血检疱疹的准确度 [复制链接]

没什么 ，学习呗，研究呗，
我们的论坛比起美国的差远了，都是跑来确诊的或者排除的，弄完了基本都不见了

我在这里耗着，不是比来了确认完就跑的强  不是么

我在这里发  你不洗喜欢就别进来就是了，我又不影响你。如果大家都觉得我烦 找管理员屏蔽我就是了

我不矫情

另外 不是科普文章  是论文

知道也不说？
好吧
血检是准确的，阴就算了
你们都没有，好好生活

血检准，尤其是北京的医院，我亲身验证，地坛，北大，协和，佑安都很准，所有的医生都告诉我血检97％准，两次即可排除。
我不研究我怎么能和专业人士比呢，见笑了。相信医生，血检可以绝对排除。不要纠结了。我诚恳的道歉，误导大家了。血检是正确的，美国fda认证，北京，上海，广州g各大医院认可，多名顶级医生肯定。放心吧

是的，我没写过论文，有也影响因子小，不懂，各位放心吧，血检多次一定排除，考虑复发性龟头炎一类的，复发了，就洗洗澡，没事

.I am 42 years old and was diagnosed with genital HSV 1 about 10 years ago by an infectious disease specialist using the standard testing methodology.  In the absence of suppressive treatment with valacyclovir, I continue to have genital outbreaks anywhere from every 6-12 weeks.  I recently stopped all treatment and validated that I still get moderately severe outbreaks every 6 - 12 weeks.  I have not other health issues and exercise regularly.  I also avoid all of the "suspect" foods (i.e.: nuts, chocolate, etc.)

I understand that recurrent genital outbreaks of HSV 1 are extremely rare, particularly this long after diagnosis. Is there anything I can be doing to to help resolve this problem other than suppressive valacyclovir therapy? Are there any other medications / treatments that could boost my immune system capability to suppress the virus over the long term?  Are there any clinical trials that I can volunteer for?

Thanks


Frequent recurrences with genital HSV-1 are infrequent, but not quite as rare as your question implies.  In the main research study on recurrence frequency, in the first 2-3 years after initial genital infection with HSV-1, 40% of patients had no recurrent episodes and about 50% had 1-2 outbreaks then none.  But the remaining 5-10% had outbreaks with frequency similar to HSV-2 infections.  It isn't known how many continue with frequent outbreaks beyond 2-3 years isn't known, but my guess is that 1-2% have the sort of recurrence frequency that you describe.

I suggest you see a provider to confirm the diagnosis of HSV-1, especially if that has not been done since the initial diagnosis.  And what do you mean by "standard testing methodology"?  If a culture or PCR test showed HSV-1 and not HSV-2, it's probably definitive -- but still worthy of confirmation.  If only by blood test, that isn't adequate to be certain.  For now, stay off the valacyclovir and see a provider within 1-2 days of the next outbreak, for another culture or PCR test.  It would not surprise me if additional testing shows you actually have HSV-2.

Assuming the diagnosis of recurrent genital herpes is correct, whether due to HSV-1 or -2, there are no known treatments, diets, exercise, avoiding stress, or other methods that are known to affect the frequency or severity of symptomatic outbreaks.  If you are convinced that your "suspect foods" really make a difference, by all means avoid them. But research shows that most such beliefs don't hold up when examined objectively.

However, here is one aspect that might be worth considering:  If the outbreaks are not too severe and/or you are not sufficiently sexually active to put new partners at risk, I would advise staying off suppressive therapy for a year or two and treat each outbreak with brief episodic therapy instead.  The natural course of genital herpes is a gradual reduction in outbreak frequency, but being on suppressive therapy might prolong the time until that happens.  This isn't proved but some experts consider it a reasonable possibility.  If so, you may find that your outbreaks decline in frequency when not taking continuous valacyclovir.

Finally, it would be good for you to be under the care of a true herpes expert; some but not all infectious diseases specialists have that expertise.  Although MedHelp does not make referrals to specific providers, if you'll say where you are, I might be able to recommend a medical institution in a nearby metropolitan area.



Thanks for your prompt reply.  I will try your suggestion to stop taking valacyclovir as suppressive therapy and let you know how it works out.

It was, in fact, a PCR test that confirmed HSV1 infection



Still you should confirm the virus type with more recent testing.  The technology and reliability of PCR has moved a long way in the past decade, and I would not guarantee that it's HSV-1 based on that single test.  If you don't want to wait for the next outbreak, have a blood test to assure it is positive only for HSV-1 and not HSV-2. .



This seems to be an intresting statistics on recurrences with genital HSV-1, could you also cite the study so that I can have a read. Thanks .


.The frequency of HSV-1 versus HSV-2 genital recurrences has been discussed many times on this forum; use the search link to find lots of threads.

