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Please enjoy this free edition of The Herpes Bible. The following is the introduction to the book. After this free introduction, please continue to read further for other free clinical information about herpes written by Michael Shirazi MD. 

Herpes is the most devastating sexually transmitted disease after HIV. Unfortunately, this extreme is paralleled by the extreme lack of knowledge and care exhibited by most clinicians and doctors with regards to this disease. The destruction of herpes rarely, solely relates to its physical morbidity; rather, what greatly affects many people with herpes is a profound psychosocial anxiety, depression, self isolation, and or self/societal inflected shame. 

When it comes to herpes diagnosis, there is a great misunderstanding and lack of knowledge among many doctors. Time after time, I have had patients flock to my office who were wrongly told that they do have herpes. Also, I have seen a sprinkling of patients who were wrongly told that they do not have herpes. This book will clarify the methods and the accuracy of herpes testing. It will answer many questions as to how herpes is diagnosed or ruled out through the use of many excellent, simulated, real-life examples. It will give percentages on test sensitivities related to specific time frames after potential exposure to herpes and when testing is accurate and inaccurate. 

Probably the most common impetus for patients arriving to my office for herpes consultation stems from other physicians' indifference when giving this diagnosis. Telling somebody that they have herpes can be a life altering message. Most doctors deal with this disease as trivial or a nuisance. The diagnosis of herpes requires a great discussion on the risk of transmission, when lesions are present and when lesions are not present. This book deals with all the different scenarios when herpes may or may not be transmitted. It details the various risks, in specific percentages and ratios, of transmitting herpes to prospective partners. Also, this book is an excellent resource for those who think they were actually exposed to herpes and want to see what their specific risk of contracting herpes was. 

Separate from the two chapters devoted to herpes transmission and herpes diagnosis, this book covers chapters on all herpes relevant topics. There is a brief, yet comprehensive chapter on the types of herpes infections, a thorough chapter on herpes symptoms and clinical syndromes, an important chapter on how to properly treat herpes, a chapter which relates herpes to pregnancy, a chapter on the psychology of herpes and how to deal with herpes in current and future relationships. There is also a chapter which has some general, yet meaningful, information on herpes. Within some of these chapters, brief remarks on some of the legal aspects of herpes are made. 

This book is designed for both patient and doctor to better understand herpes. It will arm both patient and doctor with the answers to the multitude of questions which may arise when dealing with herpes. It will also answer many other relevant questions which would not arise unless an expert was consulted. All these questions are absolutely necessary to dispel the fears and myths about herpes and to confirm its truths and realities. I trust that this book will be invaluable to anyone who wants to or needs to learn about herpes from a true herpes expert. It's unique question and answer format covers all vital aspects of herpes in an easy-to-read and understand text. It is a must read for anyone who has or thinks they may have herpes. 

The following is written by Michael Shirazi MD. The Herpes Bible contains some brief, yet educational information on herpes. For more information on herpes, you may purchase his book The Herpes Bible which discusses in detail the symptoms of herpes, the many ways herpes is transmitted, how to properly diagnose and to find errors in the diagnosis of herpes. Many other topics are covered in a question and answer format which is easy-to-read and understand.

What is Genital Herpes?

Herpes is caused by a virus called herpes simplex virus (HSV.) There are 2 different types of HSV, herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2.) Either virus can cause genital herpes or non-genital herpes. Most people who have HSV-1 and or HSV-2 infections don't have any symptoms that people normally attribute to herpes. That is, most infections are asymptomatic. 

Epidemiology of Herpes
Most cases of symptomatic genital herpes are caused by HSV-2. Most cases of symptomatic oral herpes are caused by HSV-1. However, either strain can cause disease in either location, symptomatic or not. For genital herpes, approximately 80% of cases are due to HSV-2 with the remainder due to HSV-1. 

Approximately 18-25 percent of the U.S. adult population has HSV-2 and up to 80 percent has HSV-1. Most infections are asymptomatic. 

Types of Herpes Infections

Initial Herpes Infections:

There are 2 types of initial infections: 

Primary Initial Infection

A primary initial herpes infection implies a current herpes infection without a history of herpes. In other words, there is a new HSV-1 or HSV-2 infection and there is no prior known or unknown history of either HSV-1 or HSV-2. 

