Q: An ulcer appears on the inner wall of my wife's vagina every month, which disappears after 3-4 days with pus. It is very painful. During these 3-4 days she is unable to move. What can be the problem? We are taking medicines but with no solution. This problem started after one month of marriage and has been regular for the last 7 months. Five months back similar ulcers appeared one by one on her face, arms & legs. But now only one ulcer appears on her vagina. This problem was not there before marriage. Is this some kind of STD? I have already tested negative for HIV. Please help. She is 3 months pregnant as well. Will these ulcers cause any problem in her pregnancy? I had similar problems a years back. But now everything is normal. One year back, white pus started coming out of my penis, which was very painful. This disappeared after one week. I also had few ulcers on my hand, nose and stomach.

A:It is likely that you both are suffering from genital herpes infection. Herpes simplex viruses (HSVs), causing a wide variety of illnesses, are of 2 types - HSV-1 and HSV-2. The infections may be asymptomatic in up to 80% of patients, but when symptomatic, they cause significant illness and are often recurrent. HSV-1 is transmitted by contact with infected saliva, while HSV-2 is spread sexually or from a mothers genital tract infection to the baby at the time of delivery. The virus is transmitted by close personal contact and spreads when inoculated in the mouth, cervix, conjunctiva or through small breaks in the skin. The virus has certain characteristics, which govern the disease pattern. It has the capacity to invade and divide in the nervous tissue (neurotropism); it can remain quiescent in nerve cells (latency) and it has the capability to reactivate and start dividing when induced by stresses like fever, injury, emotional stress, sunlight, periods etc), resulting in recurrent infection. HSV-1 reactivates more frequently in the oral region while HSV-2 reactivates far more frequently in the genital region. The recurrence rate for HSV-2 is much higher. The recurrence of primary genital HSV-2 is more frequent and lasts longer in those individuals who had a severe primary disease and may be seen in nearly 60% patients in the first year. It is often preceded by pain and burning at the site nearly 2 days in advance. The lesions may occur in the vagina or perineum and may be very painful and usually subside in a week to ten days. Herpetic whitlow is the infection of the fingers due to digital-genital exposure. The disease may rarely be disseminated to affect the food pipe, lung, urinary bladder, joints, meninges and brain. Involvement of the nerve ganglion or spinal cord may lead to urinary retention, loss of sensation or nerve pain in the back. The treatment is specific antiviral drugs with activity against viral DNA synthesis. These drugs inhibit the division of the virus and may suppress clinical manifestations but do not cure the disease. As the virus remains latent in nerve cells, there is no difference is the rate of relapse in treated and untreated patients. Both partners should be tested and abstinence must be practiced while the lesions are present. The use of condoms minimises exposure but the virus may still spread to areas not covered by the condom. Fungal infection (candidiasis) is often seen in women and must be ruled out. Please consult a dermatologist who can examine and advise appropriately.