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50 years ago, Mao Zedong launched the Great Proletarian Cultural Revolution, inaugurating a decade of political turmoil with his calls for young people to "bombard the headquarters." In this special live edition of our podcast recorded at The Bookworm Literary Festival in March, Kaiser Kuo and David Moser welcome Melinda Liu, longtime China bureau chief of Newsweek for a discussion of the 50th anniversary of this definitive event. The immense popularity of social media has afforded China watchers a terrific window onto public opinion in China.
Members of the Politburo are rarely praised for their dancing skills, but consider Xi Jinping's almost flawless execution of the political two-step: first casting himself as the voice of liberal moderation in the face of Bo Xilai's mass propaganda, and then draping himself in the mantle of Maoist China and the Communist Revolution once his position was secure.
Kaiser and Jeremy recorded today's show from New York, where they waylaid Holly Chang, founder of Project Pengyou and now Acting Executive Director of the Committee of 100 for a discussion on spying, stealing commercial spying, spying and broadway.Yes, you read that right. Kaiser Kuo and David Moser are joined this week by Howie Southworth and Greg Matza, creators of the independent video series Sauced in Translation, a reality show that journeys into the wilder parts of China in search of local Chinese specialities that can be repurposed into classic American dishes. With equity markets in freefall, housing prices skipping downwards, foreign reserves plummetting, and industrial production on a roadtrip back to the last decade, it's no surprise permabears like Gordan Chang are stocking up on popcorn to bask in what they see as the long-due collapse of the Chinese economy. This week on Sinica, Kaiser Kuo and David Moser are joined by Deborah Seligsohn, former science counselor for the US Embassy in Beijing and currently a doctoral candidate at UCSD, where she studies environmental governance in China. When Ernest Hemingway somewhat presciently referred to Paris as a movable feast ("wherever you go for the rest of your life, it stays with you") he captured the feelings of many long-term China expats rather concisely. With amazing research now suggesting that Beijing swifts, the tiny creatures most residents pass by without noticing, are some of the most well-travelled birds on the planet, averaging an astonishing 124,000 miles of flight in their life, barely landing for years-on-end, and migrating as far as the southern tip of Africa. This is the second part of our episode of Sinica recorded last month during a special live event at the Bookworm literary festival.
Our episode of Sinica this week was captured last month during a special live event at the Bookworm literary festival, where David Moser and Kaiser Kuo were joined by China-newcomer Jeremy Goldkorn, fresh off the plane from Nashville. The West has spent decades pleading with China to become a responsible stakeholder in the global community, but what happens now that China is starting to take a more proactive role internationally? This week on Sinica, we are delighted to present a show on Tu Youyou, the Chinese scientist who recently shared a Nobel Prize in Medicine for her discovery of the anti-malaria compound artemisinin, thus making her the first citizen of the People's Republic of China to receive the Nobel Prize in the natural sciences.
Edmund Backhouse, the 20th century Sinologist, long-time Beijing resident, and occasional con-artist, is perhaps best known for his incendiary memoirs, which not only distorted Western understanding of Chinese history for more than 50 years, but also included what in retrospect can only be seen as patently fictitious stories of erotic encounters between the British Baronet and the Empress Dowager Cixi.This week on Sinica, we are delighted to be joined by Derek Sandhaus of Earnshaw Books, who has recently produced an abridged edition of Backhouse's memoirs for the Hong Kong publishing house.
Kaiser Kuo and David Moser are joined today by Jerry Chan and Matt Sheehan for a look at hip-hop in China. The interpretation of history is an inherently political act in China, and the struggle for control of the narrative of the War of Resistance Against Japan—World War II—has heated up during the approach to the September 3 parade commemorating the Japanese surrender. As anyone who reads the Sinocism newsletter knows, Bill Bishop is among the most plugged-in people in Beijing with an uncanny ability to figure out what is actually happening in the halls of power. Someone desperately needs to call a fumigator, because China's self-help bug is eating up the woodwork.
The story started when a Buzzfeed editor lost his iPhone in an East Village bar in February of last year and blossomed into the Sino-American romance of the century, and probably the most up-lifting and altogether unlikely China story that we can remember.
We have enough favorite writers on China that we've had to develop a sophisticated classification system just to keep track of everyone. If you happen to live in the anglophone world and aren't closely tied to China by blood or professional ties, chances are that what you believe to be true about this country is heavily influenced by the opinions of perhaps one hundred other people, the reporters who cover China for the world's leading media outlets and the writers who build a narrative to encompass it beyond the frenetic drumbeat of current affairs.This week, Kaiser Kuo, Jeremy Goldkorn and David Moser are joined by accomplished writer Ian Johnson to talk about this phenomenon at first generally, but then specifically with regards to a piece Ian recently authored in the New York Review of Books called An American Hero in China, a look into the way China has embraced Peter Hessler and his writings on the country.
