Health Tips from Stanford University Medical Center News Bureau
Mike Goodkind, (415) 725-5376 or 723-6911
Email: [email protected]
November 1997
HERPES MAY SHOW UP LONG AFTER INFECTION
Don't automatically blame your current sex partner if you develop signs of genital herpes. The source may well be a partner from years ago, even if you've never had symptoms before, says an infectious disease expert at Stanford University Medical Center.
"Understanding the biology of HSV-2 (herpes simplex virus type 2) can help reduce mistaken accusations of infidelity in a relationship. "Silent spread is the rule for HSV-2, not the exception," says Dr. Ann Arvin, a professor of pediatrics who is researching herpes infection.
"HSV-2 symptoms can appear at any time, even decades after infection," says Arvin. "Until recently, we didn't know that most people become infected without having symptoms at the time."
HSV-2 is almost always spread by genital contact and has now spread so relentlessly that about 20 percent of the U.S. population is infected, Arvin says. The symptoms include intermittent ulcers or sores in the genital area, Arvin explains. However, the vast majority of infected people do not know they have HSV-2 infection because they never develop recognizable symptoms.
Genital herpes can be treated with an antiviral drug, acyclovir, but at present there is no cure. Acyclovir helps suppress the symptoms in people who have many recurrences. The condition is almost never life threatening or debilitating except in infants or in newborns, which is why Arvin, as a pediatrician, is interested in studying the condition and finding a cure.
Arvin notes that a vaccine would probably be the best long-term solution, but no effective vaccines have been developed yet.
A definitive test for the infection is also currently unavailable, unless the person has active genital ulcers.
"I wish we had a definitive way to prevent spreading HSV-2, but for now, safe sex practices are the only option," she says. Condoms, she adds, offer protection because herpes is spread by contact with skin and mucous membranes of the genital area, but they may not work if the infection is in areas not covered by condoms.
AIRPLANES OFFER SPECIAL CHALLENGES FOR AVOIDING INFECTIONS
A few simple precautions can reduce the possibility of catching a respiratory or other infection while traveling in a crowded plane -- or bus or train, for that matter -- says the head of Stanford University Medical Center's infection prevention program.
"If you get sick after a plane flight, the likely cause is contact with a seatmate or failing to wash your hands after a trip to the restroom," says Dr. Lucy Tompkins, professor of medicine (infectious diseases). "There's nothing really special about an airplane in terms of infection except that you're in very close contact with people for a relatively long period of time.
"Many people fear that the recirculating air in an airliner is a special culprit in transmitting colds or other viral infections, but colds and flu are usually picked up from surfaces, such as an armrest or a washroom basin," says Tompkins, who offers two useful suggestions for protecting yourself while in flight.
First, be sure to follow "mom's advice" to wash your hands after visiting the restroom, even if you just went in there to get a cup of water. "Many viral infections are spread from your hands to your mucous membranes, Tompkins notes. Here's a typical scenario: You touch a faucet handle that was touched minutes earlier by someone who sneezed into his hands. If you touch your nose or mouth afterward without washing, you're at risk of transmitting a disease to yourself. To be really cautious, use a paper towel to open and close the bathroom door, depositing it in the trash on the way back to your seat.
Second, if you're sitting next to someone who may be "leaking" viruses -- by sneezing or coughing -- try to avoid touching the armrest or other surfaces where the viruses may have settled. Bear in mind, however, that just touching the surface isn't likely to spread infection; it's delivering the virus to a mucous membrane, such as your mouth or nose, that causes problems. It may help to use a disinfectant-coated moist towelette or bathroom tissue to wipe off your hands and face from time to time.
ARTHRITIS, MUSCLE PAIN CALL FOR DIFFERENT REMEDIES
All over-the-counter pain relievers aren't equal, says a Stanford rheumatologist, who recommends acetaminophen for "wear and tear" arthritis without a lot of inflammation, and suggests other pain relievers, including aspirin, for sore muscles, mild sprains and general overuse from exercise.
"Aspirin, ibuprofen and acetaminophen all work well for most people with minor arthritis pain and all are fine if taken occasionally. But common pain relievers other than acetaminophen [Tylenol and generic equivalents] may not be a good idea for regular and sustained therapy," says Dr. Edward D. Harris, Stanford's George DeForest Barnett Professor of Medicine and author of a definitive textbook on rheumatoid arthritis.
"The problem is that we have some good evidence that the traditional nonsteroidal anti-inflammatory drugs [such as aspirin] may interfere with the normal metabolism [function] of cartilage, the very tissue we want to protect," he says.
"On the other hand, if your problem is muscle pain from exercise, then aspirin, ibuprofen or related formulas may be the better choice," says Harris. That's because these nonsteroidal anti- inflammatory drugs help reduce swelling in the muscles and joints. Acetaminophen will relieve the pain, but it doesn't have any therapeutic value to reduce swelling.
