Talk:Herpes

Greetings from the League of Copyeditors! Please see my comments in the "Copyedit Progress" section below. Livitup (talk) 16:20, 23 May 2008 (UTC)

Good Article Review

At this version: [1]

Reviews always dwell on faults with article so I will start on a positive note. This a very well-written and comprehensive article. During my first read through, these problems came to light:

• The Lead is way too long.

I've copy edited and trimmed this to try and improve - hoping some "professional" copyeds come soon!~ Ciar ~ _{(Talk to me!)} 05:26, 13 March 2008 (UTC)

• Citations are needed for, HSV-1 being more infectious during primary episodes, the number of asymptomatic infections and HSV-1 amelioration of subsequent HSV-2 infections.

Not sure of the correct places in the text for these. I moved a ref for asymptomatic shedding/frequency to lead, but the others I can't find. I've either deleted text during the copyediting or am just missing it! ~ Ciar ~ _{(Talk to me!)} 06:44, 14 March 2008 (UTC)

• The dates in the Table of prevalence data do not line up very well, making the table very difficult to read. Fixed.

I don't see the problems on the computers I use, so may be a browser problem. I'll try putting phyical rows in the table when I get a chance.~ Ciar ~ _{(Talk to me!)} 05:26, 13 March 2008 (UTC)

It looks OK with Firefox but it's a bit messy using Explorer.--GrahamColm^Talk 11:41, 13 March 2008 (UTC)

I altered the table and checked it with Firefox and Explorer - how does it look at your end?~ Ciar ~ _{(Talk to me!)} 06:30, 14 March 2008 (UTC)

• In the Lead the prevalence in Sub-Saharan Africa is given as 80&, where as in the body it is given as 30-80 for females and 10-50 for males.

reworded/numbered this according to table~ Ciar ~ _{(Talk to me!)} 05:26, 13 March 2008 (UTC)

• There is a big problem with how the seroprevalence data is presented. This is the prevalence of antibody and not disease. Most readers will not know the difference.
• There is a greater emphasis on herbal remedies than antivirals and the latter could be {{main|}} linked to the main article.

IMO, the herbal remedies don't warrant a page of their own, and I think it will be problematic, with some editors, to completely remove the section, so I have compromised and trimmed out the excessive details.~ Ciar ~ _{(Talk to me!)} 05:26, 13 March 2008 (UTC)

• WRT Diagnosis and testing:

"Genital herpes is more difficult to diagnose than oral herpes since most HSV-2-infected persons have no classical signs and symptoms." citation please!

The diagnosis section was covered by a rewiew article that was already cited in several sentences. I didn't wish to over cite, since this is GAR that doesn't require excessive refs, but have included the ref tag after this sentence anyway.~ Ciar ~ _{(Talk to me!)} 06:24, 13 March 2008 (UTC)

How do you test someone who is asymptomatic? What do you swab? What specimens do you send to the lab? Serology is no use because it does not differentiate between past and current infection, (is there a test for IgM?).

H'mmmm, how to answer this? Do you wish me to spell this out in the article or just respond on the talk page? My knowledge on the matter is this. People that become infected with HSV are infected for life. The virus does not get eliminated from the body by the immune system, it just goes into hiding in the ganglia. Before it hides, the immune system (in most cases) develops antibodies against the virus, and the infected person becomes seropositive against HSV (this usually takes a couple of weeks to happen). Since the virus is not eradicated, serology is used as a predictor of persons infected with the virus - modern serology tests CAN distinguish between HSV-1 and HSV-2 since there a slight differences in the proteins that these two viral species produce (Wald's group do this - I'll see if I can find a ref to support - and also if it gives details on IgM + IgG testing). Asymptomatic people are the people infected with HSV (as determined by serology testing and/or previous symptoms) that do not have recurrences. Serology testing (as mentioned above) indicates the presence of earlier infection - yes - but since the virus is not removed from the body, it is used as a predictor for current infection (HSV produces chronic infections) - and is also used to determine HSV infection in asymptomatic individuals. Although they do not have noticable symptoms, they can still release/shed the virus, and this is detected for research purposes by rubbing swabs (like Q-tips) across the infected area (e.g. if the person is seropos for HSV-2, they usually swab the anogenital area, and the swab is tested for viral DNA by PCR) - I can search for relevant articles that show this too. Is this the info you are looking for, and do you think this level of detail should be added to the article to pass GAR? ~ Ciar ~ _{(Talk to me!)} 06:51, 13 March 2008 (UTC)

