The Herpes Epidemic Among College Students: There is no such thing as "safe sex."

We recently saw a young patient in her late 30's who had blinding herpes in one eye that required multiple corneal transplants. She contracted herpes in college and it eventually destroyed her eye. She was a very pretty girl but after multiple failed corneal transplants and years of drops and frustration, she has given up on her left eye. Her eye used to look like this below, but now looks less red but still has scar tissue on the cornea with some residual eaten up sutures from the last failed corneal transplant. . 

It was assumed initially the herpes was due to HSV1, which is oral herpes (the kind of herpes you can get from kissing someone with a cold sore). But a special test from a corneal sample showed the subtype of the virus was HSV 2, which is genital herpes. 

Eye surgeons do not routinely test which herpes has cause the eye infection and subsequent corneal scar tissue and vision loss requiring a corneal transplant.

Surprisingly the CDC does not consider Herpes a reportable disease. Thus the statistics the CDC has on it's website are misleading. It appears they have no idea what the true incidence or prevalence is.

Herpes Simplex can be devastating. Abbreviated HSV for Herpes Simplex Virus, there are 2 strains:

1. HSV 1 which usually occurs around the mouth (‘‘cold sores:’’a term many doctors really dislike as it makes is sound benign/not dangerous when the fact is that these simple "cold sores" can develop on the surface of the cornea and lead to blindness--though reversible ) and 














2. HSV 2 (see photos below) which is most often around the genitals: it is almost exclusively transmitted through sexual contact but there are published case reports, as well, of HSV 2 causing corneal scarring. 
When people talk about genital herpes they mean it can be caused by type 1 and type 2 herpes simplex virus (HSV-1 and HSV-2). Both strains can destroy the cornea and eyeball but we have no data to tell us how often herpes (genital or oral version) affect the eye.

Both can cause corneas scarring and inflammation in the eye with potentially blinding results.

Herpes Simplex remains the #1 reason for needing a corneal transplant in the US.


Corneal transplant surgery is the most common organ transplant done in the world. And even though our rates of success are excellent and the risks have decreased, it is still an organ transplant which means you will need to put in drops for the rest of your life or risk rejection and another round of surgeries and pain and vision loss. 


Global prevalence of genital herpes is rapidly increasing with approximately 140 million people aged 15–49 years infected with genital HSV-1 infection and an estimated 417 million infected with HSV-2 internationally. 

http://www.who.int/news-room/fact-sheets/detail/herpes-simplex-virus

Genital herpes caused by HSV-2 is a global issue, and an estimated 417 million people worldwide were living with the infection in 2012. Prevalence of HSV-2 infection was estimated to be highest in Africa (31.5%), followed by the Americas (14.4%). It was also shown to increase with age, though the highest numbers of people newly-infected were adolescents.

More women are infected with HSV-2 than men; in 2012 it was estimated that 267 million women and 150 million men were living with the infection. This is because sexual transmission of HSV is more efficient from men to women than from women to men.

We all need to warn young people to avoid sex before marriage. It is possible. It is possible to know your partner very well. It is possible to marry as a virgin. What a radical idea! But one that is possible and sight saving!

Recently a friend told me about a "Rainbow Party" which devastated her high school son it was so traumatic. I had never heard of it before and was shocked to think of how much herpes virus could be spread in such a horrific party.

I found this online about it:

The story was originally related by American pediatrician Meg Meeker in her 2002 book Epidemic: How Teen Sex Is Killing Our Kids.^[2] The book related case stories of adolescents suffering cancer, sterility, acute infections, and unwanted pregnancies as a consequence of starting sexual activity too early in life. Meeker relates the following story from a 14-year-old patient from Michigan:

[Allyson] had heard some kids were going to have a "rainbow party," but had no idea what that meant. Still, she thought it might be fun, and arranged to attend with a friend. After she arrived, several girls (all in the eighth grade) were given different shades of lipstick and told to perform oral sex on different boys to give them "rainbows." Once she realized what was happening, Allyson was too stunned and frightened to do anything. When a girl gave her some lipstick, she refused at first but, with repeated pressure, finally gave in. "It was one of the grossest things I've ever done."^[3]

Teachers and parents need to warn their sons and daughters about these horrific "virus spreading" parties and the peer pressure one can suffer to not participate. 


