Herpes simplex 5 month old drink,how to treat autoimmune disease at home,treatment for a herpes outbreak untreated - 2016 Feature

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Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.
Herpes (oral & genital) cannot be spread through inanimate objects such as spoons, glasses, razors, towels, bed sheets, etc.
Herpes is a very manageable skin condition and does not cause any damage to internal organs. I find out 2013 all you need to do is take a day at a time it will get better hun.dont stress about you may have a breakout, my family still dont know any they would never know. It’s ok Adrianna, I know it seems so scary but you will be very much ok, this is something that happens to so many people and it is easily controlled. All I can say is just call your doctor he or she will explain what type of pill you may need. I’m in my first outbreak now and have found a regimen that reduced my pain greatly and started healing my lesions within 24 hours. There is bilateral asymmetric increased signal intensity in FLAIR sequence with corresponding diffusion restriction on DWI in anterior and medial temporal lobes as well as limbic systems, right more than left. Dramatic change in one month with cystic encephalomalacia, focal atrophy and white matter hyperintensity. TV shows, movies, and society as a whole create this stigma around herpes when really, there’s not too much to be scared of. Herpes can only be passed through direct skin-to-skin contact with the infected area such as kissing, oral sex, genital-to-genital rubbing, vaginal, and anal sex.
After diagnosis, you may feel like your life may never be the same again but you will feel better soon. The people telling you that there is a cure are trying to sell you something and it is a scam. I’ve been with mine for almost three years and went to the hospital cause of bad pain. It should reduce your outbreaks 100% however the virus is with you forever so it will be transmitted through oral sex. I got tested back in December & when the nurse pulled that up to see if I had it then, they tested for everything BUT herpes? Revisiting the indications of using allopurinol in asymptomatic hyperuricemia and a critical reappraisal of the safety profile of allopurinol is done in this article.
The aim of this study was to raise an awareness amongst medical practitioners who use allopurinol injudiciously for the treatment of asymptomatic hyperuricemia leading to potentially life threatening consequences to the patient. Allopurinol is the most common cause of Steven-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel. Fatal allopurinol hypersensitivity syndrome after treatment of asymptomatic hyperuricaemia. HSV-1 can also cause genital herpes. Herpes simplex virus 2 (HSV-2) is the most common cause of genital herpes, but it can also cause oral herpes. Most of the time, genital herpes is a mild skin condition that can be managed very effectively. There are countless online communities and support groups for you with people who’ve been in your shoes. You will discover that you may feel like you have a mild flu (sore muscles and joints, maybe slightly elevated temperature) when an outbreak is coming. The only issues i have is when im depressed or stressed i will have an outbreak but they rarely come like only 2 or 3 times a year.
If you both have it if you’re not careful and are stressed it just continues to go back and forth. Toxic epidermal necrolysis is a commonly encountered condition at the Singapore General Hospital and most cases are due to allopurinol.
Trends in HSV Types and Genital Herpes Genital herpes can be caused by either HSV-2 or HSV-1. And i fear that since symptoms have not shown up, will taking the meds possibly cause a reaction? I honestly don’t understand how basically out of nowhere I stated showing signs for it. As soon as i feel an outbreak coming i use coconut oil and i’m free of it in 3 days or less depending on when i use it. The aim of this study is to highlight the fatal consequences of the indiscriminate use of allopurinol.
This study was conducted to describe the rampant and frequently unjustified use of allopurinol resulting in toxic epidermal necrolysis. I take it the person who said this didn’t have insurance (otherwise it would cost you a fortune). 3) Make a mixture of pure,raw,unfiltered honey and pure virgin coconut oil and apply liberally to lesions. I haven’t shown symptoms or had my first outbreak I don’t think considering its described to be terrible! What I am confused about… Is it still ok to kiss someone even if you don’t have an outbreak or symptoms?
We report four cases of toxic epidermal necrolysis from allopurinol, three of which resulted in death. We report a case series of four cases linked to the unjustified use of allopurinol over the first 5 months of 2009.
In recent years, HSV-1 has become a significant cause in developed countries, including the United States.
Cried for months, lost friends who wanted to blab their mouth about it and everything in between. Our aim is to highlight that allopurinol in all these cases was not indicated and prescribed for asymptomatic hyperuricemia.