Harris also notes that ice applied to the sore muscle within the first four hours after pain-causing exercise works very well with acetaminophen.
He adds that arthritis, unlike strained muscles from work or sports, may require some long-range strategies that are best managed with professional assistance and possibly a stronger medication.
The rheumatologist notes that nonprescription painkillers, including acetaminophen and aspirin, are far less potent in their over-the- counter versions than in formulas available by prescription.
"And even if your pain is minor and infrequent, always mention joint or muscle discomfort to your physician during an annual physical. He or she may get you on a program that can help relieve pain, determine if the condition springs from a more serious illness, and help you avoid future long-term damage," Harris says.
DONATING BLOOD IS SAFE AND SATISFYING, ESPECIALLY IF YOU OBSERVE SIMPLE GUIDELINES
Healthy, vigorous donors can help ensure a safe blood supply. They can take steps to ensure that they feel good after giving, says a physician at the Stanford Medical School Blood Center.
Dr. Susan Galel, associate director of the blood center and assistant professor of pathology at Stanford, says that eating within six hours before donating, and drinking plenty of fluids - "something you enjoy, because you've earned it" - will ensure that you feel great when you resume your normal activities after donating. Drink before you donate, and then enjoy the beverages typically supplied by your blood center before you leave.
Certain foods can help, too.
"If you take extra care to eat foods rich in iron and vitamin C before donating, you will help yourself replenish your blood supply more quickly," says Galel.
Foods rich in iron include broccoli, eggs (but watch the cholesterol if this is a problem for you), dried beans, dried fruit, nuts, peanut butter, strawberries, meat and poultry. Foods naturally rich in vitamin C include broccoli, cabbage, cantaloupe, cauliflower, citrus fruits, potatoes, strawberries and tomatoes.
"Keep in mind you can get both iron and vitamin C if you eat broccoli and strawberries," she notes.
For their own safety, people in certain situations should wait before giving blood. Pregnant women should defer giving until six weeks after delivery, and surgical patients should wait until released from a surgeon's care before giving blood.
For people who weigh less than 110 pounds or are younger than 17, donating blood may pose some risk because their blood supply is smaller. These individuals shouldn't give.
Older age, however, is not necessarily a barrier, notes Galel. "Many donors are over 70. But if you're in that age group, check with your physician, because when you first donate you'll be asked to bring a signed medical clearance, renewable yearly," she says.
Allergies are not a problem for either donor or recipient, and high blood pressure isn't a barrier to giving as long as the condition is controlled.
Protecting patients who will receive donor blood is crucial, so prospective donors with coughs, colds or sore throats shouldn't give until they are symptom-free for 48 hours. In fact, any active disease is a cause to postpone giving, Galel says.
People with certain diseases should wait years before giving. For example, malaria parasites can remain in the bloodstream, so people who have had this tropical malady should be symptom-free for three years before donating blood, Galel says.
And there are a few other criteria. "Persons who have had undergone acupuncture, or ear or body piercing, should give blood only if they're sure that rigorous sterilization techniques were used. If you've had a tattoo, you'll be asked to wait a year before giving, to avoid possible infection to the person who'll be getting your blood," Galel says.
"In the past 10 years of careful effort, we have made the U.S. blood supply safer than it's ever been. For example, the risk of HIV transmission to blood recipients in this country today is between 1 in 500,000 and 1 in a million, making blood transfusion one of the safest medical procedures available. We thoroughly test donor blood and talk with potential donors about any exposures that might affect patients," says Galel.
"And, of course, for donors themselves there is absolutely no risk of contracting AIDS or other diseases by giving blood, because all equipment is sterile and has never been in contact with anyone else's blood," she says.
DON'T STOP MEDICATION JUST BECAUSE OF A MISSED DOSE
Written instructions provided with drugs tell people when to take doses, but most people are confused about what to do when they miss a dose, notes a Stanford pharmacist.
"What you're going to do about it really depends on what medication you missed and what you're taking it for," says Lisa Tuomi, drug education coordinator at Stanford University Medical Center.
For most drugs, the best way to get back on track is just to take the medication in a regular dose at the next regularly scheduled time. As a general rule, don't double the dose to "make up for" the skipped dose.
"But there are important exceptions to that," adds Tuomi. For example, with birth control pills the strategy may differ depending on the type of pill and the phase of the menstrual cycle.
"Look at the instruction sheet or pamphlet that came with the pills. It will advise you whether to begin using a backup birth control method, change your medication schedule or double up your dose," she says.
However, Tuomi warns, "an extra dose can be dangerous if it's not recommended, so do follow directions. If you have questions, contact your pharmacist or your prescriber."
Some antibiotics also have special rules. Again, ask your prescriber or pharmacist whether to double up on your dose or readjust the dosage schedule in some other way. "It will depend on which antibiotic you're taking, why and for how long you're taking it, and how much you're taking," Tuomi says.
"The most important thing, if you do miss a dose of any drug prescribed for you, is not to stop taking your medicine," she adds.
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