I saved the gory photos of syphilis, another STD I have seen affect the eye recently in 2 young people in the form of chronic uveitis: also a potentially blinding disease. 


SLC


                                                                          NOTE: Herpes Zoster or Shingles is NOT  just                                                                                   Sexually transmitted: it is from the VARICELLA virus  that causes Chicken Pox (chicken pox is super contagious from sputum, The virus spreads mainly by touching or breathing in the virus particles that come from chickenpox blisters, and possibly through tiny droplets from infected people that get into the air after they breathe or talk, for example..

Photos of Syphilis:

One of the episodes on Netflix's smash-hit CROWN has to do with the crown prince's brother who has syphilis. At one point his doctor shows him photos of what can happen if he does have sex with another woman: at that time the did not have treatments for syphilis. Seeing such photos are disturbing and so far (I have not seen the whole series) he has chosen the wise path of abstinence.

Recently I saw a woman with ocular syphilis. Her photos looked like the one below. 

We caught it early but syphilis can go on to destroy the retina and vision:

I have seen such babies born to mothers who have syphilis and worse, HIV. These poor babies have to suffer the pains of these diseases.

There are many STDs. It is not worth the risk. It is really important to tell young people to be careful and not have sex until marriage with someone they know really well. Never have sex or even kiss someone you do not know well. They could have a cold sore starting and you will never get rid of that virus either. 

SLC

References:

Conn Med. 2016 Oct;80(9):533-536.

Ocular Syphilis Presenting as Bilateral Acute Retinal Necrosis in an Immunocompetent Host.

Hussnain SA, Ketner S, Coady PA, Kombo N, Nwanyanwu K.

Abstract

Given the recent rise in reported cases of syphilis, clinicians must maintain a high index of suspicion for this great masquerader when evaluating patients with symptoms and signs of ocular inflammation. Ocular syphilis can present a diagnostic dilemma for ophthalmologists due to its myriad ofmanifestations. We report a case of ocular syphilis presenting as bilateral acute retinal necrosis (BARN) that we recently saw in Connecticut and review clinical signs, appropriate serum testing sequence, and specialized ophthalmic testing, as well as treatment of ocular syphilis.

What are early symptoms of genital herpes?

The first symptom of genital herpes that you are likely to notice is the inflammation of your skin in the genital area, which may burn or itch. This symptom often occurs within 1-2 weeks of infection, during which time the virus multiplies in your cells and causes an outbreak. As the herpes episode progresses, blisters and ulcers develop. When the symptoms begin to subside, the ulcers form scabs, then they gradually disappear.

Typical Symptoms during the early stages include:

• Fever and flu-like symptoms
• Burning or itching sensation in the genital area
• Pain during urination
• Feeling sick/nauseous
• Muscle aches and pains
• Blisters

However, the incubation period of genital herpes varies and some people do not experience the first herpes outbreak until months or even years after infection. When it occurs, the first outbreak may last for several weeks. Once the genital herpes symptoms have subsided, the virus becomes dormant again until something triggers a new outbreak. Recurrent outbreaks tend to be less severe and pass quicker. Usually, patients learn to recognise the early signs of a herpes episode, which allows them to begin antiviral treatment promptly.

What does herpes look like?

Genital herpes sores develop in several stages. When you notice the first symptoms such as tingling and itching you may not be able to see any sores. Over the course of the coming days, blisters will form. The blisters tend to be red at first and they soon fill with liquid and can take a yellow colour. Eventually, the blisters burst open and heal.

Can herpes cause just one sore?

Genital herpes outbreaks can differ in severity. While some people encounter multiple painful blisters, some only have one single sore. It is not uncommon for the symptoms to be so mild that they go unnoticed. 

