What causes this infection?
Herpes is caused by the Herpes simplex virus (HSV). There are two types of HSV:  Type 1 is usually found around the lips and is commonly known as a cold sore but can also occur on the genitals.
 Type 2 is the most common cause of genital or anal herpes.
Herpes can also affect other parts of the body such as the anus, buttocks and, rarely, the eyes. Once a person has the herpes virus, it travels down the nerves which are connected to the affected area and lies inactive. The virus can reactivate later and travel back up the nerves to cause a recurrence. What are the symptoms?
Herpes may cause sores, skin splits or a fluid-filled blisters (vesicles) on or near the genitals. If blisters are present, they are
usually painful and the skin around them is often red and sore. The number of blisters ranges from one or two up to several dozen in a first episode. The blisters burst to leave moist sores which heal. They may itch during the healing process.
The first episode of genital herpes can cause a severe illness which can last several weeks if it’s not treated. Alternatively it may cause only mild symptoms. Recurrent episodes are usually milder and shorter in length than a first episode. Some people may get warning symptoms before a recurrence of genital herpes. These may happen anywhere between a few hours to a few days before the episode. They can include: tingling, nerve pain, itching and general feelings of ill health and irritability. This is called a prodrome. The time from prodrome to the skin being completely healed is approximately 6–7 days. The first episode of herpes usually occurs 2 to 12 days after infection, but sometimes there are no symptoms until months or years later.
How does someone get infected?
HSV is transmitted through close skin-to-skin contact with someone who has the infection. This usually happens during
vaginal, anal or oral sex but transmission can also occur if there is skin-to-skin contact without penetrative sex.
It can be impossible for an infected person to know when there’s a risk of passing the virus on to a partner. Some people
know when they’re having an episode because of their symptoms – they’ll have a sore, blisters or a skin split. Others don’t
realise because they have no symptoms, or very minor ones that aren’t noticeable.
People who have the virus, whether they know or not, can also transmit it between episodes. In fact, most HSV infections
are transmitted when there are no symptoms. This is known as asymptomatic viral shedding. It is impossible to tell when
this occurs but is known to happen on at least 3% of days
How can the chances of transmitting HSV infection to a sexual partner be minimised?
From the time a person notices the warning signs, such as a burning, tingling, itching sensation, until the time when the
sores have healed, the virus can be transmitted by having close skin-to-skin contact with the affected area. Sex should be
avoided during this time.
Always using condoms reduces the risk of getting HSV from people who don’t have obvious symptom.
Antiviral treatment with valaciclovir has been shown to reduce the risk of transmission in heterosexual couples.
How often do recurrent episodes happen?
Recurrent episodes occur in most, but not all, people and can happen years after the first episode. The period between
outbreaks varies greatly from person to person. Infection with herpes type 1 in the genital and anal areas is less likely to
recur than an infection with herpes type 2. Infections with herpes type 2 around the mouth are less likely to recur than an
infection with herpes type 1.
Why do recurrences happen?
Episodes occur when the virus inside the nerve cell is reactivated. For many people there doesn’t seem to be a pattern
to their recurrences, while others notice that they get an episode of genital herpes when they are premenstrual, tired,
stressed, sunburnt or have consumed excessive alcohol or other drugs.
Does having genital herpes affect the ability to have children?
HSV is not transmitted by sperm and does not affect fertility. Recurrent episodes during a pregnancy very rarely affect the
baby in the uterus; however, a first episode late in pregnancy could be serious and immediate medical attention is required.
Women should tell their obstetrician or midwife that they have had genital herpes. If a woman has an outbreak at the time
of childbirth, proper steps can be taken to help avoid transmission of herpes to the baby.
What is the treatment?
For people having an episode of genital herpes, whether or not it’s a first episode, there is treatment which can help.
Medications include aciclovir, valaciclovir or famciclovir. Taken continuously, aciclovir greatly reduces the number of
recurrences as well as the time of healing for first episodes. However, none of these treatments ‘cure’ herpes. If you think you are having a genital herpes episode:
 If you suspect that you are having your first herpes episode,, see a doctor right away to confirm the diagnosis and talk
 Keep the area clean and dry by bathing in salty water once or twice a day and drying the area well.
 Aspirin, paracetamol, local anaesthetic jelly or applying ice may also help with pain.
 Adjusting to herpes can be difficult at first. Talking things over with a friend or partner may help the adjustment process. Counselling services are available at some sexual health services to offer support and information when patients are diagnosed with genital herpes. ERPES - PATIEN
 If you notice a pattern to your recurrences, try to avoid the triggers as much as possible. If this doesn’t work, talk to your  Be aware that the presence of any infection that causes ulcers, such as herpes, can increase the risk of HIV transmission.
 Avoid having sex with your partner until any sores have healed.
 Always use condoms with new or casual partners at any time – this also provides protection from other STIs.
 Some sexual health services run support groups for herpes sufferers. For further information about these groups, contact your local sexual health service (see Appendix B).

Source: http://ctm.ashm.org.au/images/pdf/herpes_patient_handout.pdf


The Metabolic Syndrome and Hypertension—R Kelishadi et al The Metabolic Syndrome in Hypertensive and Normotensive Subjects: The Isfahan Healthy Heart Programme R Kelishadi,1 MD , R Derakhshan,1 MD , B Sabet,1 MD , N Sarraf-Zadegan,1 MD , M Kahbazi,1 MD , GH Sadri,1 PhD ,AA Tavasoli,1 MD, S Heidari,1 MD , A Khosravi,1 MD , A Amani,1 MD , HR Tolouei,1 MD , A Bahonar,1 MD , AA RezaeiAshtiani,1

9. sleep disorders &copd

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