回复: 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
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。
Q11. I have herpes and want to be careful not to transmit it to anyone else. What can I do?
A. There are three main strategies to prevent transmission of genital herpes to sex partners. First, avoid sex when having an outbreak. For people with mild or subtle symptoms, this means being on the lookout for even mild symptoms. Second, use condoms. Condoms aren’t perfect, but provide substantial protection. The third approach is to take suppressive antiviral therapy, which not only helps control symptoms, but helps prevent transmission. Suppressive treatment with alacyclovir (Valtrex) has been proved to prevent transmission, and therefore is the drug of choice for this purpose. However, the other anti-herpes drugs, acyclovir (Zovirax and others) and famciclovir (Famvir) probably are helpful as well. By itself, none of these strategies to prevent transmission is perfect. However, using two or more of them probably is effective the large majority of the time. Because prevention isn’t perfect, even if they take all these precautions, people with genital herpes have a moral obligation to tell any and all partners they have the infection, before having sex with them. At the same time, using one or more of these methods, some couples go for several years without transmission despite frequent intercourse.
问题11：我感染了疱疹，我希望注意不要传染给其他人，我该怎样做？
回答：主要靠三种方法来防止生殖器疱疹传染给性伴侣。第一，当生殖器疱疹发作时避免发生性生活。对于症状很轻微或者非典型症状的人来说，即使症状非常轻微时也要做到这一点。第二点，使用安全套。安全套不是完全有效的，但是却可以提供最实质性的保护。第三是采用抗病毒抑制疗法，这种疗法不仅可以帮助控制症状，还有助于防止传播。使用alacyclovir(Valtrex)的抑制性疗法已经被证实可以有助于防止传播，因此出于此目的应该选择这种药物。但是，其他抗疱疹的药物，阿昔洛维（Zovirax和其他同类成分药物）和Famciclovir(Famvir)应该也一样有效果。上述方法仅单独使用，没有哪种对防止病毒传播完全有效。但是，使用两种或以上方法将大大提高有效性。由于防护措施不可能做到完全有效，因此即使上述预防方法全部都有采用，感染生殖器疱疹的人在与每一个和全部性伴侣发生性关系前仍有道德上的责任去告诉对方自己感染有HSV病毒。同时，在使用了上述一种或更多方法后，一些夫妻很多年内都未发生病毒传播，即使他们性生活的频率很频繁。
Q12. Is there a vaccine to prevent herpes?
A. Research has been going on for many years on vaccines to prevent HSV-2 infection. An experimental vaccine is currently in clinical trials. At best, this vaccine will be only partly effective in preventing infection. If the research results are positive, it will be at least another 3-4 years before the vaccine is available.
问题12：有可以预防疱疹的疫苗吗？
回答：研究能预防HSV-2感染的疫苗工作已经进行很多年。一种实验性的疫苗目前正在临床试验。充其量这种疫苗也只能对于防止感染有部分效果。如果研究结果证实这种疫苗是有效的，仍需要再过3-4年时间才可以真正可供使用。
Q13. Can I transmit oral herpes to my own genitals, eyes, or elsewhere?
A. During an initial HSV infection, sometimes the virus is transmitted by the hands to another part of the body, such as they eye (herpetic keratitis, which if untreated can seriously damage the cornea and lead to blindness) or a fingertip (herpetic whitlow). However, once the infection has been present a few weeks, it is almost impossible to auto-inoculate the virus to another part of the body. For example, people with oral cold sores do not transmit the virus to their genitals by masturbation; and persons with recurrent genital herpes almost never self-infect the eye or other body parts. However, because eye infection is so dangerous, to be extra safe, persons with oral or genital herpes are advised to wash their hands frequently and to try to avoid touching their lesions and then their face. But even so, the risk is extremely low.
问题13：我会把我的口腔疱疹传染到自己的生殖器，眼睛或其他部位吗？
回答：在HSV原发感染期间，有时候病毒可以通过手传播到身体的其他部位，例如眼睛（疱疹性角膜炎，如果不治疗会严重损害角膜并且致盲）或者手指（疱疹性素瘤）。然而，一旦感染已经存在几个星期以后，几乎不可能再自动接种病毒到身体的其他任何部位上。比如，口腔疱疹的人不会因为手淫而将病毒传染给自己的生殖器官；生殖器疱疹复发的人几乎不会再自身接种到眼睛或身体其他部位。然而，因为眼部感染非常危险，因此为了完全安全起见，建议有口腔或生殖器疱疹的人经常洗手，并且尽量避免接触患处后接触脸部。但即使接触到，传染的风险也极低。
Q14. Do people catch genital herpes through other means other than sex?