I'll take another look at this, but I think the answer is asymptomatic people are not tested.--GrahamColm^Talk 11:41, 13 March 2008 (UTC)

H'mmm, I'd say that opinion was too general. I agree that most people that do not know they are infected do not seek testing. However, some people do get tested if they find out they have had exposure to a herpes infected individual regardless of whether they develop symptoms themselves, and other people routinely get tested for STDs - if this did not happen, the existence of asymptomatic people wouldn't be known, right? Just a thought ;) Thanks for helping whittle out the probs BTW ~ Ciar ~ _{(Talk to me!)} 19:36, 13 March 2008 (UTC)

We know about the existence of asymptomatic infections from prospective epidemiological studies. This comes round to my worry about the seroprevalence data. We need to distinguish clearly between incidence and prevalence; two releted but distinct epidemiological concepts. The way the article reads now implies a high incidence of symptomatic disease in some countries, whereas there is a high prevalence of infection. I'm nitpicking because I forsee the article going to FAC sooner rather than later and we could sort these issues out now. Please don't worry about the GA - it's in the bag.--GrahamColm^Talk 19:56, 13 March 2008 (UTC)

No, I don't think this is needed to pass GAR. I've edited the serology section and would be happy to leave it at that. Also, this article will pass GAR but the references need a little work and a clear distinction must be made between seroposivity and active infection.--GrahamColm^Talk 12:57, 13 March 2008 (UTC)

I added an intro paragraph to the epidemiology section for the time being with a ref I could only get the abstract for - not ideal, but the best I could find just now. Haven't been able to identify prevelance data for active disease yet! ~ Ciar ~ _{(Talk to me!)} 07:22, 14 March 2008 (UTC)

:Although a citation is given I do not agree with: "Although these procedures produce highly sensitive and specific diagnoses, their high costs and time constraints limit their regular use in clinical practice." Even PCR isn't that expensive these days. Is this statement meant to refer to the developing countries?

The reference says discourage and I have edited this passage accordingly.--GrahamColm^Talk 11:41, 13 March 2008 (UTC)

I am placing the GA review on hold and will come back to it later. Please give me a reminder on my talk page when it is ready for reappraisal. (Watching!) Graham. --GrahamColm^Talk 11:05, 12 March 2008 (UTC)

• I am promoting the Article to GA. Thanks for being patient and addressing my concerns so quickly. You don't need me to tell you that there is still much work to be done if you are considering FAC. I hope you found the review valuable. Best wishes. Graham.--GrahamColm^Talk 10:45, 14 March 2008 (UTC)

Yipee....thanks Graham! I think I'll throw it in for peer review before tackling the jump to FAC! ~ Ciar ~ _{(Talk to me!)} 23:40, 14 March 2008 (UTC)

Herpes and Alzheimer's

• Hi There. I found some very interesting information about a possible link scientists have found between Herpes Simplex Type I and Alzheimer's disease. As the article states: "a physical connection between the herpes simplex virus and amyloid precursor protein [has been found], a protein that breaks down to form a major component of the amyloid plaques that are consistently present in the brains of persons with Alzheimer's disease." Here is the link: http://www.sciencedaily.com/releases/2003/11/031107055048.htm I'll try to write something about it if the main editors of the page think its appropriate. What do you think? Saritamackita (talk) 01:12, 15 March 2008 (UTC)

