹很容易被误认为其他问题，例如霉菌感染，股癣、尿道感染或其他类似问题。不是所有感染生殖器疱疹的人都有这些症状，很多人根本没有一点症状。然而，所有因HSV-2病毒感染生殖器疱疹的人都有“无症状排毒”期，在“无症状排毒”期内他们将可能传染给他们以前尚未被传染的性伴侣。
Q3. What are the symptoms of herpes? How soon do they show up?
A. The symptoms of a first outbreak of genital herpes usually appear 2 to 10 days after exposure to herpes and last an average of 2 to 3 weeks. With the first infection, without treatment the sores typically are active (that is, red, irritated, perhaps painful) for 1-2 weeks, then take another 7-10 days to heal completely, so total time from onset to complete healing generally pmtis 2-4 weeks. Recurrent outbreaks are briefer, typically 7-14 days. Symptoms of a first genital herpes infection vary widely and may include any of the following: blisters or other sores on the penis, vagina, cervix, anus, buttocks, or (rarely) elsewhere on the body. Small red bumps usually appear first, then develop into blisters, and then become painful, open sores. Over a period of days, the sores may scab over. Finally, they heal. In moist areas, such as around the vaginal opening, labia, or around the anus, lesions often rapidly develop into open sores that can be especially painful.First episodes often cause lesions bilaterally, that is on both sides of the genitals, anal area, etc swollen lymph glands in the groin. Recurrent outbreaks almost always are limited to once side or the other—up to but not across the body’s midline and lymph gland swelling usually is absent. Often symptoms are mild or nonspecific, such as itching, irritation, or scratch-like sores, or painful urination, so that herpes can easily be mistaken for other problems, such as yeast infection, jock itch, urinary tract infection, and others. Not everyone has all these symptoms and many infected persons have no symptoms at all. However, everyone with genital HSV-2 infection has periods of “asymptomatic shedding of the virus, when they can transmit herpes to their uninfected sex partners.
问题4：既然这样那我被传染了疱疹但是我没有症状，是不是意味着我会永远都不出现疱疹的症状？
回答：您以后可能不会也可能会。生殖器疱疹通常在感染后初发时有可以察觉到并且持续时间较长的症状。事实上，有40%的人第一次发现生殖器疱疹发作从而意识到自己感染了HSV-2时，他已经被感染了好几个月甚至好多年。还有一些感染者从来不发生任何症状，或者症状非常轻微或不典型，以至根本没有注意到。
Q4. So if I think I contracted herpes but I have no symptoms. Does that mean I never will have symptoms?
A. You might or might not. Genital herpes often first causes recognized symptoms a long time after acquisition. In fact, 40% of persons with the first known outbreak of genital HSV-2 infection have been infected for several months or years. Some infected people never develop symptoms, or have such mild or atypical ones that they don’t notice them.
Q5. How early can I take a test to determine if I caught herpes?
A. If there are fresh herpes lesions, the best diagnostic method is to take a sample from the sores to test for the virus, usually by culture. But when the culture is negative or if there are no lesions at the time, a blood test can detect antibodies to HSV – that is, the body’s reaction to the virus. However, it takes a few weeks for antibodies to develop. Most infected people have positive blood tests by 4 weeks after infection, but it can take up to 12 weeks and, rarely, up to 4-5 months. But about 90% of infected people become positive by 6 weeks. All this depends on having the right test; see Question 6.
问题5：最快多久可以通过检验来确定自己是否感染了疱疹？
回答：如果有已经发生的症状，最好的诊断是从症状处取样来检测病毒，通常医生采取的是“培养法”。但是如果通过“培养法”得出的诊断是阴性或当时没有发生疱疹的症状，则通过血清测试可以检测到是否血液中已产生HSV病毒的抗体，即身体对病毒的反应，从而判断是否感染了疱疹。然而，从身体感染了HSV病毒到产生出抗体，需要几周的时间。大部分感染者感染后需4周左右才能在血检中查出抗体阳性，但也有的最长需12周，甚至极少数人需4-5个月。但是约90%的人从感染到血检可以检出阳性的时间为6周。当然这一切都取决于准确的检验，参考问题6。
Q6. What blood tests are available to diagnose HSV infections?
Several blood tests are offered by various laboratories, and many health care providers don't know the differences between them. The accurate ones are the HerpeSelect test, produced by Focus Technologies; biokit-HSV-2, produced by Biokit USA; and the Western blot HSV test, which is used by research labs and isn't very often commercially available. Be sure that one of these was used; if not, then your result might be falsely positive. As of this writing (May 2005), no other test commercially available in the U.S. accurately distinguishes HSV-1 from HSV-2 infection. Happily, more and more laboratories in the U.S. now do the HerpeSelect test routinely. But if in doubt, ask the health care provider and be sure the right kind of test was done. (A common clue that the right kind of test wasn’t done is a result for “IgM” [immunoglobulin M] antibody. The accurate tests are only for IgG antibody; contrary to earlier beliefs, the presence or absence of IgM antibody to HSV-2 has no diagnostic value.)
