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Sexually Transmitted Diseases/HSV II/HPV: Focus on HSV & HPV; H. pylori

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Dear Mark,

First, thank you very much for taking the time to read and respond to my inquiries.  The service you provide here is very thoughtful and generous.  It astonishes me the efforts you have given to all of us and I am deeply grateful to you for that.  Thank you.

I recently found out I have herpes II (igg antibody test, I tested 8 and have to be greater than 1.1), in 2001 I had a leep for cervical dysplasia, and I just found out I have the stomach bacteria h pylori.

Regarding the herpes II.  I have never, ever had an outbreak of any kind genital, oral, or anywhere.  I was surprised to find out I have this.

Regarding the leep.  Because it was a long time ago (2001) I do not know the strain.  At that time the nurse did not talk in the sense of CIN.  She said there are 4 stages of precancer before it is classified as cancer, you are in the 4th stage of precancer.  She also mentioned I was only contagious if I had active warts.  She did state I do not have one of the high risk ones.  So, I wonder if she meant I do not have any high risk type hpv or if she was only referring to type 16/18 but it was still another high risk type.  I think it must have been a high risk type because I needed the leep, also I have never had any warts that I know of.  I also believe my first pap after the leep was abnormal. Then my paps through 2003 were normal.  I did not have a pap again until 2006 and it was normal.  The next was in 2012 it was normal.  Then just this month Oct 2014 and it is normal.  I did not know about hpv testing, I had my first cervical hpv test this month (cervical only) and it was negative.
I do not know how long I have had herpes II (I tested neg for herpes I).  I wonder if perhaps I had a low risk hpv and hsv II in order to have such high cervical dysplasia or if I had to of had a high risk hpv?  What are your thoughts on that?  

The CDC website states Fluids found in a herpes sore carry the virus, and contact with those fluids can cause infection. You can also get herpes from an infected sex partner who does not have a visible sore or who may not know he or she is infected because the virus can be released through your skin and spread the infection to your sex partner(s).  My question is, if you have no symptoms and have never had an HSV Type II outbreak, then what part of your skin spreads the infection?  My genital region only or is it spread through my arms, hands, mouth, eyes?  Is it also true they consider the genital region to be the thighs, glutes, genitalia, and even the abdomen?  I use my hands and arms frequently with other people, so it is important for me to know.  I’ve also read sneezing and coughing can spread herpes II, is that true?  What about other body fluids that are not from herpes sores that have herpes dna in it, like blood, urine, pus (not related to a herpetic lesion but related to another infection/irritation), can those infect others with HSVII if they have cracks in their skin?

For example, I have a soap sensitivity and that can cause my arms and hands to crack.  This is unrelated to HSV II, I am 100% positive about that.  However, sometimes this soap sensitivity can cause my arm skin to push out pus.  Again, this pus is not from an HSV sore, it is certainly from a rash created by soap.  Does that pus carry infectious HSV II?  I gave my friend a massage, didn’t know I had HSV II, and I do not know if he had cracks in his skin or not.  So I guess with massage you are rubbing into the skin, so there is an element of friction.  I read friction is required to transfer HSV, but how much?  With massage there is deep kneading and sometimes it is more vigorous than others.  Also, I thought the oil might help hsv live longer, not sure if that is true?  The glutes do get massaged, but it was not a sexual massage.  However, you do touch the glutes(butt cheeks only) and the thighs.  I also massaged his hands-which of course he can then touch his genitalia, mouth, eyes, and so on.  It was a full body massage.  If there were cracks in his skin is he at risk?  Would the crack have to be in his anogenital area or anywhere on the body, for example his back?  If there were not cracks in his skin is he at risk if for example any of the pus from the soap sensitivity did transfer to his skin?  

