Dr. Roach: Herpes symptoms usually appear four days after exposure

Dear Dr. Roach: I have a question regarding the transmission rate of herpes simplex virus (HSV-1). I had a sexual encounter with exposure to HSV-1. Despite being careful, there was some contact. I explained my fear of contracting HSV-1, and my partner admitted that they had the virus but had been on antiviral medication for years, to the point where it is unlikely for them to transmit it (so they say).

However, I felt really uneasy and scared that I may have contracted the virus. I got tested a few days after exposure, and the polymerase chain reaction (PCR) test came back negative for HSV-1 and HSV-2. But I’m aware that I will most likely need to be tested again. It’s now been 14 days. I am really freaking out about this and actually believe I may have herpes. What are the chances that I might?

— Anon.

Dear Anon.: Most cases of genital herpes have traditionally been caused by HSV-2, but genital HSV-1 has been increasingly found as the cause. Twelve percent of people aged 14-49 have HSV-2, and over half of adults have been exposed to HSV-1. If you have already been exposed to the same virus you might have been exposed to two weeks ago, then you shouldn’t have a fear of infection.

A brief exposure and a partner on anti-herpes drugs, like acyclovir, reduce (but don’t eliminate) the risk of transmission. Using a condom every time (for men, as there aren’t good data on female condoms) also reduces the risk of transmission. More importantly, you are now 14 days past exposure. The usual time to develop symptoms after exposure to genital herpes is four days, but it can be in as little as two days. It shouldn’t occur after 12 days.

Dear Dr. Roach: I have Type 2 diabetes and try to avoid excessive sugar. However, I use a lot of artificial sweeteners. Will this be detrimental to my health? Are natural sweeteners better?

— E.B.

Dear E.B.: There is no doubt that excess sugar is bad for people with diabetes, and people were advised for years to substitute nonnutritive sweeteners, of which there are 15 commonly used ones.

However, despite decades of research, it isn’t at all clear that switching sugar-sweetened foods and beverages with nonnutritive sweeteners leads to weight improvement. (Short-term, but not long-term, weight loss was found.) Nonnutritive sweetener use is also associated with an increase in diabetes risk. This is due to changes in the gut microbiome, changes in gut-brain signaling and other mechanisms. As far as I know, there is no convincing benefit of using natural sweetners over synthetic.

Many people find that completely avoiding sweeteners changes the way they taste food, and I recommend against sweetened beverages in particular.

Dr. Roach Writes: A recent column about a woman who had what seemed to be a heart attack after losing her husband of many years led me to suspect takotsubo cardiomyopathy (TCM). My reader wrote back that an angiogram didn’t show any blockages in the heart, and TCM was indeed the diagnosis. Only 1-2% of hospital admissions for chest pain turn out the be this diagnosis, and the prognosis is very good, although it is possible to have a recurrence.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.