Where can you get herpes sores?

The symptoms of genital herpes in women are essentially the same as in men. Because genital herpes affects the private parts, people often wrongly assume that the virus looks different in men and women. 

In men, genital herpes sores can appear inside or on the: 

• penis
• scrotum
• groin and thighs
• buttocks
• around the anus

In women, the herpes blisters or sores can appear on the: 

• labia
• inside the vagina
• groin, thighs
• on the buttocks and around the anus

In the case of female genital herpes, patients often experience pain when urinating and notice unusual vaginal discharge. Blisters inside the vagina can take up to three weeks to heal completely. An inflammation of the cervix (neck of the womb) can also be a sign of female genital herpes. If you are infected with herpes at a late stage during pregnancy, consult a doctor or midwife.

Genital herpes is not only transmitted during vaginal and anal intercourse. It also is possible to get genital herpes in the mouth, tongue, lips and other parts of the body. However, this is quite rare and it usually occurs when blisters are present during intercourse.

How long does a herpes outbreak last?

The duration of a herpes outbreak depends on how quickly your body can fight the outbreak and whether you take antiviral medication to speed up recovery.

As a general rule, the first ever herpes outbreak tends to be the most severe. In some cases, it can take 2 - 3 weeks to heal completely. Subsequent outbreaks are usually less severe and pass within a few days.

Herpes sores typically develop in the following stages:

• tingling or itching sensation in the affected area - this usually happens in the first 12 - 24 hours
• blisters form and fill with liquid
• blisters open and turn into sores
• ulcers turn into scabs and heal

How can I manage the symptoms?

In addition to taking antiviral tablets you can alleviate symptoms by trying the following:

• Keep the area clean to avoid infection. You can use water or salt water to wash the affected area.
• You can use an ice pack wrapped in a towel to reduce pain and soothe your skin.
• Drink plenty of fluids - this will dilute your urine and make passing urine less painful.
• Avoid tight clothing as it may irritate the blisters and sores further.

Herpes outbreaks - how often do the symptoms recur?

Some people have only one or less herpes outbreaks a year while others suffer numerous episodes. On average, the number of outbreaks and the symptoms they cause also depends on the type of herpes virus you are infected with. People with herpes simplex virus 1 (HSV1 or herpes type 1) - which is more common in herpes outbreaks above the waist (for example cold sores) – causes less frequent attacks and less severe symptoms than herpes simplex 2 (HSV2) which causes genital herpes.

Recurrent outbreaks tend to be less severe than the first. They usually don't take as long as the first outbreak to resolve and you are likely to have a smaller number of blisters.

How can I prevent herpes outbreaks?

A healthy immune system tends to keep the virus at bay, so living healthily and eating a balanced diet may help to prevent recurring outbreaks. 

Avoiding excessive alcohol consumption is thought to reduce the chance of outbreaks. Some patients find that stress increases their risk of a herpes episode. In some cases, sunburn has also been found to be a possible trigger. However, no one really knows what triggers herpes outbreaks.

You should try to find out what triggers the virus’s activity for you, so that you have a better chance at preventing future episodes. 

When you feel an outbreak coming on you can start taking aciclovir tablets straight away in order to keep the symptoms to a minimum.

What are the symptoms of anal herpes?

Genital herpes sore can appear on your anus, especially if the virus is transmitted during anal sex. You may notice red bumps or blisters around your anus. Anal herpes can also cause pain, discharge and constipation.

Is herpes itchy?

During beginning stages of a herpes outbreak, you may experience a tingling, itching or burning sensation. As the episode progresses and blisters form the itching sensation tends to stop and the blisters tend to be painful rather than itchy.

I have herpes symptoms. Does that mean I can pass the virus on?

Genital herpes symptoms differ between patients. While some people develop the blisters within a week of infection, others do not experience any symptoms. The most common early sign of a herpes outbreak is a burning or itching sensation on or near to the genitals.

