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Herpes labial-Congenital herpes-Hantavirus


Hantavirus is a chronic disease spreading to humans by rodents that has flu-like symptoms.

Causes: Hantavirus is carried by rodents, especially deer mice. The virus is found in urine and stools but does not cause symptoms to the diseased animal. Human beings are believed to be ill with this virus if they come into contact with contaminated dust from mice or nests, particularly when cleaning houses, halls or other closed environments that have been empty for a long time.

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Hantavirus does not spread among human beings. Those most at risk are campers and walkers because mounting a tent in a forest increases the risk of coming into contact with these substances. Most people who are exposed to the virus have come into contact with rodent excretions in their homes.

SYMPTOMS: Early symptoms of the disease are similar to influenza and include:

Muscular pain.
People with hantavirus may begin to feel better for a short time, but within 1-2 days, it becomes difficult to breathe. The disease worsens rapidly. Symptoms include:

Dry cough;
Feeling of general malaise;
Nausea and vomit;
Lack of breath.
DIAGNOSIS: Your doctor will perform a physical examination. This may reveal:

Acute respiratory distress syndrome;
Kidney failure;
Low blood pressure (hypotension);
Low levels of oxygen in the blood, which cause a blue skin color.
The following tests can be performed:

Blood tests to check for any signs of hantavirus;
Complete hemocromocytometric examination;
Complete Metabolic Panel;
Liver and kidney function tests;
Chest radiography.
THERAPY: People with hantavirus are hospitalized in the intensive care unit. The treatments include:

Respiratory tube or breathing apparatus in the most severe cases;
A drug called ribavirin for treating kidney problems and reducing the risk of death.
There is no effective treatment for hantavirus infection involving the lungs.

PROBLEMS: Hantavirus is a serious infection that gets worse quickly. Pulmonary insufficiency can occur and can lead to death. Even with aggressive treatment, more than half of people who have this lung disease can die. Possible complications may include:

Kidney failure;
Failure of heart and lungs.
These complications can lead to death.

Contact a doctor if you develop flu symptoms after coming into contact with rodent excretions or rodent urine, or dust that is contaminated by these substances.

PREVENTION: Avoid exposure to urine and rodent excretions. When hiking and camping, set up curtains in areas where there are no rodent excrement. Avoid rodents' dudes, drink disinfected water, sleep on a vegetable cover and mats, and keep your home clean. Clear potential breeding sites and clean the kitchen.

If you have to work in an area where urine or feces are possible, follow these recommendations:

When you open an unused cabin, shed or other building, open all the doors and windows, leave the building, and let it air for 30 minutes.
Return to the building and spray the surfaces, carpets and other areas with a disinfectant. Leave the building for another 30 minutes.
Spray nests and mouse excretions with a 10% solution of bleach or similar disinfectants. Allow to rest for 30 minutes. Using rubber gloves, place the material in plastic bags. Seal the bags and throw them into junk or incinerator. Dispose of gloves and cleaning materials in the same way.
Wash all potentially contaminated surfaces with a disinfectant or bleach solution. Avoid sucking until the area has been completely decontaminated. Then ensure sufficient ventilation. Surgical masks can provide some protection.
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Herpes Zoster

Herpes zoster (also referred to as Sant'Antonio's Fire) is a painful acute blister in blisters caused by a varicella-zoster virus infection, the virus that causes the varicella.

CAUSE: After contracting the crawfish, the virus "falls asleep" (becomes inactive) in some body nerves. Herpes zoster occurs after the virus becomes reactive in these nerves after many years, in practice it awakens. The reason why the virus suddenly became active is still unclear. There is often only one attack. If an adult or child is exposed to the herpes zoster virus and has not had the varicella, or has not been vaccinated, may develop a serious form.

Herpes zoster can be contagious, through the direct contact of an individual who has not had the varicella, and therefore has no immunity. Herpes zoster can affect any age group, but it is much more common in adults over the age of 60, in children who have the varicella before a year, and in other individuals with the immune system is weakened.

