Lecture Notes: Herpes and HPV

Virus Classification and Relationship:
- The virus causing sores in the mouth is a herpes virus, specifically a cold sore.
- Genital herpes is in the same class of virus as oral cold sores.
- The speaker clarifies that while they are the same type of virus doing the same thing (causing ulcers), the oral version is typically not the sexually transmitted version found on the genitals.
Permanent Nature of Infection:
- Herpes is currently incurable. Once an individual is infected, they carry the virus for life.
- The speaker notes that the virus reoccurs periodically for the remainder of a person's life.
Biological Persistence:
- Viruses are not technically "alive."
- The virus "camps out" in the neuroendocrine system or in specific pockets where the immune system cannot reach it.
- It remains in these pockets until an outbreak is triggered.
Outbreak Triggers and Patterns:
- Outbreaks are often attributed to factors like stress or technology (though the speaker notes people are still trying to figure out exact causes).
- The initial outbreak is typically the most severe, with subsequent outbreaks becoming less severe over time.

Physical Symptoms:
- The virus causes painful ulcers.
- Sensations include itching and, most prominently, burning.
- The pain is described as "hurting crazy," particularly when the area comes into contact with irritants like pizza sauce (acid) or salt.
Anatomical Locations:
- In males, it can appear on the folds of the foreskin or the glans of the penis.
- The retraction and expansion of the penis during activity can make these sores particularly painful.
- In females, the virus can manifest in the vaginal canal or on the labia.
Systemic and Flu-like Symptoms:
- Because it is a virus (similar to a flu virus), it can cause systemic flu-like symptoms.
- Generally, systemic effects are not common in healthy individuals.
- In immunocompromised individuals, such as HIV patients, the virus can go systemic, leading to a "blowout" of herpes that is significantly worse than usual.

High Infectivity Periods:
- Individuals are most infectious when they have open sores or lesions.
- An open sore represents lysed (burst) cells releasing the virus.
Asymptomatic Transmission:
- It is possible to be infectious even without an open sore (referred to as infection "in the branch" or asymptomatic shedding).
- However, the infection rate is generally lower when no active ulcer is present.
Modes of Transmission:
- Transmission occurs primarily through the opening of a sore during sexual intercourse.
- It is not typically transmitted via semen or vaginal discharge but through direct contact with the lesion.
- The virus can theoretically survive on fomites (inanimate objects like door handles), but this is uncommon because the virus tends to die when it dries out.
Co-infection and HIV Risk:
- Because herpes creates open sores, it significantly increases the risk of HIV infection as the sore acts as an entry point for the HIV virus.
- Clinicians often treat high-risk individuals (such as sex workers) for multiple STDs (e.g., gonorrhea and syphilis) simultaneously because the likelihood of exposure to multiple pathogens is higher.
Gender-Specific Challenges:
- Females may not be aware of an outbreak if the sores are located internally within the vaginal canal.
- Males are often more aware of outbreaks due to the external nature of the penis, allowing for visual identification.

Antiviral Medications:
- Common medications include drugs that end in "-cyclovir" (e.g., Acyclovir).
- These drugs work by inhibiting the reproduction/replication of the viral particles or slowing down the division of the virus.
- Some antivirals act by boosting the immune system's specific response to viruses.
Efficacy of Treatments:
- While effective at managing symptoms and reducing the frequency of outbreaks, antivirals are not a 100% cure.
- They can help prevent the spread of infection to others.
Non-Medical Prevention:
- Abstinence: The only 100% effective way to prevent transmission.
- Condoms: These work as a physical barrier to the sore, though they are not a perfect guarantee.
- Spermicides: These are ineffective because they are designed to kill sperm cells, not viruses. However, some chemicals in them might slightly lower the division rate of HSV.

Nature of the Virus:
- HPV stands for Human Papillomavirus.
- It manifests as genital warts, which are physically similar to common warts found on fingers.
Mechanism of Infection:
- The virus modifies the cell replication machinery of the host cells, leading to physical growths or formations (warts).
Location of Warts:
- Can occur on the labia, penis, rectum, or inside the urethra.
- Warts in the urethra are extremely painful and can lead to recurring Urinary Tract Infections (UTIs) due to the obstruction and irritation.
Treatment Options:
- Like Herpes, HPV is a virus and cannot be cured, but the physical symptoms (warts) can be treated.
- Cryogenic Treatment: Freezing the warts off.
- Chemical Treatment: Using drying agents to reduce the size of the warts.
- Surgical Excision: Cutting the warts off.
- Even after removal, warts are likely to return because the underlying virus remains in the body.

Association with Cancer:
- HPV is a major health concern because it is strongly associated with cervical and vaginal cancers.
- Viruses cause cancer by inducing uncontrolled cell growth and division.
Screening Procedures:
- Pap Smear: A vaginal/cervical test used to check for HPV.
- Clinicians look for "dysplasia," which is the abnormal or strange division of cells in the tissue.
Prevalence:
- HPV is common across all genders, but it is often more problematic in women due to the risk of cervical cancer.

Gardasil Vaccine:
- A vaccine designed to prevent HPV infection.
- It is often marketed toward 12-year-olds to provide protection before they become sexually active.
Vaccine Controversies and Side Effects:
- Some people experience adverse reactions to the "adjuvant" (a chemical carrier in the vaccine).
- The vaccine uses an "attenuated virus" (a weakened version of the virus that does not cause disease but triggers an immune response).
- Immunologically susceptible individuals may have an overwhelming inflammatory response.

Question regarding Gardasil controversy: Why do some people go back and forth on getting the vaccine?
Response: Some people have bad reactions to the chemicals or the attenuated virus. This is similar to the controversy surrounding the COVID vaccines.
Discussion on COVID vaccines: The speaker mentions that from an epidemiological standpoint, the COVID vaccines were not vaccines in the "classical sense."
Anecdote regarding Genetic Susceptibility: A student mentions her mother could not get the COVID vaccine due to "three disparities" or a genetic blood condition discovered through testing. If she had taken the vaccine, she likely would have faced a life-threatening reaction. This illustrates that personal genetic factors play a role in how individuals react to vaccines.