Also, we were camping and didn’t have access to hand washing, so, we would urinate and have no way to wash our hands.  I massaged him right after we went to the bathroom.  Could he get it from me massaging him immediately following urination?  Urine does come from the genital region.  I don’t know what kind of barrier toilet paper provides, if any? Some urine can seep through the toilet paper.  Which I guess the urine can have herpes in it, but is it infectious?  The skin you wipe is infectious so even if the urine isn’t, then you have that?  Again, we were camping, so… :(  I figure it would be good for me to understand this anyhow.  The consideration is people often have cracks we do not know about in their skin from scratching their backs, shaving their legs/arms/backs/chests/faces, acne, and so on.

So if they have a scratch in their back, and there is direct contact from a herpetic II lesion, they would get hsvII on that spot or it would show up on their genitals?  

The thing is I have never had an outbreak, so I do not know where I am infectious when asymptomatically shedding.  There is the potential the hsvII could be on my mouth, eyes, genitals, or it seems like anywhere for that matter, correct?  Also, there is this thing of herpetic whitlow, where it is possible to have an outbreak on hands?  Therefore, since I do not know where my infection is and could at any time be asymptomatically shedding, I should never be giving massages because people may have cracks in their skin that I cannot see?  Even though hands are washed before a massage, I can try hard to not touch my face in a massage, but what if I forget?  Or if the infection happens to be on my hands, then I can be passing it that way? People are always shaving their legs/arms/chests/face before massages, scratching their backs, acne, so they have micro cracks in skin.

Also, would the glute skin be considered too thick for the virus or not?  I did read a post about a girl having lesions on her glutes and thighs, so it doesn’t seem like the skin is too thick in these areas?

What if I have cracks in my skin from the soap, they are not excreting pus or anything else, am I spreading anything?

Is it true herpes only survives for 10 seconds?  So if I did have urine on my hand it would die in 10 seconds or since it’s my hand it lives longer?  But if it got on a toilet seat, it would die in 10 seconds?  I have read this on a few websites (one is http://www.herpesonline.org/herpes-simplex-virus/, I have yet to find a study that proves this 10 seconds statement.), but I read on an actual study it can last for 4.5 hours-8 weeks. (http://www.biomedcentral.com/1471-2334/6/130/, see table 3)  Also, it is not just that there is urine on hand, but when wiping you are in that region.  I go camping/hiking a lot where washing hands isn’t possible, and so I wonder how others could be infected.  I also react negatively to ethanol, it cracks my skin so that makes hand sanitizer out of the question for me.

Could hpv low risk be transferred through those routes(arm pus, urination from not washing hands)?  How about hpv high risk?

Also, if you have sex in a hot tub that is not chlorinated then is hsv II or hpv transmitted that way?

I live in an apartment complex with shared public laundry.  What if my dirty clothes hit the outside of the washer and dryer?  Then someone comes to do their laundry immediately after me.  What are the risks for them getting hsv II and hpv by then touching the washer and dryer and also using them after I did?

Is washing the hands for only 20 seconds with either type of soap, even if not antibacterial, enough after using the bathroom when you know you have hsv II/hpv/h pylori?  Again, I go right into massages and I want to change to 20 seconds because my hands are raw, but I feel after using the bathroom I should be washing my hands and forearms for a minute each.

I know this is not an STD, but I am wondering if you know…I also just found out I have H pylori.  Can he get H pylori from the pus?  Can he get it from me wiping after urination, not stool, since we weren’t able to wash our hands?  I know with stool you could, right?  Since I massaged his glutes that puts the bacteria close to his intestinal tract and since I massaged his hands he could have touched his mouth or his eating utensils then eaten?

I do apologize for my long inquiry, I am just trying to figure out how to operate in the world with these viruses/bacteria.  I deeply value your time and expertise into helping me understand what is going on with me.  This is a very generous service you are providing, thank you very much.

My deepest gratitude,
Star
35 years old
Oklahoma City, OK/United States

Answer
Dear Star,
You asked several questions in waaaaa-y too long of a post!! If there is a next time, please break out your questions into separate posts!  