Barbarians at the Gate is a semi-serious look at Chinese history and culture hosted by rogue historian Jeremiah Jenne and writer James Palmer. Melinda shares stories about her brother, who remained in China after the civil war and experienced it firsthand.
The changes are enough to prompt anyone to ask: how exactly did this happen and does it even make sense?Today on Sinica we take a look at the political movement some academics are calling Neo-Maoists, the traditionally conservative politicians and Party members whose influence began eroding with market reforms in the 1980s but have arguably witnessed a comeback of sorts in the last two years. After catching the Broadway musical Allegiance about the Japanese-American internment camps in WWII, we wanted to do a show discussing the experiences people of Chinese heritage have with racial profiling today, and particularly the experiences of the Chinese diaspora community in the United States. The show is a great concept, brilliantly executed, and we're delighted to have Howie and Greg here to share some behind-the-scenes stories and talk about how they got started mixing Chinese and American cuisine.
It all raises the question of how bad things are going to get, which leads to the question of how bad they are right now.Joining Kaiser, Jeremy and David in the studio today to talk about the Chinese economy and its recent tailspin is none other than Tom Orlik, an economist at Bloomberg and author of the book Understanding China's Economic Indicators. With more than 20 years of China experience, Deborah is one of the most knowledgeable people in the world on the question of China's policy response to questions of air pollution and climate change, which is why we are delighted to have her on the show.Like Sinica? In this show David Moser and Kaiser Kuo were joined by China-newcomer Jeremy Goldkorn, fresh off the plane from Nashville to field questions from our live Beijing audience.
During the show we talked about Beijing-lifers and how the city has changed during our time here. As an expert on the facts and fictions of Edmund Backhouse, Derek joins us for a discussion of what is real and less-than-real in Backhouse's deathbed reminiscences, and what we can and should learn about Qing-era China from his memoirs. Join us as we talk with Eric about the stereotypes and realities surrounding the millennial generation in China.
But as casual readers may not be aware, he is also an excellent podcast guest due to his habit of bringing first cupcakes and now amazingly smooth bottles of Japanese whisky to our recording sessions before trading the latest gossip about the goings-on in Zhongnanhai.On today's show we mark Bill's departure from China and his return to the United States where he plans to live for the next few years with his family.
As one of the earliest American-style microbreweries in China, not only has the company rescued us from endless nights of Snow and Yanjing, but its also given us something uniquely Chinese with its assortment of peppercorn, honey and tea-flavored beers. We used to buy the papers for his "Telegrams from the Orient", but then he took that Economist gig and his productivity plummeted and it has become hard to even remember what his writing is like anymore. Train station bookstores may always have served the genre's trite pabulum to bored businessmen legging it cross-country, but in recent months the popularity of the cult has spread more widely, to the point one can't go to a party these days without being accosted for one's thoughts on "the Secret", or hear co-workers fume over where their cheese might have gone and which of their colleagues has probably taken it.Drowning in this morass of anti-Enlightenment thinking? It features Apple products, global crime networks, human flesh search engines, the draw of instant celebrity, and Ellen DeGeneres. That said, one of our hardest to place somewhere in the long-form taxonomy is Chris Beam, who you may have heard on past episodes talking about his experience in Chinese ping-pong bootcamp, or maybe his account of the birth of American football with the saga of the Chongqing Dockers.If you liked those shows as much as we did, you'll be delighted to hear that Chris is back this week to talk about his latest essay, an entertaining and surprisingly sympathetic look at the international Cruise Industry and its attempts to romance one of the least sea-faring countries on the planet. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. As a bonus, site members have access to a banner-ad-free version of the site, with print-friendly pages.Click here to learn more. We’ll pick a topic and then explore that subject over four episodes released every other Friday.
A graduate of Peking University who now works for China Dialogue, Ma Tianjie offers penetrating insight and analysis written with great flare. In conversation with Jude Blanchette, former Assistant Director of the 21st century China program at UCSD, now with the Conference Board, Kaiser and Jeremy take a look at the history of the movement, who the major players are today, and how it is playing out in the Chinese media. Tom has years of experience writing about China and joins to share his thoughts on what parts of the economy are doing decently and where the real problems lie.