All four of these patients who developed TEN were elderly patients with comorbidities such as ischemic heart disease, hyperlipidemia, diabetes and hypertension. You can use one of the mild cold sore topicals to ease irritation and oral meds Acyclovir or Valtrex will help ease symptoms. The incidence and potentially severe and lethal consequences of allopurinol hypersensitivity syndrome and toxic epidermal necrolysis could be kept to a minimum by strictly adhering to the established indications of allopurinol treatment. Three out of four patients died secondary to toxic epidermal necrolysis attributable to allopurinol.
The risk of infection is highest during outbreak periods when there are visible sores and lesions. Have also had ingrown hair (although I’ve suffered from that as long as I can remember) but have recently been increasing. What I am trying to say is that if your partner loves you and understands you and is aware and does the research, then he or she will stay with you and support you. Ten days later, the patient developed painful blisters over the trunk that rapidly spread to involve more than 60% of her body involving her face, lips, eyes, oral and genital mucosa.
It’s hasn’t been happening anymore, but some weeks ago it was burning to wipe, not to pee at all, but to wipe! Couldn’t urinate with crying you have to desperate your labia when you urinate helps with pain. Symptoms When genital herpes symptoms do appear, they are usually worse during the first outbreak than during recurring attacks.
Also, will I automatically spread it during sex…or only when I’m having an outbreak? The erosions were slow to heal and cultures revealed secondary colonization with Pseudomonas and Candida. Herpes, Pregnancy, and Newborn Infants Herpes can pose serious risks for a pregnant woman and her baby. She also developed secondary pneumonia as seen on a chest X-ray which was treated with intravenous antibiotics. The risk is greatest for mothers with a first-time infection, because the virus can be transmitted to the infant during childbirth. On day 21, she developed acute renal failure and severe sepsis with neutropenia and was managed by the infectious diseases physician.
Guidelines from the American Academy of Pediatrics recommend using specific diagnostic tests for women in labor to determine the risk of transmission. She continued to deteriorate despite intravenous antibiotics and specialized care at the burns unit.
Babies born to mothers infected with genital herpes are treated with the antiviral drug acyclovir, which can help suppress the virus. Take it day by day and you will soon forget until that is you get a breakout or start a new relationship. Based on his uric acid levels alone, he was started on allopurinol by the general practitioner.
Two weeks later, he was admitted to hospital with generalized painful blisters involving his face, trunk, limbs and mucosa, oral and genital.
They include human herpes virus 8 (the cause of Kaposi sarcoma) and varicella-zoster virus (also known as herpes zoster, the virus responsible for shingles and chickenpox).
His liver function was deranged twice that of normal and full blood count revealed leukocytosis. The word "herpes" comes from the Greek word "herpein," meaning "to creep." This refers to the unique characteristic pattern of all herpes viruses to creep along local nerve pathways to the nerve clusters at the end, where they remain in an inactive (dormant) state for variable periods of time. HSV-1 can also cause genital herpes, which is a sexually transmitted disease (STD). Herpes simplex virus 2 (HSV-2) is the usual cause of genital herpes, but it can also cause oral herpes. The wounds became secondarily infected with Pseudomonas and were dressed with mepilex dressing and treated with intravenous antibiotics. Three weeks into the rash, he developed sudden hypotension and was found nonresponsive and pronounced dead after attempt to resuscitate him repeatedly failed. Cause of death still remains unclear.Case 3This is a 56-year-old Indonesian lady who was prescribed allopurinol by her general practitioner in Indonesia for back pain.
Until recently, the general rule was to assume that HSV-1 caused oral herpes and HSV-2 caused genital herpes.

It is now clear, however, that either type of herpes virus can be found in the genital or oral areas (or other sites).
In fact, HSV-1 is now responsible for more than half of all new cases of genital herpes in developed countries. The Disease ProcessHerpes is transmitted through close skin-to-skin contact. One month after taking allopurinol, she presented with generalized targetoid lesions over face, trunk and limbs, including tense blisters over the palms and soles, involving 30% of body surface area [Figure 3].
