The products have no scientific basis and their use is denounced by medical specialists in the herpes, arthritis and colitis fields. The products are marketed through Resolve All. Dave Parrish is the company’s Los Angeles-based director.

I think it’s important that people, especially those feeling the vulnerabilities of having any ongoing health condition, realise that Lala is not the misunderstood benevolent lateral-thinker Parrish promotes him to be. 

Lala was struck off the NZ medical register and jailed for what the judge called the “callous fraud” of cancer patients. Chisholm notes that The Medical Council said Lala’s behaviour was at the gravest end of the disgraceful-conduct spectrum. The irony is that now that he is not practising as a doctor, he is free to peddle his potions without sanctions. Let the buyer beware.

Catherine

Catherine Cook

Counsellor

When people contract genital herpes, I notice it’s common for people to blame themselves for not being more careful. And yet, given how common herpes is, and given that in most people it’s undiagnosed as the symptoms are so mild, there are no guarantees you can avoid HSV if you want to be a sexually active adult – like most adults do. Routine testing for HSV isn’t the solution – it’s incredibly expensive to test entire populations and the testing is not foolproof.

In my counselling work I find that for many people, a herpes diagnosis is the first time they have had an experience that stands out to them as highlighting that life is not entirely within their control – and it can be shocking. People can experience a lot of vulnerability. It can also be liberating – because recognising life’s unpredictability may free people from self-blame. I’d be interested to know what others think.

Catherine Cook

Counsellor

The health professional’s ‘comfort zone’ with sexual health is made obvious to patients through body language, the words used and the combination of skill and ‘bedside manner’ when examining a person’s genital area.

In my PhD study I asked my participants about their ‘prescription’ for an ideal consultation and what stood out to me was that people weren’t asking for the moon – they were asking for all of the above, which in a nutshell is wanting to feel respected – physically, emotionally and intellectually.

A number of participants in my study reported that they changed doctors because of a doctor’s reaction to the diagnosis. Good on them! My encouragement to anyone with herpes is that you are entitled to come away from an appointment with a health professional feeling better – not worse.

In New Zealand, given that it’s such a small country with an ‘everyone knows everyone’ feeling, many people have worries about privacy and confidentiality, even if they like their doctor – once there is a herpes diagnosis in the mix, some people have fears about  how well other clinic staff with respect their privacy. Even if people feel confident about confidentiality they may not want their friend’s daughter – the practice nurse – possibly knowing their sexual health history.

For any of the above reasons , some people choose not to consult their usual ‘family’ doctor about herpes. In New Zealand, the other easy options available to both women and men are to go to a sexual health clinic or a FPA  (previously Family Planning ) clinic. On our website you’ll see the link to contact details for all the free sexual health clinics in NZ. With both these options there is usually continuity with the same health professional with any follow-up appointment.

For privacy, some people go to a medical ‘super-clinic’ rather than their own GP when they develop a sexual health problem. Although this choice may work well for some people, in my clinical experience I have more often been told that this choice did not work – there is no guarantee of who you will see or whether the clinician has any particular sexual health knowledge and skills – and follow-up with the same person is difficult if not impossible.

My key messages are:

• if you don’t feel respected, don’t keep putting up with it!
• sexual health is a normal, adult health issue and if a doctor or nurse has a problem with this topic then the problem is theirs; no one should feel shamed or judged in a sexual health consultation
• there are some fabulous health professionals who are highly skilled and interested in your wellbeing and who are as troubled as you are about some of the (non)care people receive
• in New Zealand, if your doctor or nurse hasn’t heard of the New Zealand Herpes Foundation educational material and guidelines then hear warning bells – they may well not be up-to-date with information

Catherine Cook

Counsellor

The key message is – loving parents (this category includes includes grumpy, tired, in-need-of-a-break parents ) do not pass on genital herpes to their children through the ‘normal’ intimacies of family life. It’s important that fear of transmission doesn’t get in the way of loving touch and shared experiences.