Don't forget that you can subscribe to our iTunes podcast feed by using our custom RSS feed. And if life is so romantic here, where are the writers in our midst and what are they producing anyway?This week on Sinica, Kaiser Kuo and David Moser are delighted to host the editors of While We're Here: China Stories from a Writer's Colony, a compilation of short stories, poems and more lovingly assembled by Alec Ash and Tom Pellman of The Anthill. During this show we talk about what Beijing means to us and what we see happening in China going forward.If you're a long-time listener, be sure to check out this unusual episode—recorded in front of a live audience.
Jerry has been involved with the local music scene for over a decade and now works as marketing director for True Run Media.
While not exactly your requisite "Why I Am Leaving China" blog post, this show gives Kaiser Kuo and David Moser the chance to talk to Bill about the reasons behind his decision, and explore why he sees an increasingly strained relationship between China and the United States over the next few years.
Join us on Sinica as we excoriate the self-help movement in a show featuring an almost unanimous bewilderment, tempted only by the fascinating insights of Eric Hendriks, Peking University postdoc and lecturer and researcher on this fascinating topic. Who can resist the cross-cultural romance of Matt Stopera and Brother Orange?Joining Kaiser, Jeremy and David us to talk about this phenomenon and its backstory and are two guests who've seen it unfold from the inside: Matt Sheehan, China Correspondent for the Huffington Post, who wrote this piece about the saga, and Cecilia Miao, agent for Brother Orange and creator of Channel-C, a community for Chinese students who have studied abroad. And considering the phenomenal timing of this show -- taking place almost exactly as Jeremy Goldkorn "goes native" in America and enjoys his very first mega cruise -- we hope you enjoy the show as much as we enjoy bringing it to you.Enjoy Sinica? Our first topic appropriately enough is about barbarians, and our inaugural episode looks at An Lushan: the outsider who charmed his way into the court of the Tang Dynasty in the eighth century and who almost succeeded in bringing down the empire. He joins Kaiser, Jeremy, and Ada Shen in the studio for a wide-ranging discussion that reveals the mysterious origins of "diaosi" culture and looks at some of the controversies and conversations that have dominated Weibo and WeChat in recent months. And please feel free to download this show as a standalone mp3 file and share with anyone you think might also like hearing the show. This is part one: the second half will follow [standalone mp3 file]]]> Our episode of Sinica this week was captured last month during a special live event at the Bookworm literary festival, where David Moser and Kaiser Kuo were joined by China-newcomer Jeremy Goldkorn, fresh off the plane from Nashville. Everyone is also welcome to download this show directly from Popup Chinese as a standalone mp3 file. Matt Sheehan is the Beijing correspondent for the Huffington Post and has recently written on rap in China as well. After August excursions to lands of clean air and English-language media, the Sinica team is back this week with a show covering the astonishing explosions that gutted the Binhai economic development zone in Tianjin last week. This is a surprisingly intimate look at one of the places we've grown to take for granted, filled with details on their touch-and-go early years and the bureaucratic run-in that almost crippled the business. Also, beyond discussing his future plans and long history of covering China, we also wanted to know what's he's learned on the beat and where in his opinion one can find the best Sichuan food in Beijing. We welcome all listeners to share their feedback and thoughts in the comment section below, and encourage everyone to download our standalone mp3 file to share this show with friends and colleagues who may have fallen victim to the self-help bug. So listen in online or download our show as a standalone mp3 file and share with friends.]]> The story started when a Buzzfeed editor lost his iPhone in an East Village bar in February of last year and blossomed into the Sino-American romance of the century, and probably the most up-lifting and altogether unlikely China story that we can remember. 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.
It’s a story made for imperial slash fic: The aging emperor, his rotund but sexy concubine, and the foreigner who came between them. Thanks!]]> This week on Sinica, Kaiser Kuo and David Moser are joined by Deborah Seligsohn, former science counselor for the US Embassy in Beijing and currently a doctoral candidate at UCSD, where she studies environmental governance in China.
And if you want to pick up the book, you can find it for your Kindle here on Amazon or drop by The Bookworm in Beijing for a physical copy.
Enjoy and let us know what you think.]]> The West has spent decades pleading with China to become a responsible stakeholder in the global community, but what happens now that China is starting to take a more proactive role internationally? As the Chinese government struggles to deal with public pressures for greater transparency and conspiracy theories mount, we take a closer look at what we know and don't about the port explosion.Enjoy Sinica?
Trends in HSV Types and Genital HerpesGenital herpes can be caused by either HSV-2 or HSV-1. Join Kaiser Kuo and David Moser this week as they talk with two journalists who covered the aftermath of the Tianjin explosions in person from the Chinese equivalent of ground zero: Julie Makinen who heads the China bureau for the LA Times and Fergus Ryan who covers China for The Guardian. And feel free to download the standalone mp3 file of this show to share with friends and colleagues. Please feel welcome to listen online or download our show as a standalone mp3 file and share with friends and colleagues.]]> Insurance scam? In recent years, HSV-1 has become a significant cause in developed countries, including the United States.