To infect people, the herpes simplex viruses (both HSV-1 and HSV-2) must get into the body through tiny injuries in the skin or through a mucous membrane, such as inside the mouth or on the genital or anal areas. The risk for infection is highest with direct contact of blisters or sores during an outbreak. But the infection can also develop from contact with an infected partner who does not have visible sores or other symptoms. Once the virus has contact with the mucous membranes or skin wounds, it enters the nuclei of skin tissue cells and begins to replicate.
Over the next 1 week, the epidermal detachment continued to progress to involve 70% of the body surface area. The virus is then transported from the nerve endings of the skin to clusters of nerve cells (ganglia) where it remains inactive (latent) for some period of time. Herpes simplex type 1 was isolated from oral lesions and Candida from the buttocks and was treated with intravenous acyclovir and fluconazole. However, at some point, the virus wakes up and travels along nerve pathways to the surface the skin where it begins to multiply again.
An ultrasound and computerized tomography (CT) scan showed a pancreatic mass consistent with a pancreatic tumor.
During this time, the virus can infect other people if it is passed along in body fluids or secretions. Viral shedding may be accompanied by noticeable symptoms (outbreak) but it can also occur without causing symptoms (asymptomatic shedding).
On admission, she had 50% body surface area involvement with severe facial and oropharnygeal involvement.
In either case, a person is infectious during periods of viral shedding. Symptoms may appear as multiple small red bumps or patches that develop blisters.
The epidermal detachment continued to progress, and after 1 week, it involved 90% of the body surface area.
Her stay was complicated by gram positive cocci bacteremia, and she was started on intravenous cloxacillin and ciprofloxacin.
Certain triggers can wake up the virus from its dormant state and cause it to become active again.
However, she developed overwhelming septicemia and disseminated intravascular coagulation resulting in death due to septicemic shock. In general, recurrent episodes of herpes cause less severe symptoms than the primary outbreak.
The Center for Pharmaceutical Administration, Health Sciences Authority (HSA) is the national agency that regulates medicinal and health-related products to safeguard public health. In addition to these four deaths, there have been 19 deaths reported in Singapore over the last 10 years as a result of TEN and allopurinol hypersensitivity syndrome. The US FDA has received a cumulative report of 23 cases of severe drug reactions to allopurinol over the period 2002-2009.
HSV-1 is the most prevalent form of herpes simplex virus, and infection is most likely to occur during preschool years. The risk was restricted to short-term use less than 8 weeks and co-medications did not appear to increase the risk.Raised serum urate concentrations have been associated with insulin resistance, obesity, hypertension, dyslipidemia and atherosclerotic disease.
For these reasons, urate lowering drugs were widely used in people with asymptomatic hyperuricemia in the past. No compelling evidence shows, however, that hyperuricemia causes cardiovascular disease which was previously thought. People can get HSV-2 through genital contact or HSV-1 through mouth-to-genital contact with an infected partner. Kelly estimated that 5-8% of the general population and up to 15% of hospitalized patients have elevated uric acid levels. Thus, allopurinol treatment for hyperuricemia alone would expose a large number of people to the drug with associated risks. People with active symptoms of genital herpes are at very high risk for transmitting the infection. Consequently, urate lowering agents should not be indicated and are not warranted in the treatment of asymptomatic hyperuricemia.
Unfortunately, most cases of genital herpes infections occur when the virus is shedding but producing no symptoms. Most people either have no symptoms or do not recognize them when they appear. In the past, genital herpes was mostly caused by HSV-2, but HSV-1 genital infection is increasing. However, allopurinol is the most prescribed drug because of its efficacy, irrespective of the cause of the hyperuricemia, and due to its convenient once daily dosing. There is also evidence that children today are less likely to get cold sores and become exposed to HSV-1 during childhood. Therapeutic decisions have to take into account the imbalance between expected benefit and potential harm.
In asymptomatic patients, therapeutic interventions must be effective in preventing complications or progression of disease with low risk of adverse events or deterioration of quality of life. Allopurinol hypersensitivity syndrome and toxic epidermal necrolysis most often present as a consequence of inappropriate treatment of asymptomatic hyperuricemia. Centers for Disease Control and Prevention (CDC), about 1 in 6 Americans ages 14 to 49 years have genital herpes. While HSV-2 remains the main cause of genital herpes, HSV-1 has significantly increased as a cause, most likely because of oral-genital sex. Some researchers believe that hyperuricemia is a risk factor for ischemic heart disease, and has been associated with diabetes mellitus, lipid abnormalities, hypertension and stroke. However, till date no direct role in the pathogenesis or outcome of these conditions has been confirmed.Alternative treatments are now emerging for the treatment of gout, including rasburicase [7] and febuxostat.