Hi Saritamackita, IMO I think, since a section on Bell's palsy made it into the article with its limited and disputed data, it would only be fair to do the same for the Alzheimer's connection (the general public may be curious about this) - only it would be better if scientific journal articles rather than popular press were used as sources and that a balanced argument is presented (i.e. although the science daily article reports a potential relationship of herpes viruses with Alzheimer's it also states that too many conclusions regarding this relationship should not be made). ~ Ciar ~ _{(Talk to me!)} 01:23, 15 March 2008 (UTC)

thanks for the feedback. I'll keep all that in mind. My only question, though, is how do I get access to these scientific journal articles without having to pay for them? Saritamackita (talk) 01:40, 15 March 2008 (UTC)

You could try going through pubmed - some articles listed there are free, so if you are lucky, you may find a relevant free article there. ~ Ciar ~ _{(Talk to me!)} 04:08, 15 March 2008 (UTC)

Herpes Herbal Treatment

• Here is another popular science article about Prunella vulgaris [also known as self-heal], an herbal herpes treatment that I found interesting. http://www.sciencedaily.com/releases/2003/05/030520083354.htm. I suppose I have the same issue writing about this as I have about writing about the Alzheimer's-Herpes link though (little to no access to scientific journal articles). I'm starting to miss college right now. Those were the days of absolute access to information.

--Saritamackita (talk) 01:39, 15 March 2008 (UTC)

I just got through writing a little thing about this along with the foot note, but the foot note didn't really work out. If someone could help me with this, that would be great. --Saritamackita (talk) 02:45, 15 March 2008 (UTC)

Cha de Bugre. Let it be known!

Antiviral activity of an extract of Cordia salicifolia on herpes simplex virus type 1. Hayashi K, Hayashi T, Morita N, Niwayama S. Planta Med. 1990 Oct;56(5):439-43. —Preceding unsigned comment added by 78.148.115.127 (talk) 16:40, 2 July 2008 (UTC)

Peer review

We got some great comments during herpes simplex peer review. I copied them to the "To Do" list for ease. If any editors want to help plough through these and improve herpes simplex for WP:FAR, please go ahead! ~ Ciar ~ _{(Talk to me!)} 02:34, 25 March 2008 (UTC)

New Link

I found a virology article that I found very interesting about Herpes. I think it would be good as an extra information source on Herpes. Let me know what you think. http://www.futuremedicine.com/doi/full/10.2217/17460794.2.1.1?cookieSet=1 Saritamackita (talk) 05:07, 25 March 2008 (UTC)

Oral/Genital infection rates

The statistics only show HSV-1 and HSV-2 infection rates, not the location as to what's infected. Klosterdev (talk) 03:06, 2 April 2008 (UTC)

Non-drug heat treatment mentioned

There are some products (such as Hotkiss and Therapik) that use battery-powered heat and can reduce the severity of an episode. Failing to find any scholarly articles, I have added a mention of this under treatment and an on-line media link from New Zealand.SuW (talk) 21:16, 5 April 2008 (UTC)

Hi there, I reverted that addition because the link was to a press release from one of the companies themselves, and I couldn't find secondary sources. I think some sort of secondary source would be required before adding it to the article (otherwise there would be far too many links to products that claim to have some benefit). AndrewGNF (talk) 21:23, 5 April 2008 (UTC)

The pictures are...

GROSS! Why do we need to get so graphic. I'm against pictures on this article, because is can scare your every day Joe, who doesn't have a strong stomach. Herpes is bad. Nobody needs to see it. —Preceding unsigned comment added by NatWill2 (talk • contribs) 02:09, 11 April 2008 (UTC)

Nobody needs to read it. If you don't like it, don't read it. Nbauman (talk) 23:35, 7 May 2008 (UTC)

'Stress' is not a proven trigger of outbreaks

I read the supposed reference link #45. In no way did it prove that stress caused a herpes outbreaks. Pure theory and nothing more as far as I can see. And note the name of the journal: "Hypotheses". —Preceding unsigned comment added by 63.193.144.79 (talk) 09:49, 15 April 2008 (UTC)

Many papers have cited stress as a trigger. The listed paper was perhaps not convincing. The only supposed trigger that has not been PROVEN to my knowledge is menstual cycle. I will try to post more refs in the near future. pikipiki (talk) 05:35, 8 May 2008 (UTC)

What?