SYMPTOMS: The first symptom is usually a pain on one side of the body, with tingling and burning sensation. These symptoms can go from mild to severe. Afterwards, red spots appear on the skin, followed by small bubbles that look very similar to the early symptoms of the varicella. The breakup of bubbles forms small ulcers that start to dry in the form of crusts. The crusts fall in 2 or 3 weeks. The rash usually appears in a narrow area of ​​the spine, at the front of the belly or chest. It may also affect your face, eyes, mouth and ears. Other symptoms may include:

Abdominal pain;
Difficulty using some of the muscles of the face;
Eyewell pendant (ptosis);
General feeling of malaise;
Genital lesions;
Hearing loss;
Widespread pain;
Loss of eye movement (ophthalmoplegia);
Swelling of the glands (lymph nodes);
Taste problems;
Problems with sight.
DIAGNOSIS: Your doctor may make skin diagnosis and questions about the clinical history of the patient. Tests are rarely needed, but may include the analysis of a skin sample to see if it is infected with the herpes zoster virus. Laboratory examinations may show an increase in white blood cell counts and antibody viruses.

THERAPY: Herpes zoster usually disappears alone. You may just need a treatment to relieve the pain. Your doctor may prescribe an antiviral drug called aciclovir. This drug helps to reduce pain and complications and shorten the course of the disease. Desciclovir, famciclovir, valacyclovir and penciclovir are similar and can also be used.

Therapy should be initiated within 24 hours of pain or burning sensation, and preferably before the bubbles appear. Drugs are generally in pills, doses many times higher than those recommended for herpes simplex or genital herpes. Some people may need to receive the drug via the end. Strong anti-inflammatory drugs called corticosteroids, such as prednisone, can be used to reduce swelling and pain, but they do not work in all patients. Other medications may be:

Antihistamines to reduce itching;
Zostrix, a cream containing capsaicin (a pepper extract) to prevent post-herpetic neuralgia.
Compressing a damp cloth can serve to reduce the pain. Soothing baths and lotions, such as colloidal oatmeal, starch baths or calamine lotion, can help alleviate itching and discomfort. Sleep in bed until the fever drops. The skin should be kept clean, and contaminated objects should not be reused. The person may need to be isolated while the injuries are obvious to prevent the infection of others, particularly pregnant women.

PROGNOSIS: Herpes zoster usually passes in 2 or 3 weeks and rarely repeats itself. If the virus hits the nerves that control movement (the motor nerves), it can lead to temporary or permanent weakness or paralysis. Sometimes, pain in the area where the herpes zoster has occurred may last for months to years. This pain, called post-herpetic neuralgia, can also be extremely severe. Older people are more at risk for this complication. Other complications may be:

The involvement of the facial nerve that can cause Ramsay Hunt syndrome, which can lead to loss of movement of the face, hearing, taste, and other symptoms;
Another attack of herpes zoster;
Blindness (if the lesions occur in the eyes);
Infection in other organs, encephalitis or sepsis in people with weakened immune system;
Post-herpetic neuralgia;
Secondary bacterial infections in the skin.
Contact a doctor if there is any symptoms
Owing to herpes zoster, especially if you have a weakened immune system or if the symptoms persist or worsen. Disease can lead to permanent blindness, if not treated immediately. PRECAUTION: Avoid touching the rash and the bladder of people with the varicella if you have never had the chickenpox or the vaccine. Adults over the age of 60 should receive the vaccine as part of the medical care routine. Sources: [Kimberlin DW, Whitley RJ. Varicella-zoster vaccine for the prevention of herpes zoster. N Engl J Med 2007; Prevention of varicella: recommendations for the use of vaccine against varicella in children, including a recommendation for a routine dose of 2-varicella immunization program. Pediatrics. 2007; http://health.nytimes.com/health/; Urman CO, Gottlieb AB. New vaccines for dermatological diseases. J Am Acad Dermatol. 2008; Tyring SK. Management of herpes zoster and postherpetic neuralgia. J Am Acad Dermatol. 2007:]

Genital herpes

Genital herpes is a sexually transmitted viral infection that affects the genital skin.