African-American women are at particularly high risk. People with compromised immune systems, such as those who have HIV, are at very high risk for genital herpes. Clinical trials have demonstrated superior its ability to lower and maintain serum uric acid levels and is well tolerated.
Febuxostat has been granted marketing authorization by the European Commission in early 2008 for the treatment of hyperuricemia and gout, and is the first major treatment alternative for gout in more than 40 years. Drugs that suppress the immune system, and organ transplantation, can also weaken the immune system and increase the risk for contracting genital herpes. It is almost impossible to defend against the transmission of oral herpes, because it can be transmitted by very casual contact, including kissing. Still, you can help reduce the risk of transmitting oral herpes by not sharing objects that touch the mouth, such as eating and drinking utensils, toothbrushes, and towels.
It is best to refrain from any type of sex (vaginal, anal, or oral) during periods of active outbreak.
However, herpes can also be transmitted when symptoms are not present (asymptomatic shedding). Only water-based lubricants (K-Y Jelly, Astroglide, AquaLube, and glycerin) should be used.
It is very unlikely to transmit or contract genital herpes from a toilet seat or bath towel. Studies suggest that male circumcision may help reduce the risk of HSV-2, as well as human papillomavirus (HPV) and HIV infections. However, herpes can cause significant and widespread complications in people who don't have a fully functioning immune system.
The CDC recommends that all people diagnosed with herpes simplex virus 2 (HSV-2) get tested for HIV. Most people with HIV are co-infected with HSV-2 and are particularly vulnerable to its complications.
HSV-2 infection increases HIV levels in the genital tract, which makes it easier for the HIV virus to be spread to sexual partners. Herpes and PregnancyPregnant women who have genital herpes due to either HSV-2 or HSV-1 have an increased risk for miscarriage, premature labor, inhibited fetal growth, or transmission of the herpes infection to the infant in the uterus or at the time of delivery.
Herpes in newborn babies (herpes neonatalis) can be a very serious condition. Fortunately, neonatal herpes is rare.
Although about 25 to 30% of pregnant women have genital herpes, less than 0.1% of babies are born with neonatal herpes.
The baby is at greatest risk during a vaginal delivery, especially if the mother has an asymptomatic infection that was first introduced late in the pregnancy.
The risk for transmission also increases if infants with infected mothers are born prematurely, there is invasive monitoring, or instruments are used during vaginal delivery. Transmission can occur if the amniotic membrane of an infected woman ruptures prematurely, or as the infant passes through an infected birth canal.
This risk is increased if the woman is having or has recently had an active herpes outbreak in the genital area. Very rarely, the virus is transmitted across the placenta, a form of the infection known as congenital herpes.
Also rarely, newborns may contract herpes during the first weeks of life from being kissed by someone with a herpes cold sore. Infants may get congenital herpes from a mother with an active herpes infection at the time of birth.
Aggressive treatment with antiviral medication is required. Most infected pregnant women do not have a history of symptoms, so herpes infection is often not suspected or detected at the time of delivery. Fortunately, if a woman does have genital lesions, rapid diagnostic blood tests can quickly determine her chances of transmitting the virus to her baby during delivery. Some women with new or recurrent herpes may also be prescribed antiviral medication during pregnancy. A woman with herpes can usually safely breastfeed her baby, as long as she does not have a lesion on her breast or nipple.
Neonatal herpes can spread to the brain and central nervous system, causing encephalitis and meningitis.
Herpes can also spread to internal organs, such as the liver and lungs. Infants infected with herpes are treated with acyclovir, an antiviral drug. They usually receive several weeks of intravenous acyclovir treatment, followed by several months of oral acyclovir. It is important to treat babies quickly, before the infection spreads to the brain and other organs. Fortunately, rapid diagnostic tests and treatment with acyclovir have significantly improved survival rates and reduced complication rates.