问题6：哪种血清检查能够检测出HSV感染？
回答：有几种血清检测试剂由各个实验试使用，而很多诊所不了解他们的区别。精确的几种是Focus Technologies生产的Herpeselect，Biokit USA生产的Biokit-HSV-2，以及仅用于疱疹研究实验室而很少用于商业用途的Western blot的疱疹检测。（paozhen8.com按:其中Herpeselect和Biokit-HSV-2是通过美国FDA-“FDA是美国食品药品管理局的缩写，相当于中国的卫生部，但比中国卫生部负责多了”-认证的。对于FDA认证的严格性、通过FDA认证的难度，以及通过FDA认证意味着什么，大家可以查询相关资料和文章。Western blot是最准确的，但是仅在美国一家大学内由科研实验室使用，并且成本非常高，不作为商业使用）接受检测时你必须确认医疗机构使用的是以上几种之一，否则你的检测结果很可能是不准确的。在这篇文章写作时，美国国内没有其他可供商业使用的检测试剂可以准确区分HSV感染者感染的是HSV-1还是HSV-2病毒（paozhen8.com按，后来Trinity试剂也已于2004年8月获得FDA认证和批准因此目前通过FDA认证的HSV检测试剂已有三种：Herpeselect、Biokit-HSV-2和Trinity，三者中仍以herpeselect检测结果最精确）。幸运的是目前美国越来越多的实验室已经将herpeselect检测作为常规检查项目（paozhen8.com按:目前中国国内只有几家医院使用了Herpeselect，因此大部分医院用的试剂的准确性都不合格，这也就是为什么国内一些有责任心的医生不把血液检测结果做为诊断依据的原因，因为国内使用的试剂假阳性和假阴性都非常高，甚至准确率在50%以下，而他们大多数还未知道herpeselect产品，因此HSV的血检在国内很少普及。）如果怀疑你所接受检测的准确性，那就询问医疗机构是否用的是herpeselect检测。（最容易区分是否接受的是正确检测的办法是看检测结果上是否有IgM-immunoglobulin M抗体的检测结果，因为准确的测试只针对IgG抗体，原因简单的说是因为，检测Igm抗体的存在与否对于检测是否感染HSV-2没有意义。）（paozhen8.com按：目前国内绝大部分医院HSV的检测结果仍分为IgM和IgG两项，其实是不正确的，因此只要看到检测结果上有IgM一项就说明这个检测是不科学的。）
Q7. How reliable is the HerpeSelect test? If I test negative should I still worry I have herpes?
A. Once enough time has passed for antibodies to develop – that is, 6-12 weeks, rarely up to 4-5 months - either a positive or negative result for HSV-2 in over 95% of people.
问题7：Herpeselect检测值得信赖吗？如果我检测结果为阴性我还用担心我是否感染了HSV病毒吗？
回答：只要时间过了抗体产生的最低时间（paozhen8.com按：即窗口期，就是已感染病毒而体内尚未产生足够抗体以至血液检查无法检测出病毒抗体的这段时间），即6-12周，极少数人需要4-5个月，无论是阳性还是阴性结果其准确性都在95%以上。（paozhen8.com按：herpeselect升级后，准确率已达到98%以上。）
Q8. Will I have reoccurring outbreaks of my genital herpes?
A. In most people with genital herpes due to HSV-2, the virus reactivates from time to time and causes symptoms. The frequency and severity of the recurrent episodes vary greatly. Most persons with HSV-2 have 3-6 outbreaks a year, but some people have 10 or more episodes annually. Over several years, the frequency of outbreaks tends to decline. HSV-1 genital infection recurs much less frequently than HSV-2. Among people who acquire genital infection with HSV-1, about 40% have no recurrences at all and most of the rest experience just 1 or 2 outbreaks over the next 1-2 years, then none at all. Fewer than 10% of people with genital HSV-1 have continued outbreaks after that. For genital herpes due to either virus, recurrent episodes occur most often in the first year after initial infection.