The risk of infection is highest during outbreak periods when there are visible sores and lesions. SymptomsWhen genital herpes symptoms do appear, they are usually worse during the first outbreak than during recurring attacks.
Herpes, Pregnancy, and Newborn InfantsHerpes can pose serious risks for a pregnant woman and her baby.
The risk is greatest for mothers with a first-time infection, because the virus can be transmitted to the infant during childbirth.
Guidelines from the American Academy of Pediatrics recommend using specific diagnostic tests for women in labor to determine the risk of transmission. Babies born to mothers infected with genital herpes are often treated with the antiviral drug acyclovir, which can help suppress the virus. Herpes viruses 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). 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.
The usual cause of oral herpes (herpes labialis), which are commonly called cold sores or fever blisters. HSV-1 can also cause genital herpes, which is a sexually transmitted disease (STD). Herpes simplex virus 2 (HSV-2). 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. 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. 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.
However, at some point, the virus wakes up and travels along nerve pathways to the surface the skin where it begins to multiply again. 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). 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. Certain triggers can wake up the virus from its dormant state and cause it to become active again. In general, recurrent episodes of herpes cause less severe symptoms than the primary outbreak. HSV-1 is the most prevalent form of herpes simplex virus, and infection is most likely to occur during preschool years. In addition, because HSV-1 can be passed in saliva, people should also avoid sharing toothbrushes or eating utensils. Transmission of Genital Herpes Genital herpes is transmitted through sexual activity. People can get HSV-2 through genital contact or HSV-1 through mouth-to-genital contact with an infected partner. People with active symptoms of genital herpes are at very high risk for transmitting the infection. 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. There is also evidence that children today are less likely to get cold sores and become exposed to HSV-1 during childhood.
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. 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. 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). Although condoms may not provide 100% protection, they are proven to significantly reduce the risk of sexual disease transmission, including herpes.
Natural condoms made from animal skin do NOT protect against HSV infection because herpes viruses can pass through them. Use a water-based lubricant. Lubricants can help prevent friction during sex, which can irritate the skin and increase the risk for outbreaks. Only water-based lubricants (K-Y Jelly, Astroglide, AquaLube, and glycerin) should be used. However, it is best not to use condoms pre-lubricated with spermicides. Do not use spermicides for protection against herpes.
Nonoxynol-9 can cause irritation around the genital areas, which makes it easier for herpes and other STDs to be transmitted. Use a dental dam or condom for oral sex.
If you have any symptoms of oral herpes, it is best not to perform oral sex on a partner until any visible sores or blisters have healed. Limit the number of sexual partners.
The more sexual partners you have, the greater your chances of becoming infected or infecting others. 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, often 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.
Ocular herpes is usually a simple infection that clears up in a few days, but in its more serious forms, and in severe cases, it can cause blindness. It only affects the upper layer (epithelium) of the cornea and heals with scarring. Stromal Keratitis. Iridocyclitis is another serious complication of ocular herpes, in which the iris and the area around it become inflamed. 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. Untreated, this condition can be extremely serious and possibly fatal. Gingivostomatiti Oral herpes can cause multiple painful ulcers on the gums and mucus membranes of the mouth, a condition called gingivostomatitis.


Children with gingivostomatitis commonly develop herpetic whitlow (herpes of the fingers). Herpetic Whitlow A herpetic whitlow is an infection of the herpes virus involving the finger, often around the fingernail. 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.
Women may also experience vaginal discharge. Recurrent Genital Herpes Outbreak In general, recurrences are much milder than the initial outbreak. 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 HerpesOral 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. A herpes infection may occur on the cheeks or in the nose, but facial herpes is very uncommon. Primary Oral Herpes Infection If the primary (initial) oral infection causes symptoms, they can be very painful, particularly in children. 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. The outbreak of infection is often preceded by a prodrome, an early group of symptoms that may include itchy skin, pain, or an abnormal tingling sensation at the site of infection. Recurrent outbreaks feature most of the same symptoms at the same sites as the primary attack, but they tend to be milder and briefer. 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. Oral herpes can be triggered within about 3 days of intense dental work, particularly root canal or tooth extraction. Timing of Recurrences Recurrent outbreaks may occur at intervals of days, weeks, or years. 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. 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, Campho-phenique, 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.
Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection.



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