Nearly all who recover have some impairment, ranging from very mild neurological changes to paralysis.

Like encephalitis, meningitis symptoms include headache, fever, stiff neck, vomiting, and sensitivity to light. Fortunately, herpes meningitis usually resolves after about a week without complications, although symptoms can recur. Herpes Eye ComplicationsOcular herpes is a recurrent infection that affects the eyes. Herpes Skin ComplicationsEczema Herpeticum: A rare form of herpes infection called eczema herpeticum, also known as Kaposi varicelliform eruption, can affect people with skin disorders and those with a weakened immune system. In children, this is often caused by thumb sucking or finger sucking while they have a cold sore.
It can also occur in adult health care workers, such as dentists, because of increased exposure to the herpes virus. The use of latex or polyurethane gloves prevents herpes whitlow in health care workers. SymptomsHerpes symptoms vary depending on whether the outbreak is initial or recurrent. The primary outbreak is usually worse than recurrent outbreaks, with more severe and prolonged symptoms.
In fact, studies indicate that 10 to 25% of people infected with HSV-2 are unaware that they have genital herpes. The first signs are a tingling sensation in the affected areas (genitalia, buttocks, and thighs) and groups of small red bumps that develop into blisters. The sores may sometimes itch, but itching decreases as they heal. About 40% of men and 70% of women develop other symptoms during initial outbreaks of genital herpes, such as flu-like discomfort, headache, muscle aches, and fever. Some women may have difficulty urinating and may, occasionally, require a urinary catheter.
The virus sheds for a much shorter period of time (about 3 days) compared to an initial outbreak of 3 weeks. Women may have only minor itching, and the symptoms may be even milder in men. On average, people have about four recurrences during the first year, although this varies widely. There are some differences in frequency of recurrence depending on whether HSV-2 or HSV-1 caused genital herpes. HSV-2 genital infection is more likely to cause recurrences than HSV-1. Symptoms of Oral Herpes Oral herpes (herpes labialis) is most often caused by HSV-1, but it can also be caused by HSV-2.
It usually affects the lips and, in some primary attacks, the mucus membranes in the mouth.
The sores last 10 to 14 days and can be very uncomfortable. Blisters that may be preceded or accompanied by sore throat, fever, swollen glands, and painful swallowing.
Recurrent Oral Herpes Infection: A recurrent oral herpes infection is much milder than the primary outbreak. It usually manifests as a single sore, commonly called a cold sore or fever blister (because it may arise during a bout of cold or flu). The sore usually shows up on the outer edge of the lips and rarely affects the gums or throat. Recurrences of genital herpes are more likely with HSV-2 infection than with HSV-1 infection.
Occasionally, the symptoms may not resemble those of the primary episode, but appear as fissures and scrapes in the skin or as general inflammation around the affected area.
They include sunlight, wind, fever, physical injury, surgery, menstruation, suppression of the immune system, and emotional stress. For most people, outbreaks recur with more frequency during the first year after an initial attack.
The good news is that in most healthy people, recurring infections tend to become progressively less frequent, and less severe, over time. However, other conditions can resemble herpes, and doctors cannot base a herpes diagnosis on visual inspection alone. These tests include: Virologic tests (viral culture of the lesion) Serologic tests (blood tests that detect antibodies) The CDC recommends that both virologic and serologic tests be used for diagnosing genital herpes.
People diagnosed with genital herpes should also be tested for other sexually transmitted diseases. At this time, experts do not recommend screening for HSV-1 or HSV-2 in the general population. Genital herpes can be caused by either HSV-1 or HSV-2.
It is important to determine which virus is involved, as the type of herpes infection influences prognosis and treatment recommendations. Recurrences of genital herpes, and viral shedding without overt symptoms, are much less frequent with HSV-1 infection than with HSV-2. False-negative (testing negative when herpes infection is actually present) or false-positive (testing positive when herpes infection is not actually present) results can occur.
Your health care provider may recommend that you have a test repeated. Virologic TestsViral culture tests are made by taking a fluid sample, or culture, from the lesions as early as possible, ideally within the first 48 hours of the outbreak. PCR tests are much faster and more accurate than viral cultures, and the CDC recommends PCR for detecting herpes in spinal fluid when diagnosing herpes encephalitis. PCR can make many copies of the virus' DNA, so that even small amounts of DNA in the sample can be detected. However, many labs now use PCR for herpes testing because it is highly accurate. An older type of virologic testing, the Tzanck smear test, uses scrapings from herpes lesions.