Most people do not have noticeable symptoms during a primary initial infection. When symptoms are present, they are often very mild and thought to be a result of another cause. For example, symptoms might be thought to be from a vaginal yeast infection or from vigorous genital manipulation. Sometimes, however, the symptoms of a true primary initial infection are very severe. In fact, of all the HSV infections, the most severe symptoms are caused by primary initial infections. Often an experienced herpes clinician can guess that an infection is a primary initial infection just by appreciating the severity of the outbreak. Nevertheless, it is often prudent to confirm this diagnosis with proper testing. 

Non-Primary Initial Infection

A non-primary initial infection implies a new HSV-1 or HSV-2 infection in the setting of an old herpes infection caused by a different type of HSV. In other words, there is a new HSV-2 infection and there is a prior known or unknown history of HSV-1; or, there is a new HSV-1 infection and there is a prior known or unknown history of HSV-2. This most commonly occurs when a person with a history of "cold sores" caused by HSV 1, or when a person with an asymptomatic HSV-1 infection, newly contracts HSV-2 genitally.

People are less likely to have noticeable symptoms during a non-primary initial infection when compared to a primary initial infection. When symptoms are present, they also tend to be milder.

The established antibodies to an established herpes infection, HSV-1 or HSV-2, lessen the symptoms of a newly acquired HSV type, HSV-1 or HSV-2. Unfortunately, antibodies to one type of HSV do not prevent the infection of another type of HSV. 

Recurrent Herpes Infections: 

A recurrent herpes infection implies an outbreak caused by an established herpes infection, HSV-1 or HSV-2. The outbreak may occur at or near the same body site of the initial infection. Recurrent outbreaks do not appear at distant body sites, except in very rare cases when the virus is transmitted to multiple sites, read the chapter on herpes transmission. Recurrent outbreaks are almost always less severe and shorter in duration than an initial outbreak. Often, symptomatic initial herpes infections manifest with a second crop of lesions which form a few days after the first crop. This second crop is not considered a recurrence; rather, it lies in the realm of an initial outbreak.

Within 12 months of a new HSV-2 infection, 90 percent of patients will have at least 1 recurrent outbreak, 38% will have greater than 6 recurrences, and 20% will have 10 or more recurrences. However, with time, recurrent outbreaks tend to decrease in frequency. 

HSV-2 recurs up to 10 times more often anogenitally than it does orolabially. Oral HSV-2 recurs less commonly than does oral HSV-1.

HSV-1 recurs anogenitally much less frequently than does HSV-2. In fact, it is uncommon for HSV-1 to recur more than a handful of times when this area is infected. Orolabial HSV-1 outbreaks recur much more often than anogenital HSV-1 outbreaks. 

Herpes Diagnosis
There are many different tests available that claim to diagnose herpes. 

Unfortunately, only a handful of these tests diagnose herpes with any accuracy. Most tests are not type specific, that is, a test may come back positive for HSV-2 when a person only has HSV-1. Only glycoprotein-G based IgG antibody tests should be used on blood tests. Please note this is different than just HSV-1 IgG and HSV-2 IgG. Furthermore, even when type specific tests are ordered, they are not always fully accurate. That is, falsely positive results still may occur. A medical practitioner most be keen to subtle differences among the many tests available in order to properly diagnose or exclude herpes. 

No IgM tests should ever be ordered as they have little relevance clinically. For most other infections, an IgM test often proves that an infection is new. For herpes, a positive IgM test does not mean that somebody has a new infection let alone any infection. 

Swab tests have different accuracies depending on who is performing the swab and which detection method is used. 

For much more detailed information about herpes written in a easy-to-read question and answer format, purchase The Herpes Bible or consult with Michael Shirazi MD.

A seemingly endless supply of information on herpes symptoms, herpes transmission, herpes treatment, herpes diagnosis, herpes with relation to pregnancy and fertility, psychological aspects of herpes, partner notification and legal matters with regards to herpes can be found by purchasing The Herpes Bible or by consulting Michael Shirazi MD.

This material was written by Michael Shirazi MD.  It is meant for informational purposes only.  All material is protected under U.S. Copyright Law.

Copyright © 2011 Dr. Shirazi - All Rights Reserved