Dear Dr. Roach: Several times you have mentioned herpes viruses. How many are there?

— K.C.H.

Dear K.C.H.: In the herpes family, there are eight viruses that primarily infect humans, as well as a few animal herpesviruses that rarely do so.

The herpes simplex viruses are the best known. HSV-1 is the usual cause of oral cold sores, while HSV-2 is the usual cause of genital disease. In a few people, those can be reversed, but HSV-2 is generally more severe than HSV-1. Very recent studies have shown that HSV-1 and HSV-2 can share genetic material in people who are infected with both strains.

Varicella zoster virus is the cause of chickenpox. Like all herpesviruses, it can remain dormant in the body for decades, and when it reactivates, it causes a localized reinfection called shingles.

Epstein-Barr virus is the classic cause of infectious mononucleosis, a disease familiar to most, which causes tremendous fatigue and may affect the liver and spleen. Cytomegalovirus causes similar monolike symptoms, and is a severe danger to people with immunosuppression, such as organ transplant recipients or those with HIV. The unimaginatively named human herpesvirus 6 is similar, in that it can cause a mild monolike illness in healthy children (rarely, it can affect the brain). HHV-6 is also the most common cause of roseola (also called sixth disease, or exanthem subitum). It is dangerous in adults and children with severe immune system disease, not only to the brain but to the lungs as well. HHV-7 rarely causes symptoms, but is also an occasional cause of roseola in children.

HHV-8 is the cause of Kaposi sarcoma, a cancer found in older men, especially in Israel and around the Mediterranean, but is much more common now in people with advanced HIV disease (AIDS). Kaposi sarcoma was one of the first cancers to clearly show an infectious link.

Of the animal herpesviruses that can possibly infect humans, the one that is most frightening is called B virus. It is fatal in about 75% of the reported cases. It is a concern mostly in laboratory staff working around primates, especially macaques.

Dear Dr. Roach: I had a back operation about six months ago, a disc decompression. The operation was presented to me as “a minor procedure.” Immediately after the surgery, as I got off the operating table, I experienced severe pain in a location where I had none before. The doctor never saw me in recovery, in the hospital during my one-night stay nor in my follow-up appointments. The pain seemed to get better after about six weeks, but then started to get worse after about three months. It continues to get worse. Do you think I should go back to my operating physician, or seek out another physician?


Dear M.G.: I only ever hear one side of the story, and yours is hard to believe. The sort of behavior you describe from a surgeon is completely unacceptable, for many reasons. No back surgery is free of risk, and always has the potential to make things worse, so it never should be undergone lightly. It is mandatory to see your patient after the surgery and postoperatively, especially when there is a problem.

I would recommend that you get additional help, possibly through an expert in pain management, but I do think you need to talk to the surgeon who performed the operation.

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