The only study that has carefully addressed this issue, to my knowledge, is Benedetti J et al, Ann Intern Med 1994; here is a link to the abstract:  http://www.ncbi.nlm.nih.gov/pubmed/7978697

In one way, the data are expressed in a non-intuitive fashion, as outbreaks per month.  To me it is easier to convert to outbreaks per year.  For example, 0.36 episodes per month is 4.3 per year (multiply by 12). .


.

.Dear Doctor,

I was dx with Herpes Simplex 1 genitally and orally, about a year ago, by both blood test and culture.  I continue to have monthly recurrences, on both locations, although at different times.  I understand this is very rare.  Any reasons why I might be such a statistical outlier?  

I have my "genital" outbreaks on my upper thigh, not my vagina.  I also understand this a rare breakout location for HSV1.  Any again reasons why I might be so different in this regard?

How contagious am I in terms of a potential sex partner?

What are your thoughts on suppression therapy for this condition?

Looking forward to your thoughts on this.   .


.Welcome to the forum.  I'll try to help.

As you seem to know, this is an extremely uncommon situation; I have never heard of HSV-1 causing such frequent recurrent episodes.  So the first and most important thing is to be sure that your recurrent symptoms are in fact herpes outbreaks.  I am quite skeptical.  Let's start with a detailed description of the symptoms:  exact location(s), how the symptoms start, how they change over the next few days, how long each outbreak lasts, and so on.  If any outbreaks were examined professionally, what the provider said about them and the results of any additional HSV tests done.  Also what treatments you have tried and how effective treatment has been.

In addition, say a bit more about the initial infection a year ago.  Was the positive culture from the genital ares, mouth, or both?  How long after symptoms started was the blood test done?  And the detailed blood test result -- type of test, numerical value, etc.

If indeed the problem is recurrent herpes, it should be pretty easily controlled by treatment with one of the antii-herpes drugs, i.e. acyclovir, valacyclovir, or famciclovir.  What has your provider said about all this?  Other than that, I'll need all this additional information before I can answer your specific questions.

Best wishes--  HHH, MD   .





.Thank you.  I will try to clarify:

I get approx 4 or 5 genital OBs a year and 3 or 4 oral OBs a year.  They do not occur simulataneously, although they did when I was first dx--both places by culture.  I had a blood test a few months later, IgG, numeric values in the mid 4 range.  I can't remember the specifics.  

The OBs last around 1 - 2 weeks, the legs ones longer.  

The doctor suggested on episodic therapy with Valtrex, and told me that HSV1 should never be treated suppressively, only HSV2.  

The episodic therapy helps but not 100%.  I don't use it for all OBs, just the oral ones.

Thanks.  
.Thanks for the additional information.  Although you don't describe the outbreaks in detail, if they are typical for herpetic episodes -- a cluster of one or more blister-like lesions that then become pimple-like or ulcers and heal with scabs -- then herpes indeed is likely.  If there is any doubt, however, it would be good to see your doc within a day or two of an outbreak (of either site, perhaps both) for testing for HSV-1.  But if the appearance is typical and your doc is convinced of the diagnosis, it probably isn't necessary.

There is no reason not to take suppressive therapy for HSV-1.  There are more data available for genital HSV-2, simply because more research has been done, but that doesn't mean suppression isn't useful and effective against HSV-1.  (The official labeling may say treatment is only "approved" for genital HSV-2, but that is not a regulatory limit of any kind.)

HSV-1 is inherently less susceptible to the antiherpetic drugs than HSV-2, so a larger dose may be necessary. The standard dose of valacyclovir (Valtrex) for suppression of HSV-2 is 500 mg once daily, increasing to either 500 mg twice daily or 1.0 g (1,000 mg) once daily in those with especially frequent outbreaks.  For HSV-1, I would start at 500 mg twice daily; and if only partially effective, increase to 1.0 g twice daily.  The drug is very well tolerated, even at high doses, with few if any side effects.  The drug is expensive, so the main "side effect" will be financial, depending on your medical insurance coverage for drugs. .

I want to enroll in a research study (unrelated to HSV) and you need not have any chronic illnesses to qualify.  Does my situation count as a chronic illness? .

.Normally people with genital HSV-1 are not highly infectious through genital intercourse.  But your situation isn't normal, and there may be substantial risk of transmission, if a future sex partner is susceptible.  Your partner(s) can have HSV-1 blood tests; if positive, he is already infected and won't catch it again.  (People are generally immune to new infections with the HSV type they already have, anywhere on the body.)  If negative, there will be some risk, which will be reduced but perhaps not eliminated by taking valacyclovir.  But it isn't possible to say exactly the chance of transmission either with or without treatment. .
For most clinical research, "chronic illness" is meant to exclude people with things like abnormal kidney function, liver disease, cancer on chemotherapy, and the like.  But the definition varies from study to study.   You should tell the investigators about your recurrent herpes and your treatment (or plans for treatment) of it -- and let them decide whether you remain suitable as a study subject. .


.

Herpes outbreaks never alternate from one side of the body to the other.  See the comment above about herpes recurrences always happening at more or less the same spot every time.

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