Causes: Herpes is caused by two viruses:

Herpes simplex virus type 1 (HSV-1);
Herpes simplex virus type 2 (HSV-2).
HSV-1, the virus responsible for common cold sores, can be transmitted through the fluid from the mouth. It is responsible for some cases of genital herpes because it can spread from the mouth to the genitals during oral sex. HSV-2 causes most cases of genital herpes because it can spread through the secretions of the mouth or the genitals. The virus is transmitted from one person to another with the simple contact with the skin, and is visible with the emergence of sores, blisters or redness. The HSV is only transmitted to the skin part it comes in contact with. There are also some cases where other types of contact can spread herpes viruses such as a variant known as herpes gladiatorum, transmitted through contact sports such as wrestling. Because the virus is transmitted through secretions from the mouth or genital wounds (mucous membranes), common infection sites in men include:

Thighs inside;
Penis punch.
Common infection sites in women include:

Thighs inside;
Big lips;
The mouth can also be a site of infection in both sexes. Research suggests that the virus can be transmitted even when there are no symptoms present, so that a sex partner without obvious genital herpes wounds can transmit the disease. In fact, asymptomatic diffusion can actually contribute to a greater extent to the spread of genital herpes than that of obvious symptoms.

SYMPTOMS: For people who come into contact with HSV-1 or HSV-2 for the first time, the initial infection involves both the entire (systemic) and the restricted areas. The most common symptoms include:

Decreased appetite;
Muscular pain.
Local symptoms include repeated small eruptions of painful blisters full of light pus, straw-colored, near the genitals, around the rectum or nearby skin areas. Before the blisters appear, the person may experience increased skin sensitivity, tingling, burning sensation, itching or pain at the point where the bladder is born. When it gets deflated, it will leave very painful ulcers. After that, surface cuts are formed that heal slowly in 7-14 days. Women can also develop vaginal secretions and painful urination. Men may develop painful urination if the lesion is near the opening of the urethra. Once a person is infected, the virus is hidden within the nerve cells, making it difficult for the immune system to find and destroy them. Within the nerve cells, the virus may remain inactive for a long period of time (latency) to reactivate at any time, with the same or worse symptoms. A variety of events can trigger latent infection and make it become active, including:

General illness;
Immunosuppression due to AIDS or chemotherapy or steroids;
Trauma for the affected area, including sexual activity;
Attacks may rarely come back once a year, or so often that the symptoms seem continuous. Recurrent infections in men are generally mild and of shorter duration than women.

DIAGNOSIS: The physician will submit the patient to the following examinations:

Searching the virus in the wart liquid to detect herpes simplex virus, which can grow in 2-3 days;
DNA analysis, always in the wart liquid, which can tell if the virus is present;
Skin lesion test that can show results consistent with herpes virus infection. This test involves the staining of human cells within the wart with a dyeing liquid. If liquid cells contain viral particles, they become visible. However, the test does not determine which strain it is.
Recently, an antibody test has been developed to determine whether a person has HSV-1 or HSV-2. These tests can also tell whether a person has ever been exposed to one of these strains in the past or has only recently been exposed to one of them.

THERAPY: Genital herpes can not be cured. However, antiviral treatment can relieve the symptoms. Some drugs can quickly relieve pain and discomfort during an outbreak, and may reduce healing time, but also relieve symptoms in early attacks. If needed, patients may use suppressive therapy, which may reduce the frequency of recurrences in patients with frequent genital herpes. For maximum benefit during recurrences, start therapy as soon as the formic
Lio, burning sensation or itching start, or as soon as you notice the birth of the wart. Possible side effects of the drugs include: Fatigue, Headache, Nausea and vomiting, Redness, Weight gain, Tremor Some people need intravenous medications for severe herpes infections that may involve the brain, eyes, and lungs. These complications sometimes develop in people with a compromised immune system. Hot baths can relieve the pain of genital injuries. A mild detergent with soap and water is recommended. If you develop a secondary infection of bacterial skin lesions, you can use oral antibiotics. PROBLEMS: Once you are infected, the virus stays in your body for the rest of your life. Some people have never relapsed, others have frequent recurrences. In people with a normal immune system, genital herpes remains an annoying and localized infection, but rarely endangers life. Any complications may be, in women, cervical cancer. The risk increases when the virus is present in combination with the human papillomavirus (HPV), the viral genital condyloma virus (condyloma). For pregnant women, HSV-1 or HSV-2 are a threat to the baby. Newborn infestation can lead to herpes meningitis, herpes viremia, chronic skin infections, and even death. For AIDS patients, or if they undergo chemotherapy or radiotherapy or take high doses of cortisone, there is a risk of developing infections of the various organs, including: Encephalitis; Herpetic esophagitis (herpes of the esophagus); Herpes keratitis (eye infections); Herpetic hepatitis (liver infection); Incontinence; Persistent mucous and nose, mouth and throat infections; Pneumonia (lung herpes infection); Recurrent disease; Dissolution of the virus To other organs of the body; Transverse myelopathy (damage extends throughout the spinal cord). PREVENTION: Condoms remain the best way to protect themselves from genital herpes during sexual activity. Using a condom properly and consistently will help prevent the spread of the disease. Do not use condoms made with animal membrane, as the virus can go through, but only latex. The female condom can be enough. Recent data show that using an antiherpes drug can help prevent the spread of the virus to others. People with genital herpes should avoid sexual contact when injuries are active. In addition, people who have had genital herpes in the past, but are currently without symptoms, should inform their partners of their condition. This precaution allows both parties to use protective barriers to prevent the spread of the disease. Pregnant women with herpes simplex infection should receive weekly cervical and external genital care. If there are active lesions at the time of delivery, a caesarean section is necessary to prevent the infant from infusing. There are vaccines against herpes, but are still considered experimental. However, vaccines are not a cure or treatment for people who have already contracted herpes. Facts: [Centers for Disease Control and Prevention, Workowski KA, Berman SM. Sexually Transmitted Diseases Treatment Guidelines, 2006. MMWR. 2006; Mandell GL, Bennett JE, Dolin R. Principles and Practices of Infectious Diseases. 5a ed. Philadelphia, PA: Churchill Livingstone, 2000; http://health.nytimes.com/health/]