The scrapings are stained and examined under a microscope for the presence of giant cells with many nuclei or distinctive particles that carry the virus (called inclusion bodies). The Tzanck test is not reliable for providing a conclusive diagnosis of herpes infection and is not recommended by the CDC. Serologic TestsSerologic (blood) tests can identify antibodies that are specific for either HSV-1 or HSV-2. When the herpes virus infects you, your body's immune system produces specific antibodies to fight off the infection.
If a blood test detects antibodies to herpes, it is evidence that you have been infected with the virus, even if the virus is in a non-active (dormant) state.
The presence of antibodies to herpes also indicates that you are a carrier of the virus and might transmit it to others. Serologic tests can be especially useful for people who do not have active symptoms, but who have other risk factors for herpes (such as other STDs, multiple sex partners, or a monogamous partner who has genital herpes).
Although glycoprotein (gG) type-specific tests have been available for many years, many of the older nontype-specific tests that cannot distinguish HSV-1 from HSV-2 are still on the market. Canker sores frequently crop up singly or in groups on the inside of the mouth, or on or underneath the tongue. They usually heal within 2 weeks without treatment. Canker sores (Aphthous ulcers) are very common. The drugs are used initially to treat a first attack of herpes, and then afterward to either treat recurrent outbreaks (episodic therapy) or reduce frequency of recurrences (suppressive therapy). Drugs can, however, reduce the severity of symptoms, improve healing times, and prevent recurrences. If people experience very severe disease or complications, they need to be hospitalized and receive an antiviral drug intravenously.
Your health care provider will prescribe one of the three antiviral medications, which you will take for 7 to 10 days. You should begin the medication as soon as you notice any signs or symptoms of herpes, preferably during the prodrome stage that precedes the outbreak of lesions.
If taken during prodrome, episodic therapy may help prevent an outbreak from occurring or reduce its severity. Valacyclovir is taken once a day. Suppressive treatment can reduce the frequency of outbreak recurrences by 70 to 80%. It is generally recommended for people who have frequent recurrences (6 or more outbreaks per year).
Because herpes recurrences often diminish over time, you should discuss annually with your health care provider whether you should stay with drug therapy or discontinue it. While taking any suppressive therapy for genital herpes, it is still important to regularly use latex condoms and to avoid any sexual activity during recurrences. A new form of acyclovir (Sitavig) is administered orally as an adhesive tablet; it is applied to the gum region of the mouth, where it dissolves during the course of the day.
In addition, acyclovir is available in topical form, as is the related drug penciclovir (Denavir). Topical TreatmentsThese ointments or creams can help shorten healing time and duration of symptoms. However, none are truly effective at eliminating outbreaks. Penciclovir (Denavir) heals HSV-1 sores on average about half a day faster than without treatment, stops viral shedding, and reduces the duration of pain. Ideally, you should apply the cream within the first hour of symptoms, although the medication can still help if applied later. Apply the cream 5 times a day, beginning at the first sign of tingling or pain. Over-the-counter topical ointments may provide modest relief. They include Anbesol gel, Blistex lip ointment, Camphophenique, Herpecin-L, Viractin, and Zilactin. Some contain a topical anesthetic such as benzocaine, tetracaine, or phenol. Lip balm that contains sunblock, or sunscreen applied around the lips may help prevent sun-triggered outbreaks. Herbs and SupplementsGenerally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products.
Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been several reported cases of serious and even lethal side effects from herbal products. Always check with your provider before using any herbal remedies or dietary supplements. Many herbal and dietary supplement products claim to help fight herpes infection by boosting the immune system. There has been little research on these products, and little evidence to show that they really work.
Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women.
Seroprevalence of herpes simplex virus type 2 among persons aged 14 - 49 years -- United States, 2005-2008. Guidance on management of asymptomatic neonates born to women with active genital herpes lesions. Epub 2013 Jan 28. Martin ET, Krantz E, Gottlieb SL, Magaret AS, Langenberg A, Stanberry L, et al.
Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection.

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