HSV & HPV:
Both viruses require skin to skin exposure where live virus from one person is spread to scratched or abraded skin of the previously uninfected person, and are NOT blood borne.  It is essentially NOT spread from inanimate objects (fomites such as underwear or towels, etc.) or surfaces (hot tub ledges, toilet seats, massage table surfaces, etc.) although these viruses may survive for hours or even days in a semi-dried state as essentially a blob of goo or pus.  

Herpes 1 or 2 differ primarily in the tissue they tend to infect, although either strain may infect any skin anywhere. They are usually transmitted from adults to babies or children from either kissing, or rough & tumble play between kids when they have colds, or shortly before a cold develops when the virus might be shed.  Many viruses are heavily shed and capable of causing infection in others in the day immediately before the full blown infection may be evident.  If I'm okay today, but tomorrow I will have a herpes outbreak, I may be shedding the virus today and be capable of spreading it during kissing, saliva sharing, etc.

So massage is okay, although any cracks on the skin are unsightly and unsanitary, and you should refrain from any contact with others when you have such injuries, unless the open areas are properly covered-- which might interfere with your doing a massage. Other casual contact is also fine. Germs do not cause infection without coming into contact with a susceptible target (cut or mucous membrane), and intact skin isn't susceptible. Urine is similarly not an infectious carrier of herpes or HPV, but it can transmit gonorrhea or chlamydia which are other STDs. It's not the thickness of the skin, but whether the skin gets scratched or abraded that allows infection to occur.

HPV includes over a 100 strains of virus that may cause nuisance warts as well as the precancerous (high oncogenic/cancerous risk) varieties. A Pap test sometimes with DNA HPV specific test can differentiate these high risk strains from the low risk nuisance varieties. Treatments are usually designed to injure the skin where the warts or HPV are located (through acids, freezing, or mitochondrial poisoning agents such as podophyllin or combinations of these), and stimulate the body's repair process (the immune system) to eradicate the virus.

Herpes and HPV are not known to "work together, syngergestically" to cause worse disease.  They are totally separate and don't integrate their viral DNAs so can't work together. However one virus can disrupt the skin and make the other one if present, easier to cause infection. But you had a LEEP procedure on your cervix, and have had negative Paps, so that has been cured.

H. Pylori:
Your question indeed, is too involved to easily and quickly answer. You have three concerns regarding HSV 2 without known signs or symptoms of infection; HPV and cervical dysplasia and your subsequent LEEP procedure and negative followup Pap tests and HPV testing, without known signs or symptoms of warts or HPV; and H. pylori infection of the stomach.

You may wish to read up on each of these topics by visiting the Medlineplus.gov web site, which will provide you excellent information that is unbiased. Mayo Clinic, CDC, and NIH's web sites are prominently featured.

I will try to address each of the topics in brevity over the course of the next week, but the final authority should be a trusted health care provider.

H. pylori (Helicobacter pylori) is a bacteria residing in the stomach, and is associated with both acid reflux and gastric (stomach) ulcers. It is essentially spread between people and possibly pets who share saliva contaminated with regurgitated food (reflux). It is not considered a STD, however can be spread by deep kissing.  If the live viable germ gets into someone else through the mouth-- not the skin or sores, or any other way-- than it can spread to the uninfected person. If untreated, it may be associated with gastric and esophageal cancers through a complicated mechanism that TAKES TIME-- many years. There are other causes of these types of cancers as well. You can't catch it from pus, urination, or probably stool.

And save your money with over-the-counter (nonprescribed) antibacterial soaps as they don't really work any better than traditional inexpensive soaps. Soaps "work" by removing dirt and skin oils that may contain germs through friction, and water. Filthy hands may have no dangerous germs, and conversely stunningly clean hands may have lots of disease causing germs. Washing lessens this risk, and alcohol based hand sanitizers also help alot.

Hopefully that will help. Good luck!
--mark

Sexually Transmitted Diseases

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Mark P. Behar

Expertise

Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!

Experience

Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Organizations
Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Publications
Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Education/Credentials
Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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