Dear Dr. Roach: I think I may have herpes, but I鈥檓 not sure. What are the symptoms of the virus? When I go to the doctor, what do I say? When I was there last time, I was given a urine test for STDs, which was negative, but now I urinate a lot and have a bump on my penis.
M.G.
When we are discussing herpes as a sexually transmitted disease, we usually refer to herpes simplex virus type 2. Even though other herpes viruses can be transmitted sexually, HSV-2 is the most prevalent, with about 50 million people in the U.S. infected.
HSV-2 usually is asymptomatic, but in both men and women it can be associated with periodic outbreaks of blisters, classically filled with clear fluid and painful.
During this time, the virus can be accurately identified by a laboratory. However, it is often not a classic appearance, and it鈥檚 wise to consider the diagnosis of HSV for any genital lesion. The quality of the herpes blood test has improved in recent years, and it is a good way to make the diagnosis in someone who doesn鈥檛 have a lesion at the time they see the doctor. 听
Two other STDs 鈥� gonorrhea and chlamydia -- can be diagnosed using a urine test, but not HSV. When you go to the doctor, ask for a blood test to rule out herpes definitively.
Urinating a lot is not a usual symptom for STDs, but painful or uncomfortable urination is.
Dear Dr. Roach: I recently heard that after age 50 you should not take in any caffeine. I do enjoy a cup of regular coffee with breakfast. Is this dangerous?
Anon.
The majority of people over 50 continue to drink and enjoy caffeine in coffee, tea and other drinks. At reasonable doses it is very safe, and previous studies showing links to cancers have been pretty thoroughly discredited. I am all in favour of maximizing enjoyment of life in ways that aren鈥檛 harmful, and a cup of coffee in the morning is not harmful and is a big source of enjoyment to many.
As we age, many drugs (I鈥檒l consider caffeine a 鈥渄rug鈥� for this purpose) are metabolized more slowly by the body, so some people may find that the same 鈥渄ose鈥� affects them more. This may occasionally cause a problem with sleeping for people who drink caffeine later in the day or at night, in which case the solution is to drink less or drink earlier.
Finally, age 50 seems pretty young, to me, to be concerned about changes in drug metabolism.
Dear Dr. Roach: You always seem to have the answers. I read your column every day and look up to you for advice.
A.
You are very kind, but I often receive letters that I wish I could answer, but either medical science doesn鈥檛 have an answer or I just don鈥檛 know what it is. I also have the luxury of time to look things up, and have at my fingertips the best medical resources available. So while I appreciate your kind comments, I have to admit that I don鈥檛 know the answers a lot of time.
In my own medical practice even now, and with the medical students and residents it鈥檚 my privilege to teach, I find I still am looking things up in textbooks or in medical journals, or asking colleagues. Knowing to get help when you don鈥檛 know is an important skill to have and to teach by example.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
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