DEAR DR. ROACH: Please write about shingles. I am a 77 year old woman, married for 30 years and I have shingles on my face and head. I am being treated with acyclovir. I have no idea what happened. How did I get this?
After two days of treatment, my face is not much better and my eye is still swollen. When people ask me what I have and I say shingles, I get a weird look. So I looked up some information and read that shingles is a form of herpes. I don’t have herpes, otherwise my doctor would have told me, right? I didn’t sleep before the wedding. Please be honest with me. –KH
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ANSWER: The herpesvirus family is a diverse group of viruses that can cause serious illness and affect many different organ systems. When people hear “herpes,” they often think of herpes simplex, which causes cold sores and genital blisters. But there is much more to discover in the herpes family.
Shingles is caused by one of eight herpes viruses that affect humans, called the varicella-zoster virus. Shingles is caused by an activation of the virus that a person gets when they get chickenpox (or when they receive a live vaccine). This happens frequently as we age and our immune systems slow down.
The varicella zoster virus is related to the herpes simplex virus, but they are not the same thing. Chickenpox is spread by very small respiratory particles and is extremely contagious. Herpes simplex viruses are spread through close contact, such as kissing or sexual contact. Kissing is also a common way to transmit Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6, all of which are herpesviruses that cause mononucleosis syndromes.
Chickenpox and shingles have nothing to do with herpes simplex viruses. They are also largely preventable through vaccination. Almost everyone over the age of 50 should get the shingles vaccine.
DEAR DR. ROACH: I have a question that I hope you can help me with. I am a 70 year old man with benign prostatic hyperplasia (BPH). My urologist, whom I see every six months, prescribed finasteride and Flomax to relieve my enlarged prostate and empty my bladder. Both were effective. Over the past few years, I have had both a negative prostate biopsy and a negative MRI, performed in 2019.
Recently I started experiencing pain when ejaculating. I wonder if this is normal, given the two medications I’m taking. It’s a little awkward to ask this of a doctor who is also a friend. I appreciate your thoughts. –HM
ANSWER: Pain related to ejaculation is not normal, but it is not uncommon. An enlarged prostate is a common cause, but there are others, including infection of the prostate or urethra, abnormal anatomy (especially after surgery), and certain medications such as older antidepressants. An assessment should look for these possibilities. Pain is not common with finasteride or Flomax.
You can be friendly with your doctor, but I don’t think it’s a good idea to have one of your friends as your doctor. This can cause the doctor to lose some objectivity and, as your case demonstrates, prevent you from being completely honest. If you can get over your embarrassment (and honestly, there’s no reason to be embarrassed), then don’t hesitate to go see your urologist friend. Otherwise, it might be prudent to find another urologist and explain why to your friend. They will understand.
Dr. Roach regrets not being able to respond to individual letters, but he will incorporate them into the column as much as possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu or mail to 628 Virginia Dr., Orlando, FL 32803.
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