Congenital herpes

Congenital herpes is a herpes virus infection that a child acquires at birth.

Causes: Infants may be infected with herpes virus:

In utero (intrauterine herpes, very rare);
Passing through the delivery channel (most common);
Right after birth.
If the mother has an active genital herpes infection at birth, the child is more likely to be infected. Some mothers do not know if, within the vagina, there are sores of herpes, so it is important to tell their doctor if they have had a case of genital herpes.

Also, some people who have had herpes infections in the past, but were unaware of it and never treated it, have good chances to pass it on to their baby. Type 2 herpes (genital herpes) is the most common cause of herpes infection in newborns, but type 1 herpes (oral herpes) can also occur.

SYMPTOMS: Intrauterine herpes may cause:

Eye disorders, such as retinal inflammation (corioretinitis);
Severe damage to the brain;
Skin lesions.
Congenital herpes can be localized (in a body area) or systemic (throughout the body). Babies can develop only a localized skin infection consisting of a fluid of small filled vesicles that break, form a crust and, after cure, often leave a mild scar. A second type of herpes leads to encephalitis, a brain inflammation that can lead to seizures and nervous systems. If not cared for, it can lead to death. A widespread herpes infection is the most dangerous type. In this type, herpes virus can affect several internal organs, including the liver, lungs, kidneys and the brain. There may or may not be blisters on the skin. This type of infection is often fatal. Herpes acquired in the period immediately after birth has similar symptoms to the congenital:

Easy hemorrhages;
Difficulty breathing;
Burning to the nostrils;
Tired breathing (tachypnea);
Short periods without breathing (apnea episodes);
Enlarged liver and spleen;
Kidney failure;
Low body temperature (hypothermia);
Difficulty of feeding;
Epileptic attacks;
Skin lesions;
Stress and anxiety.
DIAGNOSIS: Exams to diagnose congenital herpes include:

DFA test for herpes;
Magnetic resonance of the head;
Spinal fluid culture;
Culture of the vesicle.
Additional tests that can be made if the baby is very ill are:

Blood gas analysis;
Coagulation studies (PT, PTT);
Complete blood count;
Electrolyte Measurement;
Liver function tests.
THERAPY: Herpes virus infections in infants are generally cured with the intravenous medicine. Aciclovir is the most common antiviral drug used for this purpose. The baby may need to take the medication for several weeks. Other therapies are often needed to cure the effects of herpes infection, such as shock or seizures. Often the treatment is done in an intensive care unit if the baby is serious.

PROGNOSIS: Children with systemic herpes or encephalitis often struggle to heal, despite antiviral drugs and early treatment. In children with skin disease, vesicles may return several times, even after the treatment is over. Possible complications may be:

Bacterial or fungal infection of skin lesions;
Delay in development;
Excessive bleeding, disseminated intravascular coagulation;
Eye problems (corioretinitis, keratitis);
Gastrointestinal problems, including diarrhea;
Hepatic insufficiency;
Pulmonary problems, including pneumonia;
Brain and nervous system problems;
Respiratory failure;
Skin lesions
Contact a doctor if your child has any symptoms of herpes, including only skin lesions.