Some people carry the herpes virus without developing any symptoms of it. This makes it easy to pass on to others. The virus is particularly contagious when herpes symptoms are showing, from the point that blisters form to the time the scabs heal off completely. You are most likely to transmit the virus to a sexual partner at the end and the beginning of each herpes episode, but you can pass it on even if you don’t have symptoms.

I have herpes symptoms - What should I do?

1. Get diagnosed

Sores or bumps on your genitals can be caused by a range of conditions. You need to see a doctor or you can use our online photo diagnosis to get diagnosed. If you have sores you can use a swab test for herpes. 

2. Get treated

Antiviral medication helps your body fight the herpes virus and speeds up recovery. You can get your treatment from your GP or order online from Superdrug Online Doctor.

3. Prevent further outbreaks

Living healthily and avoiding stress are believed to help reduce the risk of recurrent outbreaks. You may also notice that certain things trigger outbreaks, which will help you avoid symptoms in the future. If you suffer from 6 or more outbreaks in a year you may wish to consider suppressive treatment.

http://connect.jbiconnectplus.org/ViewSourceFile.aspx?0=19495

The below post by Dr. Vaughn, is a travesty! Could this be malpractice to even tell college students to relax about one of the most devastating STDs out there?

Herpes is a big deal. The anxiety college students could feel about "getting herpes" is nothing compared to the true anxiety, depression, and despair that occurs in students who contract herpes.

I am perplexed of why he would post this. Was this even challenged by anyone?

RELAX. IT'S JUST HERPES

AUTHOR NAME

John Vaughn, MD, Director of Duke Student Health

BODY

There is a Herpes epidemic on campus. Not of the actual infection, but of an overwhelming, almost paralyzing fear about the possibility of getting the infection. 

For the sake of your mental health, my Dear Dukies, I’m going to go out on a limb here with a relatively bold statement:

In the grand scheme of things, Herpes is not that big of a deal, so everyone just CHILL OUT! 

I’m not making light of it. I’m not saying you shouldn’t think about, or do your best to protect yourself from it, or talk to your partners about it.  You should do all of those things, but do them with a healthy dose of perspective, which I will hopefully provide to you here. 

I get it.  The thought of being “infected” by anything – especially below the belt – can make you feel gross and embarrassed and affect relationships. Even the name sounds creepy.  But while Herpes is very common and there is no cure, it’s also very manageable, not a threat to your health or the health of your sexual partners1, will not make you a social pariah, and will not doom you to a life of celibate childlessness.  Dealing with the possibility of acquiring HSV is just part of the cost of doing business when you become an adult with an active and healthy sex life.

The CDC and the American Sexual Health Association both have excellent FAQ sheets about HSV that cover all of the bases, but here are the basics.

Wanna be really creeped out?  Many, probably most, people get HSV1 from their mom or grandma!  That’s because when we talk about Herpes we are talking about two types of viruses – Herpes simplex type 1 (HSV1) and Herpes simplex type 2 (HSV2) – and for the most part, HSV1 is the “cold sore” virus that affects the mouth and lips.  So all of those smooches you got from family when you were a kid were probably exposing you to HSV1.  Have fun at that next family reunion!

HSV2 has traditionally affected the genitals.  However, both viruses are spread by direct skin-to-skin contact, and either can infect the mouth or genitals, so we are starting to see more HSV1 infections “south of the border.”  A 2011 study showed that HSV1 accounted for 78% of female and 85% of male genital herpes infections in college students. 

Why?  Because like most people, college students assume that oral sex is totally safe and are therefore much less likely to use a condom then they are with vaginal or anal sex.  Now, unless you have a really bad sense of direction, you can safely say that oral sex eliminates the risk of pregnancy, but it definitely does NOT eliminate the risk of transmitting STI’s.  In fact, it increases the risk of transmitting HSV1 because it is spread by direct contact. 

How many people have HSV?  About one in six people aged 14 to 49 years have it, and up to 90% of those people don’t even know it. 