问题8：我的生殖器疱疹会复发吗？
回答：对于大多数感染HSV-2型生殖器疱疹的人来说，病毒会反复复发并且引起症状。复发的频率和复发症状的严重程度在不同的人之中差别非常大。大部分感染HSV-2的人一年之中复发3-6次，但是一些人可能一年中发作十次或十次以上。在几年内，复发的频率倾向于越来越减少。相对HSV-2型生殖器疱疹，HSV-1型生殖器疱疹复发的现象要少得多得多。在感染HSV-1型生殖器疱疹的人群中，大约40%根本没有复发，其余大部分在感染后的1-2年内只复发1-2次，然后不会再复发。感染HSV-1型疱疹的人中少于10%的人会在1-2年后仍持续复发。不论是HSV-2型或是HSV-1型生殖器疱疹，在原发感染后的第一年中复发最为频繁。
Q9. What about asymptomatic shedding? How frequent is it and how long does it last?
A. The frequency of asymptomatic shedding parallels that of symptomatic outbreaks. There is little asymptomatic shedding in people with genital herpes due to HSV-1 (and therefore not much risk of transmitting herpes to their partners). For genital herpes due to HSV-2, every infected person sheds virus without symptoms from time to time. Just as symptomatic outbreaks are most common in the first months or years after catching the infection, asymptomatic shedding is most frequent in the first year. It isn’t known how long asymptomatic shedding goes on, but in most infected it probably continues for at least several years. Asymptomatic shedding isn’t present all the time, but occurs on and off (and unpredictably). This is why every person with genital herpes due to HSV-2 needs to inform his or her sex partner or partners, so that those persons are aware of the risk.
问题9：关于无症状排毒的情形是什么样？无症状排毒的频率如何以及每次持续多久？
回答：无症状排毒的频率与有症状的复发频率相似。感染HSV-1型生殖器疱疹的病人很少会有无症状排毒的现象（因此传染给他们伴侣的风险就不会很高）。对于HSV-2型生殖器疱疹，每一位感染者都会反复发生无症状排毒。正如有症状的复发在刚感染后的第一个月或第一年内频率最密集一样，无症状排毒在第一年内发生最频繁。目前还不清楚无症状排毒会在感染多久后才不会发生，但是在大多数感染者中至少在感染后几年内会反复发生。无症状排毒并不是一直在进行着，而是时断时续（并且无法预测）。这就是为什么每个感染有HSV-2的患者需要告诉他的性伴侣的原因，这样可以使伴侣明了他们应该知道的风险。
Q10. What treatments are available and how good are they?
A. No available drugs or other treatments cure herpes, i.e. eliminate the virus from the body. However, three drugs are highly effective in speeding healing of the first infection, preventing recurrences, and, to a lesser extent, healing recurrent outbreaks. These are acyclovir (trade name Zovirax, also available generically); valacyclovir (Valtrex), which actually is a variation of acyclovir that produces higher levels of the drug in the system; and famciclovir (Famvir). They are all about equally effective; the differences are in dosing frequency and cost. (Actual cost varies widely, and the drug that is least expensive in one city or pharmacy might be the most expensive in another.) There are topical versions of acyclovir and famciclovir (actually, penciclovir, the active ingredient in the latter drug) – that is creams or ointments to put directly on herpes lesions. However, they have little effect; most people who need treatment should take one of the drugs by mouth. Do not be tempted by other products sold in health food stores, over the counter, or online. Such things like Blistex, lysine, or various vitamins or “immunity boosters” have no effect whatsoever and are a waste of your money. To my knowledge, there are no drugs in the research pipeline that are likely to truly eradicate HSV infection, and none that are likely to be any better than acyclovir, valacyclovir, or famciclovir.
问题10：有哪些治疗方式，以及效果如何？
回答：目前没有药物和其他治疗方式可以治愈疱疹，即完全从体内清除这种病毒。但是三种药物对于加速初发症状的愈合，最大限度的防止复发频率和程度以及治愈复发有非常显著的效果。它们是阿昔洛维（商品名叫Zovirax，不是这个品牌的也可以）、valacyclovir (Valtrex)，实际上是一种品质较高的阿昔洛维、famciclovir (Famvir)。他们的疗效差不多都一样，不同之处在于服药的剂量、频率以及价格。（实际上价格差异非常大，并且可能其中一种药在某地是最便宜的但是在另一个地方却是最贵的。）目前有一种倍受谈论的阿昔洛维和famciclovir的药品形式（事实上是penciclovir，一种最近药物中比较流行的成分）。即在疱疹患处直接涂抹的药霜或药膏。然而他们的效果很小，大多数需要治疗的患者应该服用上述三种药物中的口服药剂。不要被健康食品店在柜台或网上卖的其他产品迷惑。比如Blistex、赖氨酸、或者各种维他命以及“加强免疫力”的产品，它们根本没有任何效果，只是对你钱财的一种浪费。以我所知，目前没有任何在研发中的药物可能真正完全根除HSV感染，也没有任何药物可能会比阿昔洛维、valacyclovir、 或者 famciclovir效果好。
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