PREVENTION: Safer sex practices can help prevent genital herpes in the mother. Mothers who are not carriers of the herpes virus can not pass the herpes virus to the fetus during childbirth. People with "cold sores" (cold sores) should avoid contact with newborns. Mothers should ask their doctors the best way to minimize the risk of transmitting herpes to their child.

Sources: [Cernik C, K Gallina, Brodell RT. Treatment of herpes simplex infections: An evidence-based review. Arch Intern Med 2008; http://health.nytimes.com/health/; Hollier LM, Wendel GD. Third trimester antiviral prophylaxis for genital herpes simplex (HSV) recidivism and neonatal infections. Cochrane Database Syst Rev. 2008]

Herpes labial

Laryngitis is an infection of the lips, mouth or gums from herpes simplex viruses. It leads to the development of small painful vesicles.

Causes: Cold sores are a common disease caused by an infection of the oral zone with type 1 herpes simplex virus. Most cases occur around the age of 20. Initial infection may not cause symptoms or mouth ulcers. The virus remains dormant in the nervous tissue of the face. In some people, the virus reacts and produces recurrent herpes labs usually in the same area, even if they are not serious.

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Type 2 herpes virus, which usually causes genital herpes, can infect children during birth by infected mothers, and can also cause cold sores. Herpes viruses are contagious. Spreading can occur through direct intimate contact, or through contact with infected razors, towels, crockery and other shared objects. Occasionally it can spread by oral contact with the mouth.

SYMPTOMS: The first episode may be slight or severe. Usually occurs in children between 1 and 5 years. The first symptoms usually appear within 1 to 2 weeks, and up to 3 weeks after contact with the virus. Sore throat and fever that can last up to 5 days may appear before the bubbles. There may also be swelling of the neck glands. The first episode can last 2-3 weeks. The lesions may be on the gums, mouth, throat, or face. Subsequent episodes are usually milder.

The condition may be triggered by menstruation, exposure to the sun, fever, stress or other unknown causes. The symptoms of itching, burning, increased sensitivity or tingling may occur approximately 2 days before the lesions appear. An outbreak usually involves:

Skin lesions or rashes around the lips, mouth and gums;
Small vesicles full of light yellowish liquid;
Embossed, red and painful vesicles;
Vesicles that form, break and exude;
Yellow crocuses that break and become pink before healing.
Several small blisters may melt to form a larger bubble.

DIAGNOSIS: Diagnosis is made on the basis of the appearance or analysis of the lesion. The examination can also show enlargement of the lymph nodes in the neck or groin. Viral analysis, viral DNA testing, or Tzanck test of skin lesion may reveal herpes simplex virus.

THERAPY: Untreated symptoms generally disappear within 1 or 2 weeks. Oral antiviral drugs can help accelerate healing and decrease the pain. Aciclovir, famciclovir and valaciclovir are the three oral treatments currently available. The sores often return. Antiviral medicines work better if they are taken when the virus begins to manifest before plagues appear. If the virus returns frequently, your doctor may advise you to take the medicine continuously.

A topical antiviral cream (wiped on the skin) such as penciclovir and andacyclovir can be used but should be applied every 2 hours. Creams are expensive and often reduce episodes from a couple of hours up to a day. An antiseptic soap can be recommended. The application of ice or heat in the area can reduce the pain. Other tips to prevent future epidemics include applying a lip balm containing zinc oxide when sores or a moisturizing balm to prevent the lips becoming too dry.

PROBLEMS: Cold sores usually go away alone in 1 or 2 weeks, but can come back. Infection can be severe and dangerous if it occurs in or near the eye, or if it occurs in people with immunodeficiency. Possible complications may be:

Spread to other areas of the skin;
Secondary bacterial infections of the skin;
Generalized infection;
Herpes eye infection is one of the main causes of blindness as it causes scarring of the cornea. Contact a doctor if you have severe laryngeal herpes symptoms or who do not go away after 2 weeks, or if you have immunodeficiency and develop symptoms.