• Snuggling in bed together is ‘safe’ – the virus isn’t crawling on the sheets from one person to the next
• Sharing a bath or shower together isn’t a way the virus is passed on – the same is true for spa baths and swimming pools
• Washing clothes in the same washing machine, even when a person has a recurrence, will not pass on the virus
• A child brushing against an adult’s upper thighs or abdomen while the adult has a recurrence won’t pass on the virus
• If an adult uses the toilet or has touched the genital area and forgotten to wash their hands this omission is not problematic in terms of herpes. The virus is fragile and dies when it leaves living cells
• Washing with ordinary soap and water is clean enough – there’s no need to use any special hand or toilet seat sanitisers
• I know children do all sorts of odd things that you can’t anticipate but even if they put your worn knickers on their head they are not going to contract the virus – relax and laugh with them

I hope this information will reassure any of you who are parents (nieces, nephews, grandkids, step-kids etc) and help you to enjoy your children.

Catherine Cook

Counsellor

I remember one woman telling me that having genital herpes had actually become a relationship-positive factor in her life – sorting out the ‘players from the stayers.’ Other people have also had similar experiences, where they have found that although talking about herpes isn’t necessarily the easiest thing, a conversation about sexual health showed up so much about the other person’s ability to communicate – about their attitudes and values – that would likely have been discovered later in the relationship anyway.

In some instances, people tell me this early talk about sexual health has paved the way for a partner to talk about dilemmas or private ‘tender spots’ in their own lives.

There isn’t a ‘standard’ attitude towards herpes any more than there is about politics, religion or sport, and so sometimes having different beliefs about HSV can be a tension in a relationship. I’ve talked with many people whose greatest fear is passing on the virus to a partner – even when the partner is informed and says they think that in the scheme of things, herpes sounds manageable.

The topic of herpes highlights for couples that they’re likely to have somewhat different ideas about all sorts of areas in their relationship – money, child-rearing and what to do about the in-laws. It’s very easy for couples to think that the problem is herpes whereas perhaps the topic provides a useful spotlight for couples to see communication patterns that affect other areas of their relationship.

Catherine Cook

Counsellor

Tips for lip care:

Ultraviolet light is a major trigger or ‘cold sores’ so wear a hat and a high-factor sunscreen when you’re outside. Damage from sunburn and windburn in the form of dry, chapped lips is also a trigger so use lip protection to avoid your lips getting dry and cracked.

Some people also notice certain foods seem guaranteed to bring on a recurrence – some people will swear that nuts, chocolate or red wine is trigger for them. There’s no clear research ponting to specific triggers but you might want to pay attention to your body to see if you notice anything specific.

If you have a ‘cold sore’ then for a few days there will be HSV-1 on the skin and so finding other ways to show love, affection/passion other than kissing or giving oral sex is the way to go to avoid passing on the virus. Some people use flavoured condoms or latex dams for giving/receiving oral sex. Her’s some more useful information about HSV-1 and oral sex:

The possibility of passing on HSV-1 though oral sex happens if the person receiving oral sex hasn’t ever contracted HSV-1 facially. People who have symptoms with type-1 genital herpes in almost all circumstances haven’t previously contracted facial herpes (caused by type-1 herpes simplex virus).

If you have HSV- facially and do pass the virus to your partner through oral sex, you won’t then go on to contract HSV-1 genitally from your partner so there is no need to suddenly start using latex protection in the relationship if you haven’t previously.

If you know that you get ‘cold sores’ then ask your partner if she/he has any knowledge of having had ‘cold sores’ at any time. However, many people don’t recall ever having had facial herpes even though they do have positive antibodies to HSV-1 on a blood test.

If you have HSV-1 facially and have a partner who has never contracted HSV-1 facially then it is possible that they could contract HSV-1 from you. HSV is most infectious when there is an actual recurrence visible, and in the days just before and after the recurrence. Some people get a ‘warning’ sign like an itch or a tingle prior to a ‘cold sore’ appearing so that would be part of the time frame to avoid giving oral sex.

Other useful transmission information:

If you have type-1 facially you can still contract HSV-2 genitally but the good news is that you will be most likely to have few, if any symptoms.

If you have type-1 genitally you can still contract HSV-2 genitally but again, the chances of having any symptoms are very slim.

