28 May 19
Dear Doctor: Are cold sores and herpes the same thing? I’ve got both, and finding out there’s no cure really stinks. My friends say lysine can help. Is that true?
Dear Reader: Cold sores and genital herpes are caused by different types of the herpes simplex virus, or HSV. Each type is quite contagious.
HSV-1 causes cold sores on the lips and mouth. It’s estimated that half of the population in the United States is infected with the oral herpes virus. The majority of genital herpes, which is a sexually transmitted disease, is caused by HSV-2. The infection rate of HSV-2 in the U.S. is estimated to be at least 15 percent and as high as 20 percent. Some cases of genital herpes are caused by HSV-1, as the virus can be spread from the mouth to the genitals.
You’re correct that at this time, there is no cure for either type of herpes infection. Instead, people who have frequent outbreaks seek to manage the condition. Many people infected with HSV-2 rely on antiviral medications, which can shorten or suppress outbreaks of genital herpes and also lessen symptoms when an outbreak does occur. The three main drugs are acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). Antivirals may also be prescribed to people infected with HSV-1 who are having frequent or severe outbreaks. The over-the-counter cream Abreva, which targets oral herpes, can be useful at curbing an outbreak when used at the first sign of symptoms.
When it comes to lysine, there is both scientific and anecdotal evidence regarding its efficacy in diminishing the frequency of herpes outbreaks. The results of the earliest yes-it-works lysine studies, which date back to the 1970s and ’80s, have been replicated in subsequent studies over the years. And the first time we wrote about HSV-2 in this column and didn’t mention lysine, we got a flood of letters from readers with testimonials as to its usefulness. However, due to conflicting data regarding whether lysine will also decrease the severity or duration of an outbreak, that particular effect remains up for debate.
Lysine is what is known as an essential amino acid. Amino acids are the organic compounds from which proteins are made. Of the 20 amino acids we humans require, 11 are produced by our bodies. The remaining nine, known as essential amino acids, must be obtained through diet. Lysine is found in dairy products like milk, cheese and yogurt; meat; beans; brewer’s yeast; and wheat germ. Supplements are also widely available. Although the mechanism by which lysine interferes with the herpes virus is not yet clear, researchers believe that it somehow short-circuits the reactivation functions of the virus.
Side effects can include stomach upset, abdominal pain, nausea and diarrhea. Lysine can increase how much calcium the body absorbs, so taking lysine along with calcium supplements requires caution. Although rare, lysine has been tied to reports of certain kidney problems. The safety of taking lysine while pregnant or breastfeeding is not known. If you decide to try lysine, please check with your family doctor for recommended dosages.
Dear Doctor: We’re used to hearing about the measles outbreaks that happen in areas where parents have refused to let their kids get childhood vaccinations. Is it true that now a kid wound up with tetanus for the same reason? That sounds so dangerous.
Dear Reader: You’re referring to the case of a 6-year-old boy in Oregon who developed tetanus after getting a gash on his forehead while playing on his family’s farm. The event actually took place in 2017, but a recent write-up of the case has pushed it into the headlines.
About a week after the parents cleaned and stitched up the boy’s cut, he developed troubling symptoms. In addition to involuntary muscle spasms, he couldn’t unclench his jaw and had difficulty breathing. Doctors at a regional medical center diagnosed him with tetanus, a disease for which he had not been vaccinated. His was the first case of tetanus in the state in more than 30 years.
Tetanus is a disease of the nervous system caused by one of two toxins that are released by a bacterium called Clostridium tetani. Spores of C. tetani are found in the feces of a number of animals, including cattle, horses, sheep, dogs, cats and chickens, and in contaminated dust and soil. The bacterium enters the body via a wound that has broken the skin, like a cut or a puncture, then releases a toxin called tetanospasmin, which impairs the motor neurons.
As the neurotoxin travels through the circulatory system, it binds to nerve endings in certain sites throughout the body. Once this occurs, there is no known way to clear the toxin from the nerve endings. The only treatment is to manage the painful and dangerous symptoms that the toxin causes while waiting weeks — or even months —for new nerve endings, which are toxin-free, to grow.
The effects of the tetanus neurotoxin are severe and life-threatening. The muscle spasms it causes can be sustained and powerful enough to cause a bone to break. Spasms of the muscles of the respiratory system and of the vocal cords interfere with breathing and often require an alternative airway and mechanical breathing support.
In the case of the Oregon boy, he experienced muscle spasms so severe they caused his spine to arch backward. His breathing was compromised, and he spent more than a month on a ventilator. Over the course of the eight weeks he spent in the hospital, he was tended by more than 100 nurses and doctors, none of whom had ever seen a case of tetanus before. Although having tetanus does not confer immunity, the boy’s parents reportedly refused to immunize him.
Tetanus is a preventable disease, and the Centers for Disease Control and Prevention recommend vaccines for people of all ages. Children receive tetanus protection via the DTaP vaccine, which covers diphtheria, tetanus and pertussis (whooping cough). It is recommended for babies at ages 2, 4 and 6 months, and again at 15 through 18 months old. The CDC also recommends a booster shot for children ages 4 through 6 years old. Adults need a tetanus booster every 10 years to stay protected.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health.