One topic that I feel is very important, yet I don’t feel like I’m an expert on, is sexual health. For this reason I’ve decided to bring on someone else to tell you about how to diagnose herpes, treat herpes, and more important than all the rest, prevent herpes outbreaks. The Khan Academy does a great job at educating people on this topic, so I’ll let Raj tell you a bit about this.
Let’s Talk About Herpes
Speaker: We’ve talked quite a bit about herpes already. The next step would be to understand how do we diagnose herpes. Commonly, what physicians will do is ask the patient about their medical history, recent sexual practices and other things that may suggest a mode of transmission or some way the patient could have already been infected with herpes. Combined with this history and the symptoms that they may be exhibiting such as the cold sore either on their lips, that’s called herpes labialis or if it’s on their genitals, that’s herpes genitalis, that’s usually enough to make the diagnosis. That’s actually what physicians most commonly will do.
Beyond that, there are a couple of tests that can be used to make the diagnosis. One test that used to be more commonly employed is called the Tzanck smear, which is named after a famous French dermatologist, so let me draw the French flag here. Let’s put in a little red, white and blue. This test was first described by a French dermatologist and what they would do is take a swab sample of a cold sore or an ulcer. Here’s our sample right there. That sample would be applied onto this slide right here. Let’s smear this sample onto the slide right over here and then, what you’ll see after adding a stain, this could be either a Giemsa stain or a Wright’s stain. Don’t worry about those names, but there’s a specific dye that’s added to this, so I’ll just write up here, “A dye of some sort is added.”
What you should see if this patient has herpes are these giant cells. These are supposed to be epithelial cells from the swab of the lip or from the genitals. That’s one giant cell. I’ll write down here, “We see a couple of giant cells.” There are a few other here, but what’s interesting about these cells is that they don’t have just one nucleus. There’s several of them. I can count oneish right there. Maybe here’s another one right there. Then, there’s another one right there. This cell is multinucleated. We say that we have multinucleated and this is suggestive of a diagnosis of herpes, but the problem is this Tzanck smear is suggestive of a couple of other things as well. In addition to being positive for HSV1 and HSV2, this can also be found with cytomegalovirus or even with varicella or herpes zoster, which is another type of virus altogether, which is why this test isn’t as commonly done because usually a history and symptoms can be suggestive of herpes by itself.
But even beyond that, another test that used to be done is what’s referred to as a cytopathic culture. I think you’ve heard the term culture before I’ll describe it a little more in detail below here, but the reason why it’s called cytopathic is that what we try to do in this test is to take cells or cytes and kill them. That’s why it’s a cytopathic culture. Pathic you might recognize from the term pathology, which the study of disease. We take cells and we give them a disease, so specifically we have this culture right here. We start off with a couple of cells. These are cells that aren’t necessarily from the patient, but can be from a stock cell line in a laboratory and to this we add a sample of our patient’s blood. I’ll draw the patient’s blood right here and I’ll label it. For suspecting that this patient has been infected with herpes, I’ll draw this triangle, our symbol for the herpes simplex virus. What we should see over here is our culture of cells dying off, which means that there’s something in the patient’s blood that’s taking over the cells and not allowing them to grow. That’s a suggestive diagnosis for herpes. But again, this is also something you’ll see with a variety of other viruses as well.
All right. Let’s say we’ve made our diagnosis. The next step would be treatment. For viruses, there’s a specific class of antibiotics referred to as antivirals that we’d use on them, but as you remember from the timeline of symptoms that you’ll see with herpes, they usually go away in about 10 days, so we don’t often give antivirals. These are specifically given to patients that are at high risk for complications of herpes and these folks tend to be immunosuppressed. We only give antivirals to those that are immunosuppressed. There are some exceptions to this rule, but this is the general trend. An immunosuppressed is an umbrella term for a lot of things. Women that are pregnant are relatively immunosuppressed, so we’ll treat them with antivirals if they’re positive for herpes sometimes.
In addition to treatment, what can we do to prevent the herpes virus from happening in the first place? Prevention. The mainstay of prevention for all sexually transmitted infections is to block transmission. Going down our list of modes for transmission of herpes, we see sex is one of the common ways to do it and so, one of the things that we can do during sex is to use a condom. That’ll help limit direct contact and then, additionally for oral sex, use of dental dams can also decrease direct contact as well. During childbirth, there are two ways that we can limit spread of herpes from an infected mother to a child. One would be to just treat mom with antivirals and the other is if a pregnant woman has active sores in their genitals, one strategy would be to deliver the baby by C-section because removing the baby through abdominal surgery rather than through a vaginal delivery will decrease their contact with the open sores and thereby, block direct contact to decrease their risk of developing neonatal herpes. These last two modes of transmission pertain mostly to healthcare workers in which case use of gloves is a very prudent way to make sure you don’t touch an open sore when examining a patient. Another issue that healthcare workers come in contact with is sometimes getting needle stuck when drawing labs from a patient and so, safe needle disposal practices will help decrease their risk of a needlestick injury and thereby, limit their risk of developing herpetic whitlow as well.
—-> Herpes and Alzheimers linked? Click that link to find out more.