Let me know if there’s questions you’d like addressed in the blog – in my email nurse/counselling work I’ve found that oral sex is a topic people find hard to raise with health professionals.

Catherine Cook

Counsellor

This post continues my thoughts about the online magazine Gloss recent articles on herpes. I am going through the article bit by bit as I’m keen to clarify what ‘works’ about the piece and where there are gaps in accuracy and usefulness. A big element that’s missing from the article is how to live with the virus once it’s been contracted – surely a theme that affects many ‘Gloss’ readers.

The Gloss author uses the ‘incurable’ word:

“A major downside to Herpes is that fact that it is not curable.”

It’s technically correct in that there isn’t a cure for herpes currently. However, there are many things for which there aren’t cures and yet we don’t label them as incurable. Most of us have had chicken pox and therefore permanently have the herpes zoster virus living in the body that could reactivate as ‘shingles’ and yet we don’t think of ourselves as a society of incurables. The upside as I’ve mentioned is that in most people the herpes simplex virus is so untroublesome that most people don’t know they have it – hardly warranting the ‘incurable’ label.

Gloss: If there is no cure, what is the prevention?

I would suggest the question they should be asking is: “If herpes is so common, then I may well contract the virus even if I practice safe sex so how do I live a ‘normal’ life with herpes?”

Next point.

Gloss: It is very hard to completely protect yourself from Herpes as the blisters are not always present, and a carrier may have Herpes and never suffer an outbreak, so they may not even know. The most important way to protect oneself against Herpes type 2 is to use condoms at all times. In addition to condom usage, sexual contact should minimized during periods of outbreak when the infection levels are at there highest. Limiting the number of sexual partners minimizes ones risk as well. For type one avoiding contact between someone with cold sores or other outbreaks can reduce the risk.

The above information is correct. The important point that may seem self-evident is that the condom of course has to be worn by the male partner and many Gloss readers, being women, will be well aware of how hard it often is to negotiate condom use with a male partner – this is a research finding that comes up repeatedly in academic sexual health research.

Useful oral sex tip: for oral contact with the genital area couples sometimes choose to use latex dams (flavoured and available for discerning pharmacies – ask you local sexual health clinic where the friendly pharmacies are). Where there’s a penis involved then flavoured condoms are available for giving oral sex.

Another transmission point not mentioned in the Gloss article:

The photo accompanying the article shows the torso and bikini-clad pelvis of a young woman, obviously with a waxed pubic area – the current erotic ideal. Removal of pubic hair has become increasingly fashionable to the extent that it’s become normal in the under-30′s age group. The practice is quite incorrectly thought of as being cleaner than having pubic hair. The delicate skin of the genital area is damaged with waxing and shaving making even easier entry points for the viral STIs, herpes simplex virus and human papilloma virus. It’s a fashion that sexual health physicians wish would change as it adds to the likelihood of people contracting viral STIs.

Some closing comments: living well with genital herpes:

What all the above information about herpes means for couples varies from relationship to relationship. For most people, it is the misinformation and stigma about herpes that cause the problems – not the symptoms. In short -term or casual relationships I would recommend male condom use for overall sexual health (and possibly pregnancy risk) reasons. The avoidance of skin-to-skin contact facially or genitally (depending where the infection is located) will greatly reduce the likelihood of the virus being passed on. If a person with genital herpes and their partner are anxious about transmission then the person with the virus may choose to take medically prescribed antiviral medication on a daily basis to significantly reduce the likelihood of transmission.

In long term relationships, many couples choose to dispense with condom/dam use and take the chance of transmission. This decision is based often on the understanding that, while a small group of people will experience troublesome symptoms with this infection that requires ongoing medication to control symptoms, in the majority of people herpes is a mild skin infection. Couples need to come to their own decision about the place of latex and beliefs about the relevance of transmission in their relationship. As health professionals our role is to advise- it’s not the place of health professionals to dictate to people about their preferences and choices in their private, intimate lives. Whew – I hope all’s these clarifications help to settle any anxiety and confusion the Gloss article may have inadvertently generated.

