YOU HAVE HERPES AND DON'T KNOW IT: THE FAILURE  PROPERLY DIAGNOSE AND/OR TREAT HERPES SIMPLEX VIRUS 

There are two strains of the Herpes Simplex Virus, HSV-1 and HSV-2.  Genital herpes is usually caused by HSV-2. HSV-1 causes about 80% of all oral lesions and only about 20% of genital lesions.  How many people in the U.S. have herpes?  The estimates vary widely but all the numbers are shockingly high.  Oral herpes has been estimated to be present is 50 to 80 percent of the population.  Genital herpes has been estimated to be present in 20 percent of the population, and almost 50% for certain race/sex groups.           

So what’s the big deal you may ask.  If herpes doesn’t cause any symptoms then it doesn’t cause any problems?  Wrong.  Not everyone is symptom free and some of those who get symptoms, may end up getting them really bad.  Furthermore, those who have never had symptoms and are unaware that they are infected, present significant health risks to themselves and to others.  HSV, existing or newly acquired, can lead to serious illness and death for those with compromised immune systems, including cancer patients, pregnant mothers, and newborns.  The good news is that even for those with compromised immune systems who have become gravely ill, HSV can be still be effectively treated simply by the timely administration of the anti-viral drug acyclovir.  The catch is the health care professionals have to wise enough to know what you have just learned. PLEASE TELL THE DOCTOR THAT THERE IS GOOD A CHANCE THAT THE PATIENT SICK WITH VIRUS LIKE SYMPTOMS HAS HERPES AND NEEDS ACYCLOVIR.  AND IF THE PATIENT IS REALLY SICK, DON'T WAIT ON THE HSV TEST RESULTS, start the acyclovir now.  Unfortunately, in far too many case the diagnosis of HSV is not considered and the illness progresses systemically to cause permanent organ damage, including brain, and oftentimes death. Not only are the overall percentage numbers shocking.  Most people with genital herpes would be shocked to learn that they are amongst those who have it.  Most people with genital herpes have had only mild symptoms or no symptoms at all.  It has been estimated that as many as 80%-90% of those who have been infected were unaware of that fact.

HERPES SIMPLEX VIRUS IN THE IMMUNOSUPPRESSED PATIENT: WHEN IN DOUBT TREAT FIRST, TEST LATER

Neonatal Herpes

Four years ago I successfully concluded a case involving the failure to diagnose and treat HSV in a newborn.  As a result of this failure to diagnose the child failed to get the much needed, and highly effective, anti-viral medication acyclovir and the virus spread systemically and she developed severe brain damage.  

This was yet another medical malpractice case that almost wasn't.  When the child's father went looking for an attorney it wasn't because he thought the doctors mistakenly failed to diagnose and treat herpes.  It was because he mistakenly thought a delivery room nurse had given his baby herpes when a fetal scalp electrode was placed.  Although placement of fetal scalp electrodes are on of the ways the virus is spread to newborns, the source is the mother and not the nurse placing the electrode.  The scenario of the virus being spread from a nurse to the baby sounded so unlikely that the father's phone call to another law firm was met with no interest.  What should have been of interest was the 2-3 days delay between when the sore was first noted  on the babies scalp and when the diagnosis of HSV was made.  Newborns lack a developed immune system and vulnerable to getting severely sick from viruses and bacteria which would otherwise be considered benign.

Given the child's development of virus like symptoms, the diagnosis of herpes should have been considered, tested for, and treated with acyclovir pending the results.  The fact the neither the mother of father indicated they had the virus should not have thrown the doctors off.  The fact that the scalp lesion could have been a sore from a fetal heart electrode likewise should not have thrown the doctors off, since placement of fetal heart electrodes are one of the ways that the virus can be spread from mother to baby.  Interestingly, although an intrauterine pressure catheter had been placed, the baby's heart beat was monitored externally from a device on the mother's belly.  A fetal scalp electrode had not been placed.  This fact had been easily overlooked by the treating nurses and physicians and all the experts involved in the lawsuit.  After reviewing the records countless times it dawned on me that the tracings on the fetal heart strip and the nurses notations on them could mean only one thing--a scalp electrode was never placed.  This is yet another of many instances where it is demonstrated that there is no substituting for the work of the medical malpractice attorney without whom this critical fact would have gone unnoticed. 

Other Immunosuppressed Persons

Newborns are not the only ones who's suppressed immune systems make them vulnerable to severe illness from herpes.  Pregnant mothers and chemotherapy patients are also particularly vulnerable to severe illness from the herpes virus.  Again, the fact that the patient has no history of herpes should not dissuade the doctor from considering the diagnosis.  The diagnosis of disseminated herpes should be considered in anyone who is suffering virus-like symptoms from an unknown source.

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