Dear Doctor: What are the best ways to cope with herpes simplex 2?

Dear Reader: Herpes simplex 2 is a sexually transmitted disease, or STD. Herpes simplex 1, which is also called oral herpes, causes cold sores or fever blisters on or around the mouth and lips. Herpes 1 can also be transmitted to the genitals. However, the majority of cases of genital herpes are caused by herpes simplex 2. Both types of herpes are viruses.

Herpes is a common STD. According to the Centers for Disease Control and Prevention, one in every six Americans is infected with genital herpes. The infection is acquired through contact with the herpes virus, which can be present in lesions or sores on the genitals or anus, in mucosal secretions and even on the skin. Even without an active outbreak, the herpes virus can be transmitted to sex partners. In many cases of transmission, the infected partner doesn't realize he or she has the virus. It is estimated there are between 750,000 and 1 million new cases of herpes simplex 2 in the United States each year.

Symptoms of an outbreak include the lesions previously mentioned, as well as localized genital pain. Possible but less common are tingling sensations or shooting pains in the legs, hips or buttocks. Perhaps the most serious complication of a genital herpes infection is the chance of spreading it during childbirth. Neonatal herpes infections, while rare, can be fatal. Pregnant women with herpes should let their doctors know about their infection.

At this time, there is no cure for either oral or genital herpes. Antiviral drugs like acyclovir, famciclovir and valacyclovir can help to reduce the severity of symptoms and the frequency of outbreaks of herpes 2. That means that individuals who are infected with the virus have a lifelong condition that must be managed.

As for how to manage a genital herpes infection, the main concern is to not spread it to sexual partners. Herpes is at its most contagious when sores or lesions are present. However, we must repeat that it can be transmitted at any time, whether or not there are visible symptoms.

During outbreaks that involve sores, infected individuals should abstain from sex. (And if you're having sex with someone and see genital sores, stop.) The difficult truth is that, even when sores are not present, condoms are only partially successful at preventing transmission of the virus. That's because the virus can be present in areas that are not covered by the condom.

If either you or your romantic partner has genital herpes, the risk of transmitting the virus can be lessened by taking an antiviral medication. The medication lowers the incidence of visible outbreaks, which is when the risk of acquiring the virus is highest. You should also avoid any kind of sex with your partner during an outbreak. Anyone with herpes simplex 1, which causes cold sores, should never engage in oral sex, as it can result in a genital infection in their partner.

Anyone who suspects he or she has herpes should see a doctor. A visual examination of an active sore, culturing a sore or a blood test for antibodies will give you an answer.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My husband, who has been diagnosed with a sleep disorder, acts out all his dreams. He recently tore his rotator cuff and dislocated his shoulder when he fell out of bed during a dream about playing basketball. We're worried this might happen again. Are there any new treatments or research into this disorder?

Dear Reader: It sounds as though you're describing what's known as REM Sleep Behavior Disorder. This happens when an individual overcomes the natural paralysis that typically accompanies the dream state and literally engages in the physical activities of the dream.

We spend our time in two basic stages when we sleep. There's REM (rapid eye movement) sleep, which is when we dream. And there's non-REM sleep, which is made up of several different stages of deeper sleep. Throughout the night, we cycle through these different stages, with up to a quarter of the time spent in REM sleep, and the rest in the various stages of non-REM sleep.

During REM sleep, blood pressure goes up, breathing becomes uneven, the eyes dart back and forth, and the brain is extremely active. In normal REM sleep, a natural paralysis sets in, which ensures that our dreams remain in our minds and don't cross into the physical realm. However, in REM Sleep Behavior Disorder, also known as RBD, that paralysis is either incomplete or not present at all. As a result, the sleeper takes an active part in those dreams.

The behaviors of RBD range from speaking, shouting and swearing in one's sleep, to running, leaping, grabbing and punching. Patients report that their dreams are always active, and often violent. Although this time it was your husband who was hurt, those who share a bed with someone with RBD are also at risk of physical injury.

At this time, treatment consists of making the bedroom safer for the patient and his or her bed partner, and medications for the patient. Padding on, around and below the bed, lowering the bed itself, and de-cluttering and removing potentially dangerous objects, is recommended. When it comes to medications, the anti-anxiety drug klonopin has been shown to be effective. Sometimes melatonin, a regulator of the sleep cycle, is prescribed as well.

Although the cause of REM Sleep Behavior Disorder is not yet known, studies have found a link between the disorder and the future onset of degenerative neurological conditions like Parkinson's disease. According to the authors of the most recent study, published in the journal Neurology Today in September 2017, up to 75 percent of patients eventually develop Parkinson's or a related condition. The thinking is that the symptoms of RBD indicate neurological changes that precede the symptoms of Parkinson's and other similar disorders.

We realize this sounds alarming, which is why we urge you and your husband to get a second opinion at a recognized sleep center. Your husband will undergo a physical and neurological exam, may be asked to undergo an overnight sleep study, and you may be interviewed for details about his sleep patterns. If the RBD diagnosis proves accurate, you will then be in good hands to deal with the disorder.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: It was really scary to read about the man who lost parts of his hands and feet after a bout of strep throat. What's going on? I get strep fairly often; am I at risk too?

Dear Reader: Considering that strep throat is a common infection that typically results in a sore throat, the news reports you're referring to were indeed alarming. We suspect you have quite a few fellow strep sufferers also wondering whether that next episode will turn out to be deadly.

Let's start with reassuring news. For a strep infection to move beyond the throat and tonsils and wreak the kind of havoc we heard about in that case is extremely rare. That's why stories like those get such prominent play in the news. To put things into perspective, just 3.5 of every 100,000 cases of strep will go on to cause severe complications, according to the Centers for Disease Control and Prevention.

Strep throat occurs when the throat or tonsils (or both) become infected with group A Streptococcus bacteria, often referred to simply as "group A strep." It's a lot more common in children, but as you know from experience, adults do get it as well. The bacterium, which is highly contagious, spreads through contact with the spray of tiny droplets from an infected person's sneeze or cough, or with the skin rash that can sometimes appear. Transfer those droplets to your own nose, mouth or eyes, and you're at risk of becoming infected.

Symptoms often begin with a painful sore throat, which develops quite rapidly. A case of strep throat often includes fever, headache, swollen lymph nodes and distinctive white spots that appear on the roof of the mouth, tonsils, and soft and hard palate. You can have many of these symptoms but not have strep. You can also be exposed to strep and not become visibly ill. And while certain symptoms can suggest a strep diagnosis, a throat swab is the only way to definitively diagnose the infection.

In the case you mentioned, a 44-year-old man whose son had recently recovered from strep throat became ill with flulike symptoms. He tested negative for strep. He soon developed severe abdominal pain, which was accompanied by visible swelling. This led to exploratory surgery, which revealed a large quantity of infected pus within his abdomen. Typically, this is due to a puncture in an organ such as the colon, but none was found. It wasn't until a red rash appeared on the man's chest that his baffled medical team realized the patient had developed a strep infection in his abdomen.

Unfortunately, the infection had a head start and caused the man to go into septic shock. This inflammatory response to infection causes a life-threatening drop in blood pressure that can lead to organ failure, respiratory failure and stroke. The medical team was able to control his infection, although the treatment caused tissue death, which required partial amputation of his feet and fingers.

It's a difficult story with a challenging outcome, which is why we're going to repeat ourselves -- this type of complication from a strep infection is exceedingly rare.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)