"Risk Factors for acquiring HSV-2 include: ... black race;" Wait, what? First, there is a general consensus that there are no races. And how could a race have a color? It's like asking what color "red" has. This line should be rewritten, so it's not racist-POV. Also, there should be a source that says that certain ethnicities are more likely to be infected. Thanks, and don't turn this into a silly race conversation that has nothing to do with this POV. That could be held in some other article, such as race. —Preceding unsigned comment added by Ran4 (talk • contribs) 18:40, 29 April 2008 (UTC)

I believe that was one of my additions, and it is based on the NHANES surveys conducted since the early 60's and the information derived from them, as well as several retrospective seroprevalance studies done on sera collected during the NHANES studies. The information is available on the CDC.GOV website and any issues that you have with the way they title their surveys and the facts that are derived from them should be taken up with the Center for Disease Control, the US government, those researchers that have used the NHANES material in their research, or JAMA, NEJM, JID, STD, and other journals that have published these findings. If you would like more information try PUBMED.GOV and search "NHANES herpes seroprevalence". If you would really like to blow a gut, search "herpes seroprevalence survey". The paper at the top of the list, about HSV-2 in NYC, from STD April 2008, contains the phrase "Black women had the highest seroprevalence (59.7%) of any sex or race/ethnicity group." I again apologize for confusing you with facts. pikipiki (talk) 06:06, 8 May 2008 (UTC)

I also reverted your deletion. I read medical textbooks and journals all the time, and they regularly refer to "black race" or "African-American." They usually specify "self-identified." So that's what "black race" means. They also regularly refer to "Ashkinazi Jews" or "people of Celtic origin" for other diseases. Some diseases are more frequent in some populations, and "black race" is a good marker for those populations.

People with "black race," or whatever you prefer to call it, are more likely to have sickle cell anemia, and aggressive breast and prostate cancer, and diabetes, and less likely to have osteoporosis. Feel free to separate the genetic and environmental components.

The bottom line is that when a doctor has a patient in the hospital who is steadily declining while they try to figure out how to save the patient's life, they can save the patient's life more often if they use race as a clue in coming up with a diagnosis.

Would you prefer that they try to diagnose that patient without taking race into consideration? Nbauman (talk) 15:28, 8 May 2008 (UTC)

The following text is copied from a discussion on Nbauman's (talk page regarding the same subject, in an attempt to make the discussion available to all interested parties. Please help us sort out the issue in question. Thanks, ~ Ciar ~ _{(Talk to me!)} 13:54, 9 May 2008 (UTC)

Hi Nbauman, I couldn't hep but notice the small conflict beginning on the herpes simplex page over race/gender issues in the lead paragraph, so I wrote directly on the concerned user's talkpage to invite them to comment on the article's talkpage - they may be a new user that is not completely familiar with WP procedures so may not realize there was a discussion occurring there! I agree the sentence is question is a little clunky and might benefit from rewording - maybe some compromise can be worked out! Best wishes, ~ Ciar ~ _{(Talk to me!)} 17:51, 8 May 2008 (UTC)

Thanks. I'm trying to use it as a teachable moment. This issue comes up regularly. I didn't think of using the talk page of an anonymous user. Nbauman (talk) 17:55, 8 May 2008 (UTC)