PREVENTION: Avoid direct contact with open wounds. Minimize the risk of indirect diffusion by thoroughly washing items such as towels before re-use. Do not share objects with an infected person, especially when there are herpes lesions. Avoid triggering agents (especially sun exposure) if you are prone to oral herpes. Avoid having oral sex when you have active lesions above or near your mouth, or use a condom.

Herpes simplex

Herpes simplex is a viral infection that mainly affects the mouth or genital area.

Causes: There are two virus strains of herpes simplex:

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It is supported by a study by the International Agency for Research on Cancer
Herpes simplex virus type 1 (HSV-1) is usually associated with lips, mouth and face infections. It is the most common and many people develop it during childhood. HSV-1 is often the cause of wounds (lesions) inside the mouth, cold sores or eye infection (especially conjunctiva and cornea). It can also lead to brain infection (meningoencephalitis). It is transmitted by contact with infected saliva. In adulthood, 30-90% of people have antibodies to HSV-1.
Herpes simplex virus type 2 (HSV-2) is generally sexually transmitted. Symptoms include genital ulcers or sores. However, some people with HSV-2 have no symptoms. Up to 30% of adults have antibodies against the virus. Cross-type infections of type 1 and 2 can occur from oral-genital contact.
HSV can infect the fetus and cause anomalies. A mother who has been infected may transmit the virus to the infant during vaginal delivery, especially if she has an active infection at birth. However, 60-80% of HSV infections acquired by babies occur in women who have no symptoms of HSV infection or a history of HSV genital infection.

It is possible that the virus is transmitted even when there are no visible symptoms or sores. Two thirds of people with HSV genital infections have recurrence of symptoms, and one third have three or more relapses per year. HSV is not eliminated by the body, but remains latent and can reactivate, causing new symptoms.

SYMPTOMS: The most common are:

Bladders or ulcers, most often on the mouth, lips and gums, or genitals;
Enlarged lymph nodes of the neck or groin (usually only at the beginning of the infection);
Herpes labial;
Fever, especially during the first attack;
Genital lesions with a burning or tingling sensation;
Plague at the mouth.
DIAGNOSIS: Many times doctors can say if you have an HSV infection simply by looking at the sores. However, some tests may be required to be sure of the diagnosis. These include:

Blood test for antibodies from HSV (serology);
Direct Immunofluorescence (DFA);
Viral culture of the lesion.
THERAPY: Some cases are mild and do not require treatment. People with severe or prolonged episodes (especially if it is the first time), those with immune system problems or those with frequent recurrences may take antiviral drugs such as acyclovir (Zovirax), famciclovir (Famvir) and Valacyclovir (Valtrex).

People who have frequent recurrences or severe cases of genital or oral herpes may choose to continue taking antiviral drugs to reduce the frequency and severity of recurrences.

PROGNOSIS: Oral or genital cord injuries usually heal by yourself in 7-10 days. The infection may be more serious and last longer in people who have a condition that weakens the immune system. Once the infection occurs, the virus spreads to the nerve cells and stays in the body for the rest of a person's life. Recurrence can often occur and may be triggered by sunlight, fever, stress, acute illness, and drugs or conditions that weaken the immune system. Possible complications may be:

Eczema erpetiforme;
Eye infection (keratoconjunctivitis);
Infection of the trachea;
Prolonged and severe infection in immunodepressed subjects.
Contact a doctor if you develop symptoms that resemble a herpes infection. There are many different conditions that can cause similar lesions (especially in the genital area). If you have a history of herpes infections and develop similar lesions, if you do not improve after 7-10 days, or you have a condition that weakens your immune system, you should advise your physician.

PREVENTION: Preventing infection by HSV is difficult because people can spread the virus even when they have no symptoms. Avoiding direct contact with an open lesion lowers the risk of infection. People with genital herpes should avoid sexual contact when they have active lesions. More secure sexual behaviors, such as the use of condoms, can also reduce the risk of infection.

People with active lesions should also avoid contact with infants, children with eczema, or persons with repressed immune systems because they are at higher risk of more serious illness. To reduce the risk of infesting babies, Caesarean section is recommended for pregnant women who have a viral

Contact your doctor for more information. The information provided on (what the health) is of a general nature and for purely disclosure purposes can in no way replace the advice of a physician (or a legally qualified person) or, in specific cases, of other operators health.


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