Why is it so common?  Because about one in six people aged 14 to 49 years have it, and up to 90% of those people don’t even know it.  (Are you paying attention??)  And unfortunately, an infected individual can just as easily spread the infection when they don’t have any symptoms as when they do. 

So how do you know if you have it?  Your healthcare provider can often diagnose Herpes based on a history and physical examination if you are having symptoms, but there are some lab tests that can be done as well.  If you’re having symptoms, the fluid from a blister can be tested directly for the presence of the virus. 

What if you’ve never had any symptoms?  A blood test for antibodies to both viruses can be done.  The presence of these antibodies doesn’t necessarily mean you have or will ever have an outbreak, but if you don’t have any antibodies to the virus, you can pretty safely say that you don’t have HSV.

Can we do all of the above testing at Student Health?  Yes.

So yes, there is a fairly good chance that you will be exposed to HSV when you become sexually active.  And yes, there is no cure.  But…

There is also a fairly good chance that you were exposed to HSV at your 3rd birthday party! And it’s not a threat to your health or your future sex life.  And there are good medications that can help manage flare-ups and decrease the risk of transmitting the virus.  And you can do 2 simple and effective things (that you should already be doing anyway) to decrease your chances of getting it.  What are those, you ask?

1. Talk to anyone you plan on getting nekked with!  Even though it’s an awkward conversation to have at the beginning of a new relationship – or the end of a long night – it’s the best way to keep you and your partner safe.
2. Use protection every time you have sex… yes, even with oral sex!  For those keeping score at home, that means condoms or dental dams: [[[SLC note: again I think this is malpractice to tell students and patients that this is "safe" that is not true! I have seen patients who have used these "preventions" and get herpes! What can Dr. Vaughn say to such patients except, "Sorry. Maybe you did not use it correctly." Doctors and surgeons need to tell patients the truth! These are no where near 100% safe so do not use the word "safe" do not even indicate it is an option as it does not sometimes and Herpes is a lifetime of pain of and on or oral pills or drops for life. Doctors should tell patients this. ]]]]]

So to finish with some more bold straight talk (because that’s how I roll)… RELAX!  Be smart, be safe, be confident enough to be chatty with your partners, get tested if you are worried, and move on with your life.  There are much more important things to worry about at Duke – like where to park without getting towed, or figuring out why everyone you meet is an Econ major from New Jersey.

If you have any questions about HSV or any other sexually transmitted infections, make an appointment to see us at the Student Health Center.  We can answer your questions, take a look at what’s worrying you and perform any necessary lab testing.

John A. Vaughn, MD
Director, Student Health Services
Duke University

1Genital HSV can cause problems during pregnancy, so if you have HSV and are pregnant or planning to become so, be sure to discuss it with your health care provider.

DATE

THURSDAY, SEPTEMBER 17, 2015

References:

J Dtsch Dermatol Ges. 2018 May 15. doi: 10.1111/ddg.13529. [Epub ahead of print]

Vertical transmission of herpes simplex virus: an update.

Bhatta AK1, Keyal U1, Liu Y1, Gellen E2.

Author information

Abstract

Herpes simplex virus (HSV)-1 and -2 infections are highly prevalent worldwide. HSV infection during pregnancy can result in neonatal herpesinfection, which is characterized by lifelong infection with periods of latency and reactivation. HSV can be acquired by an infant during one of three periods: in utero (5 %), peripartum (85 %), or postnatal (10 %). Neonatal HSV is a rare but significant infection that may be associated with severe morbidity and mortality, especially if there is dissemination or central nervous system involvement. Diagnostic and therapeutic advances have led to a reduction in mortality and, to a lesser extent, improvement of neurodevelopmental outcomes, but further developments are still needed. It is essential to improve the clinician's ability to identify infants who are at increased risk of HSV infection and to prevent mother-to-child transmission. The development of novel antiviral agents with higher efficacy is a worthwhile aim for the future.


References:

http://klinikstd.com/herpes/


https://www.wehoville.com/2015/03/21/syphilis-eye-infections-are-reported-in-l-a-county/