Herpes 

Herpes is a virus that causes vesicular blebs or blisters that "pop up" like pimples. These nasty eruptions show up at the most unsuitable times, like before a big date or prior to a business presentation, and in the most inappropriate places -- genitals, lips, and anus. Stress can induce an eruption of herpes, and the only recourse a man has is to flee to his doctor for some help!

Herpes usually appears as blister-like lesions on the mouth, which are typically herpes type I, or sores on the genitals, which is herpes type II. That is not to say that a lesion found on the mouth has to be herpes type I, and only lesions of the genitals have to be herpes type II. It all depends on the mode of transmission and who was doing what to whom. A male with herpes type I lesions on his lips is contagious, and if he performs oral sex on you, then you can inherit the type I virus on your genitals. The same goes for the opposite -- that is, passing herpes type II from your genitals to someone's mouth.

Common terms for herpes include "cold sore" or "fever blister." These painful papules can drive you insane once they rear their ugly head, and usually someone with a history of herpes can tell when one is coming on because of an annoying tingling sensation that develops at the site of eruption. Men with active herpes lesions are considered contagious and they should warn you about that. That is why you shouldn't kiss anyone on the mouth who has a "fever blister" or engage in sexual activity if they have any active lesions on their penis or anus.

The CDC estimates that there are over one million new cases of genital herpes each year in the United States. Genital herpes is the most prevalent STD in the United States with an estimated one in five adults infected. When clinicians speak of genital herpes, they are referring to herpes type 2 (HSV- 2). HSV- 2 is a sexually transmitted disease that often causes no visible symptoms, and it is possible to contract genital herpes from someone who has no symptoms at all. The majority of cases of HSV- 2 transmission are due to this type of asymptomatic viral shedding.

For the initial outbreak of HSV- 2, the time from exposure to the initial presentation can be up to two weeks. Some patients develop flu-like symptoms. Blisters may develop on your genitals or anus. Within a few days the blisters will break and ooze. These sores will usually heal within three weeks without treatment. During the time these sores begin to heal you are extremely infectious and susceptible to HIV if exposed.

There are cases of people who develop HSV (types 1 and 2) and never have a recurrent outbreak. Usually patients develop a recurrence if they are exposed to stress, fatigue, and other infections. If you have never been diagnosed with HSV, and you develop suspicious ulcerations or sores, then you should see a health-care provider. HSV can be diagnosed by physical exam, culture, and blood test to detect HSV antibodies in the blood. Once you've been diagnosed with HSV, there are various antiviral medications that your doctor can prescribe to provide relief of symptoms and speed up recovery. Antiviral medication like acyclovir, famciclovir, and valacyclovir are commonly prescribed to treat initial and recurrent outbreaks of HSV. Also there are over- the- counter nonsteroidal anti- inflammatories that can provide relief from the pain of the ulcerations. Topical creams, however, are not made for the treatment of genital herpes.

Currently, the CDC recommends "suppressive therapy" (that means taking antiviral medication daily for one year or more) in patients who have frequent outbreaks of genital herpes. Daily treatment not only decreases the rate of recurrent outbreaks, but it also decreases the likelihood of transmission to your sexual partner. However, despite being on suppressive therapy, patients can still have outbreaks. So be sure to contact your doctor if you feel you are having an outbreak while on antiviral medication. This is especially important to consider if you are HIV positive, because an impaired immune system makes you more susceptible to future outbreaks. HIV positive men who have several outbreaks a year should be on suppressive therapy indefinitely.

In 2007, the CDC defined the synergistic relationship between genital herpes and HIV as a syndemic. The relationship between these two viruses adversely affects both people at risk of HIV and those who are already HIV positive. Simply put, genital herpes is fueling the fire of the AIDS epidemic. It is known that a significant proportion of HIV infections in the United States can be attributed to HSV- 2. Studies show that HSV- 2 significantly increases the risk of acquiring HIV due to mucosal barrier breakdown, which increases susceptibility to HIV. Based on this evidence, it is important that men who have sex with men get screened routinely for all STDs, including HSV- 2, especially if they are HIV positive.

For a discussion of Human Papilloma Virus (HPV), please see the section on "male Pap smear"