Dear Dr. Roach: My 20-year-old son is intelligent, handsome and popular. However, he has just confided in me that he has contracted herpes. He and I are devastated, since we understand that he will have it forever. I'm worried about the effects on his self-esteem. He wants to be truthful with women, so he feels most of his relationships are over. He feels a future with marriage and children is now out of the question.
He takes college classes, has a successful music business and does not do drugs or drink alcohol.
Please explain what he is up against, and advise. - T.F.
Answer: Genital herpes simplex, HSV-2, is extremely common - about 1 adult in 6 in the U.S., 1 in 11 in Canada, has HSV-2. Only about 20 percent of them know they have it.
He is absolutely right, and should be commended for his decision to be truthful with potential partners. Condoms can reduce the risk of transmission. Medications like valacyclovir can reduce outbreaks. And although some women may lose interest in him once they know, I am convinced that there will be someone more concerned with who he is than with what he has.
Self-esteem is always an issue when one gets a new medical condition. Having family to talk to is very important - it's much harder alone.
Dear Dr. Roach: I am 67 years old, and the iron in my blood is 500. I am told 300 is normal. The doctor said that giving blood at the blood bank will lower it, perhaps every eight weeks. I also was told by my doctor it could damage my organs, such as my heart. How treatable is my condition? I am worried. - A.M.
Answer: It sounds like you are being diagnosed with primary hemochromatosis. This is a genetic condition in which the body constantly absorbs too much iron. Iron overload damages the heart and the liver, among other organs. Men and women get the disease at the same rate, but men are diagnosed more frequently, because the iron that women lose in their monthly periods tends to protect them. However, I received a letter from a reader with experience of women with advanced disease diagnosed at an early age. There can be a lot of variability in the disease. If you do have hemochromatosis, your family members - siblings, children - should be tested as well.
The first step is to be sure of the diagnosis. Other iron studies from the blood support it, and there is a genetic test as well. Bone marrow biopsy still is occasionally done to be sure. Treatment is also straightforward - you are right that giving blood removes the iron from the system, but at the beginning it may need to be much, much more frequent than every eight weeks. The first patient I had with this condition needed 52 blood donations to get his iron level down to normal. Hematologists, gastroenterologists or internists may all be experts in this field.
The Iron Disorders Institute has a helpful website at www.irondisorders.org.