A. No. You need not worry about catching genital herpes by sharing the bathroom, toilet, shower, etc with an infected person. On common-sense grounds, it is wise to avoid using the same moist towel immediately after someone whom you know to have genital herpes dries themselves, but even there the risk is extremely low. The folklore about toilet seats and other kinds of nonsexual acquisition originated before we knew that HSV could be transmitted when a person had no symptoms, and before we knew that people could catch herpes then show no symptoms for a long time. So when herpes appeared in a person who hadn’t had sex for a long time, or in a monogamous person whose partner apparently didn’t have herpes, it was assumed the infection was acquired by non-sexual means. But it just doesn’t happen. There is one important exception: babies born to infected mothers can catch neonatal herpes, a very dangerous infection that sometimes is fatal.
问题14：除了性行为，人们会通过其他方式感染生殖器疱疹吗？
回答：不会。不用担心会因为与感染者共用浴室、厕所、淋浴等而感染生殖器疱疹。从一般常识性的角度来说，避免立即使用你所知道的生殖器疱疹患者刚使用过的湿毛巾是明智的做法，但即使这样做了风险也是极端之低。在我们知道HSV可以在患者没有任何症状时而传播给其他人之前，以及知道人们感染生殖器疱疹后可能一段时间内没有任何症状之前，就会经常误以为通过厕所坐垫以及其他性行为以外的方式可能会传染。（paozhen8.com按：这种误解在国内很普遍，很多国内网站都认为生殖器疱疹可以通过性行为以外其他方式感染，是因为他们不清楚HSV可以无症状排毒，可以被感染后相当长的时期内没有症状，因此不能找到传染的原因，只能怀疑是通过其他方式传染。）因此当一个在很长时间没有性生活的人出现生殖器疱疹症状时，或一个一直坚持一夫一妻的人出现生殖器疱疹症状，而他的配偶从没有出现过疱疹症状（paozhen8.com按：注意“没有出现”不等于“不患有”），就会猜想是通过性传播以外的途径感染。但事实上不是这样。但有一个很重要的例外情况：感染病毒的母亲生出的婴儿会被感染先天性疱疹，先天性疱疹是非常危险的一种感染，甚至会致命。
Q15. Is herpes a lifelong virus or will it ever go away?
A. Once a person has HSV-2, the virus is believed to persist for life.
问题15：疱疹是否是终生性的病毒，是否可以清除？
回答：一旦感染了HSV-2，可以确信病毒将在患者有生之年一直存在于他体内。
Q16. You tell people who have HPV that it’s not necessary to forever inform future partners long after their warts/symptoms go away. So that means I don’t need to inform future partners about my herpes, right?
A. Wrong. Human papillomavirus (HPV) usually goes away after several months; although the virus may persist, it generally does so in amounts that cannot be transmitted to sex partners. Herpes is different; the virus persists for life and is transmissible to partners (on and off) for many years. Whether infectivity lasts for a whole lifetime, however, isn’t known. Therefore, anybody who has reason to believe s/he may have genital herpes has an ethical obligation to inform current and future sex partners before having sex, even if s/he isn’t having an outbreak at the time, intends to use a condom, or is taking antiviral therapy.
问题16：你告诉那些曾经感染过HPV但已经很长时间没有再出现湿疣及其他症状的人们没有必要将自己的感染告之未来的伴侣。那么同理我也不需要告诉我未来的伴侣关于我患有疱疹的情况，对吗？
回答：不对的。人乳头状瘤病毒（HPV，paozhen8.com按：引起尖锐湿疣和宫颈癌的病毒）通常在感染几个月以后被清除；尽管病毒可能仍继续存在，但一般来说数量已经微乎其微因此不会传染给性伴侣。疱疹就不同；病毒会在病人体内永久存在并且在很多年内具有传染性（时断时续），尽管目前还不知道传染性是否会持续一生。因此，任何有理由确认自己有可能患有生殖器疱疹的人在道德上有义务在与现在及以后的性伴侣发生性关系前告诉对方，即使目前并没有发作，并打算用安全套，或正在进行抗病毒治疗。
Q17. I’m pregnant, and I have genital herpes. What should I do?