I am a new user. My issue with the sentence is that you are taking seroprevalence data, and making a statement about risk factors based upon that data. Seroprevalence data of virus infections is not the same as risk factors. I have no problem with mentioning what percentage of the populuation of women, urban, racial, etc. have the HSV virus. But to say that simply having sex with a female, black person, poor person, or a city dweller puts you at risk of HSV2 is applying personal bias to the data. The risk factor of HSV2 is unprotected sexual contact. If you just limit your statement to the data without trying to apply an interptation (sp) to the data i will be content. Until then I will deleting that biased sentenced. (I did notice that you were previously lectured on Wiki's bias rules). —Preceding unsigned comment added by 70.165.104.101 (talk) 20:05, 8 May 2008 (UTC)

So sorry to butt in here - the risk data doesn't actually mean you are at higher risk of acquiring HSV infection if you have sex with the listed groups of individuals, it means the listed individuals show a higher risk of acquiring the virus themselves, from whatever source. Maybe we could move the discussion to Talk:herpes simplex? ~ Ciar ~ _{(Talk to me!)} 20:28, 8 May 2008 (UTC)

Yes, let's take the discussion to Talk:herpes simplex, which is where it belongs. I'll be glad to continue it there. Nbauman (talk) 21:05, 8 May 2008 (UTC)

From my scan of the article in question, it seems to me that the indicated populations have higher seroprevalence, but not that these groups are more likely to be infected given exposure. As it's worded now, I think it's ambiguous and would agree with a change that was more specific in simply saying that these groups have higher seroprevalence. AndrewGNF (talk) 19:44, 9 May 2008 (UTC)

Risk factor is part and parcel of the epidemiology of a disease. It does not mean they are more likely to catch the disease if exposed. It is part of diagnosing the disease. To ignore risk factors is to endanger your patient. Imagine leaving a child to die because you don't want to offend them and ask if they're Jewish and might have tay-sachs. If it will make 70.165.104.101 feel better, I'm willing to post HSV-1 neonatal risk factors which are: White race, young age, first pregnacy, HSV seronegative, and receptive oral sex in the third trimester, along with the appropriate references.pikipiki (talk) 09:43, 13 May 2008 (UTC)

Nahmias AJ. Neonatal HSV infection Part I: continuing challenges. Herpes. 2004 Aug;11(2):33-7. PMID: 15955265. Reference for my comment above on NHSV-1.pikipiki (talk) 09:58, 13 May 2008 (UTC)

As part of the copyedit process I have taken that sentence out. Not due to bias or POV, but because it just doesn't belong there. My role as a copy editor is not to evaluate the factual basis of any statement, but just to make the text read well. When I get to the epidemiology section the satement, or at least the intent of the statement will go in there. You all can argue about it then. :) Livitup (talk) 20:43, 23 May 2008 (UTC)

Copyedit Progress

Greetings from this humble representative of the League of Copy Editors... :)

Normally when copyediting an article I just attack with my red pen, and upload the changes all at once or in big chunks. But since this article is long, complex, and has subject matter experts actively editing the article I'm going to take a different approach. Since you all are far more familiar with the subject than I am, I'm going to propose major changes here for your comment, before I make them. This will draw out the copyedit process, but I think the reward will be a much better article and no angry editors. :)

To start with the lead:

• Overall comment, the lead is really long. There's a lot of detailed information that I think should be moved to individual sections of the article. I'll make those changes, but make that the last edit, so you can revert it if you think I cut too deep.

Agree, the unfortunate problem with having a long article is the intro tends to grow - I've tried to cut down some of it, but it needs someone with better grammar to form more efficient sentences. Chop away - there should not be any info in the lead that isn't covered in more detail in the main article. There is one sentence in particular (see the discussions above on this talk page) that is causing concern that may need some subtle tweaking so it doesn't get misinterpreted too - any suggestions?~ Ciar ~ _{(Talk to me!)} 17:11, 23 May 2008 (UTC)

You wanted the red pen, you got the red pen. :) Oh, and I took care of that troubling sentence in particular. :) I think that's something you can cover in more detail in the appropriate subsection, which will probably result in people reading it better and not getting worked up about it. :) Livitup (talk) 20:32, 23 May 2008 (UTC)

• I agree with your peer reviewer that references don't belong in the head. Hopefully my reworking the head will take care of a lot of that, but you can help me by moving the references to the first place that those facts are stated in the article.