Catherine Cook

Counsellor

Gloss: Herpes infects more then 25% of the world’s population and up to 100% of the population of some smaller, less developed areas. Learn to protect yourself early as there is no cure…
Most developed countries have herpes in some form or another with the occurrence being around 25% of the population. New Zealand is no different, with its occurrence rate being par with most other nations.

I’m not sure where these statistics come from. It’s perhaps important to begin with the clarify the two types of herpes simplex virus and then to comment on their prevalence. I’ll explain the two types of HSV. There are two types of herpes simplex virus, types one (HSV-1) and two (HSV-2). Type one easily infects the facial area and is commonly passed on through a social or intimate kiss.

Interesting fact #1

Type one may be passed to the genital area through oral sex and the genital area, but only if the person receiving oral sex has never previously contracted HSV1 facially. Type one ‘prefers’ the facial location and often does not recur as frequently as type 2 when the infection is contracted in the genital area. Type two ‘prefers’ the genital location and is rarely contracted orally. HSV-1 used to be such a common infection that most people in Western countries had contracted the virus by the time they reached adulthood.

Interesting fact #2

Now it is less common for people to contract HSV-1 facially in childhood and so more people are contracting HSV-1 genitally through oral sex in adulthood. The number of people with HSV-2 increases with age and by mid-t-late twenties approximately 22-25% of the population has HSV-2.

Interesting fact #3:

Women are more likely than men to contract HSV genitally as the mucous membrane of women’s genital area is more vulnerable to infection than the skin of a male’s genital area.

I also find the comment, ‘learn to protect yourself’ problematic. Yes, it’s great to learn about safer sex but the key point about herpes is that even if a person is careful about safe sex they may still contract herpes – contracting herpes is not about a failure to be careful – it’s about how common the virus is and how easily it’s passed.

Gloss: With such a high infection rate the most important question is how is it transmitted?
Type two Herpes is sexually transmitted.
There are 2 different types of Herpes and that type 1 is relatively common in young children and infants, while type 2 is most commonly seen as a sexual transmitted disease. Herpes Type 1 is more commonly known as cold-sores, however the types cannot be defined as ‘oral’ or ‘genital’ Herpes – most people do not realise each type of the Herpes virus can and does affect either area.
The infection can be passed along from person to person, with or without symptoms, through contact with saliva and genital secretions. The concentration of the virus is between 100 to 1000 times greater when symptoms are visible.
It can also be received through minor injuries such as those in babies with mouth sores or damaged areas around the cuticles of nails.

It’s correct that the infection is named for where it occurs – facial herpes or genital herpes – type-1 as you now know can be the cause of genital herpes as well as type-2. As I’ve mentioned though, type-2 rarely infects the facial area.

Interesting point #4

Although many people have contracted HSV of either type, it’s important to realise that the virus is dormant most of the time and is only active on a small percentage of days – people are not continuously infectious. It’s correct that people are much more likely to pass on the virus when they have symptoms. Interesting point: the main way that the virus is passed is through the action of skin rubbing against skin or mucous membrane – although the herpes simplex virus has been found in secretions, the virus stays alive in living human cells. This is the reason why condoms or dams are only partially (although significantly ) effective in reducing transmission – because the virus may be present on the skin of the genital area beyond the area coverd by the dam or condom.

Gloss: What are the symptoms of herpes?

Most important point!!

Before we get on to how Gloss answer this, it is really important to understand that in the majority of people with either facial or genital herpes, the symptoms are SO mild and untroublesome that people do not know they have the virus. The infection is often mistaken for chapped lips, or jock itch. Symptoms may be blisters may be as tiny as a pin head or fine cracks like a ‘paper-cut’. It’s really important point to get that for the majority of adults herpes is not any sort of a deal physically. The photos of herpes lesions are misleading in that only people with major symptoms are photographed – otherwise there’d be nothing to see – and these images lead to a myth about herpes that people inevitably have major blisters – they don’t – more on this point shortly.

And so, on to Gloss’ answer to the question.

Gloss: Herpetic gingivostomatitis or mouth infections are the most common symptom of Type 1. This includes things like cold sores and fever blisters. Most of these cases occur in children infancy to preschool age. The incubation period is 4-5 days, after which the infected individual will begin to develop a fever, they may be restless and have increase saliva flow or drooling. Blisters then develop as well as ulcers and a yellow coating of the tongue. It usually clears up within about 2 weeks.