A. Women with longstanding recurrent genital herpes are at low risk for transmitting the virus to their babies. To be safe however, a cesarean section often is done if a woman with recurrent herpes has an outbreak when she goes into labor. (A cesarean section delivers the baby by surgery, so the infant does not pass through the vagina.) Any pregnant woman with genital herpes, or whose partner has either genital or oral herpes, should inform the doctor or other clinician providing care for the pregnancy. Many obstetricians now prescribe acyclovir to pregnant women with herpes during the last month before delivery. This helps prevent outbreaks, and therefore can prevent an otherwise unnecessary cesarean section.
问题17：我是孕妇，并且我患有生殖器疱疹，我应该怎样做？
回答：如果一个妇女已经患有复发性质的生殖器疱疹很长时间，那么她将病毒传给婴儿的风险是较低的。然而为了安全起见，当临产时发生疱疹复发时一般采用剖腹产方式。（剖腹产通过手术接生婴儿，因此婴儿不用经过阴道。）任何患有生殖器疱疹的孕妇，或者其伴侣患有生殖器或口腔疱疹，应该告诉医生及为怀孕提供照理的医疗机构。对于患有疱疹的孕妇，很多产科医生在她们分娩前一个月让她们服用阿昔洛维。这可以帮助防止复发，因此可以避免不必要的剖腹产。
Q18. I’m pregnant and haven’t had herpes, but my husband or partner has herpes. Should we do anything?
A. Yes! By far the greatest risk for neonatal herpes occurs when a woman first catches herpes when pregnant, especially in the last trimester. If your partner has genital herpes, you should avoid intercourse after the 6th month; if that isn’t practical, be sure your partner uses condoms consistently or takes suppressive antiviral therapy (preferably both). Even better, get a blood test: if your test is negative for HSV-2, take the precautions I just outlined. But if the result is positive, you don’t need to worry about getting a new infection from your partner; your risk of transmitting herpes to your baby is low (although your obstetrician will want to be on the lookout for herpes outbreaks as your due date approaches). Similarly, if your partner has oral herpes (due to HSV-1), and your own blood test is negative for past HSV-1 infection, you must not receive oral sex during the last 3 months of your pregnancy.
问题18：我是孕妇并且没有患有疱疹，但是我的丈夫或伴侣患有疱疹。我们要采取什么措施吗？
回答：是的！对于先天性疱疹最大的发生风险是在妇女怀孕时初次感染疱疹，特别是在最后三个月。如果你的伴侣有生殖器疱疹，你应该在怀孕6个月后避免和他性交。如果实际上做不到，那要保证你的伴侣一直使用安全套或者进行压抑性抗病毒治疗（最好以上两种方式都使用）。当然进行血液检测更好，如果你的HSV-2检测结果为阴性，就按照我刚才提到的预防措施处理。但是如果结果为阳性，那么你不必担心会从你的伴侣那获得新的感染；你传染疱疹给你的胎儿的风险非常低（尽管你的产科医生在你产期临近时仍会密切留意你的疱疹是否会发作）。同样的，如果你的伴侣有颜面疱疹（由HSV-1引起）
（paozhen8.com按：即口腔疱疹或唇疱疹，他们都由HSV-1引起），而你自己的血检结果说明你的HSV-1为阴性，即以往未曾感染过HSV-1，那么你在你孕期的最后3个月必须避免接受口交。
Q19. I feel ashamed and dirty I have herpes, is it common?
A. Don’t feel ashamed. An estimated 25% of adult Americans (1 out of 4) have genital herpes. Each year, 500,000 to a million new infections are believed to occur. Studies show that most people with genital herpes do not realize they are infected; they either have never had symptoms or have not recognized their symptoms as herpes.
问题19：我因患有疱疹而感到羞耻和肮脏，疱疹是很常见的吗？
回答：不要觉得羞耻。大约25%的成年人（1/4）患有生殖器疱疹。（paozhen8.com按：这是来自美国CDC对美国人口调查的权威统计，但是不适用于中国。由于大部分感染HSV的人并没有任何症状，同时因为此也更加强传染的隐蔽性。因此国内感染HSV的人数应该不在少数，保守估计约在1/100以上，但由于herpeselect检测试剂未在国内普及，未能进行实际抽样统计。）每年，确信有50万到100万的新感染发生。研究证明大部分感染生殖器疱疹的人并未意识到他们已获感染；他们或者从没有症状出现或者不知道所发生的症状就是疱疹。