Most people who contract herpes either facially or genitally don’t have significant symptoms. For the minority who do, antiviral medication is available that greatly reduces the duration and severity of symptoms. If a person does have symptoms, the first episode will be the most obvious as this is the time before the body has built up immunity to limit the effects of the virus.

Gloss: Type 2 infection presents itself differently as it is most typically contracted from sexual activity. As a result genital Herpes develop. This can be ulcers on the penis that are very sore and painful, or in women, similar lesions will develop around the vagina or the anus and sometimes are even found as deep within the female as the cervix. This can cause severe ulcers upon the cervix, which can lead to permanent damage.

Important point #5

I have never heard of any women having permanent damage to the cervix from a first episode of herpes. In most people herpes does not cause scarring. In a minority of people scarring may occur but in most people there is absolutely no sign of having had a herpes episode once healing has taken place.

Important point #6 (and at the risk of being seen to repeat myself but it bears repeating )

The literature about the length of time from contracting the virus to the appearance of symptoms can be confusing – including now the Gloss article! If a person has never contracted the herpes simplex virus before, in the form of facial herpes then they may have a significant first infection as they will not have any antibodies to assist with dealing with the infection. A first genital infection may, in a minority of people, include extensive genital blistering and an overall ‘flu-like illness. This type of first infection occurs between 2-20 days after having contracted the virus. If a person had a blood test at this stage they would not have antibodies to HSV as it can take up to 12-16 weeks to develop measurable antibodies. The majority of people don’t have this type of initial episode. The majority of people develop mild symptoms at a variable time after having contracted the virus. The majority of people who pass on this infection don’t know they have it as they have such mild symptoms that they are never diagnosed.

Gloss: Recurrent breakouts will occur after first infection and are often much milder then the first outbreak. In type 1 it is typically nothing more than a few cold sore blisters upon the lip. Type 2 tends to appear in the same general region as original outbreaks, however a person with Herpes Type 1 (they get coldsores) can pass this type of Herpes to a partner through oral sex.

Important point #7

No, people will not necessarily ever have a second episode after an initial episode. In the case of type-1 being contracted genitally, this group of people may never have another episode or may have one or two a year. A minority of people get more regular recurrences with type-1 in the genital area. With type-2 in the genital area, once a person has had an initial episode they are more likely to experience 2-4 recurrences a year.

Gloss: What are the tests for Herpes?

Gloss: The most common method is a simple blood test, although this can only test a positive result for Herpes in general and not tell which type it is. Another method is a viral culture, where cells or fluid from a sore are collected with a swab.

Oh dear, this is a muddled bit of information about testing – and it’s back-to-front. The most common way a diagnosis is made is by a health professional looking at a sore, and thinking hmm, this might be herpes and taking a swab. Treatment should be offered straight away in the form of a short course of antiviral medication. (People sometimes need pain relief prescribed too.)

Important point #8

The result of the swab may be misleading. This is because the herpes simplex virus is a fragile virus and it is difficult to obtain on a swab, especially if a few days have lapsed between the beginning of symptoms and the swab being taken. If a swab result comes back showing the virus has not been detected, this is not a clear negative result. If a person wants a swab test taken, it is preferable to see a doctor for a swab test as soon as possible after symptoms appear, within the first 24 hours.

Now a bit about blood tests – well, Gloss has got the first part right – having a blood test is simple – BUT it’s the interpretation of the result that is the tricky part, especially if the health professional giving the result doesn’t have a detailed understanding of HSV. Here’s some of the important points to know about blood tests:

Antibody blood tests for HSV are available that show if a person has ever contracted the herpes simplex virus. These are type-specific blood tests and the result is clear as to whether type one or type two is detected. A positive antibody test for type-1 HSV is a confusing result – it may either indicate a genital or an facial infection. A type-1 antibody blood test result would need a confirmatory genital swab that shows type one HSV in order to confirm type-1 genital herpes. A positive antibody result for type-2 almost always is means the infection is genital.

Very important points

After someone has first contracted herpes, it can take 12-16 weeks for a positive blood test result to occur as it may take this length of time for antibodies to form. Blood tests are not infallible and there is approximately a 10% false negative/false positive rate. Not all people develop or retain antibody levels that are measurable on a blood test, even though they do have herpes.

Gloss: How is Herpes treated?

The most common treatment is an oral antiviral agent. Unfortunately, 2 out of 3 of the most common treatments are not available within New Zealand, so it is Acyclovir that is prescribed. A major downside to Herpes is that fact that it is not curable. Medications can only minimize outbreaks and prevent attacks. Once Herpes has infected an individual, it can lay dormant within the nerve cells for the entire lifetime of the person.

Well I think that the above comments about treatment are a bit doom-and-gloom so I hope to provide a more positive look at treatment. It’s true that in New Zealand, Pharmac, the government pharmaceutical funding authority, will only fund the oldest generic medication, aciclovir (despite lobbying from The New Zealand Herpes Foundation) . However, in most people aciclovir is a very effective medication. It’s also been around for 20+ years and is known to be a very safe medication. The key downside of aciclovir is that it needs to be taken more often than the newer medications. Our website www.herpes.org.nz has lots of information about how medication is used.

Interesting point #9

Most people with herpes aren’t on medication and have only taken aciclovir with a first episode.

In my next post I continue a discussion about living with herpes for “an entire lifetime.”

Catherine Cook

Counsellor

The Herpes-Coldsore website has a more sympathetic page on celebrity stories with coverage of various cases where the issue of disclosure has ended up a factor in the messy divorce cases that celebrities have to contend with.

If Katie Holmes was my daughter I certainly wouldn’t be thinking that it was the end of the world or even newsworthy that she had contracted facial herpes – (caused by type -1 herpes simplex virus). Just to clarify, this common infection is often contracted in childhood, through receiving a loving kiss from a relative with a ‘cold sore’. There’s a major up-side to having contracted type -1 facially – it means that the person won’t re-contract type-1 genitally later in life through receiving oral sex from someone with facial herpes. It’s only people who’ve never contracted type-1 herpes facially who go on to contract type-1 genitally. Also, the antibodies created through contracting type -1 help to reduce the symptoms if type-2 herpes simplex virus is contracted – it means that many people are without symptoms at all or have few, if any genital symptoms.

I do feel exasperated with what I think as incredibly irresponsible media in relation to sexually transmitted infections. Dealing with sexual health issues as they arise is part of living an ordinary, responsible adult life – yet media representations so often attend to sexual health as if it’s the doman reserved for the weird and deviant (whoever they might be!) The scaremongering about facial herpes is particularly alarming – any child who receives what they deserve – lots of loving hugs and kisses from family and friends – might contract facial herpes – it’s called Having A Normal Life.

Catherine Cook

Counsellor

Here are the important facts:

• the herpes simplex virus is a very fragile virus that can only remain alive in living human cells.
• once the virus leaves the body it rapidly dies
• the herpes simplex virus (HSV) isn’t spread through sharing communal facilities
• HSV is a fragile virus which is passed only through direct skin-to-skin rubbing with the infected area.

Therefore people need to either kiss a person who has a ‘cold sore’ (caused by type-1 herpes simplex virus) or receive oral sex from a person with a ‘cold sore’ or have direct genital-to-genital contact with someone who is infected genitally with either type-1 or type-2 herpes simplex virus. When the virus leaves living skin cells, it dies.

People with genital or facial herpes are able to use the same showers, toilets, swimming and spa pools as anyone else. Their clothes can be washed in the same washing machine at the same time as other people’s clothes.

A child can jump into bed for a cuddle with a parent who has genital herpes – the virus isn’t going to be passed on through the usual intimacies between parents and children. Nor will the virus rub off the sheets on to someone else – and no – herpes isn’t contracted through trying on someone’s jeans.

I think one of the problems with herpes in the media is the emphasis is on the contagiousness of herpes – so people imagine it’s much easier to contract than it actually is – many couples can be in a sexual relationship for years and not pass it on – in most people it’s more dormant than it is active – but that’s another story that I’ll write about soon.

Catherine Cook

Counsellor