I did this, and I think I preserved all your references too! Not bad for someone who hates research. :) Livitup (talk) 20:32, 23 May 2008 (UTC)

• From the first paragraph: "Oral herpes, colloquially called cold sores…" I think should read "Oral herpes, the visible symptoms of which are colloquially called cold sores…" Would that be more factually correct, as the sores themselves are not herpes per se, but symptoms of the viral infection?

I do not have any problem with your alternative so would support that change.~ Ciar ~ _{(Talk to me!)} 17:11, 23 May 2008 (UTC)

Done. Livitup (talk) 20:32, 23 May 2008 (UTC)

• End of the first paragraph: "Occasionally, these viruses reactivate and return to the area…" Occasionally is vague, can you quantify it at all?

This is a difficult thing to do - reactivation differs from individual to individual - some people have reactivations many times in a year, others never (noticeably) reactivate.~ Ciar ~ _{(Talk to me!)} 17:11, 23 May 2008 (UTC)

Meh, I just cut the sentence. I cover the posibility in another statement, and you can delve more deeply into this in the relevant section. Livitup (talk) 20:32, 23 May 2008 (UTC)

• Third paragraph: "developing countries, such as those in Sub-Saharan Africa…" and "industrialized countries like the United States and countries in Northern Europe…" I think calling out individual regions or countries isn't necessary and is probably even pejorative. Can we let the terms "developing countries" and "industrialized countries" stand on their own?

Yes, the regions are described in more detail further down the manuscript in the epidemiology section - perhaps this actual sentence (in a more elgeant form ;)) can be moved to the introductory statement for that section?~ Ciar ~ _{(Talk to me!)} 17:11, 23 May 2008 (UTC)

Cut it for now, but I'll remember to make sure the intent is conveyed in the proper section. Livitup (talk) 20:32, 23 May 2008 (UTC)

• Also in the third paragraph: "The risk of infection for HSV-1 is associated with lower standard of hygiene and a more crowded living environment." Lower than what? More crowded than what? Again, I fear POV influence with these statements.

Ahhh, this is getting into the risk assessment statements - they need work! So, I think this part is supposed to highlight that higher seroprevalence of HSV-1 is reported in groups that live in more crowded environments - the hygiene thing I'm not sure about. With the additional sentence closing out that paragraph, I think this sentence is actually redundant and may be removed - maybe another editor should comment.~ Ciar ~ _{(Talk to me!)} 17:11, 23 May 2008 (UTC)

I agree, and I removed it. This goes along with the general theme of not cluttering the head with details, it's just a summary. You can cover that later in the epidemiology. Livitup (talk) 20:32, 23 May 2008 (UTC)

I will go ahead and make some minor edits to the prose, punctuation, and grammar, but will wait for your comments for the bigger edits. Livitup (talk) 16:18, 23 May 2008 (UTC)

Yay! Welcome Livitup!! I am glad you have arrived - the article is in dire need of copyediting! I've responded to some of your comments above - hopefully in a helpful way. There are some other editors that regularly come through here too, so maybe they'll add some comments too. Please, work your magic and if anything looks out of place, I'm sure we can communicate that with you here. Thanks. ~ Ciar ~ _{(Talk to me!)} 17:11, 23 May 2008 (UTC)

*shy bow* Let me know what you think of what I did to the head and we'll progress from there. Livitup (talk) 20:32, 23 May 2008 (UTC)

Wow....how do you guys do that!!??! The intro is much improved and reads very smoothly - thanks! Looking forward to the rest :o) ~ Ciar ~ _{(Talk to me!)} 21:20, 23 May 2008 (UTC)

• Hi again. The section lead for disorders and orofacial herpes are done. I cut out a number of lines that dealt with seroprevalence in underdeveloped vs. industrialized nations. I think that discussion belongs soley in epidemiology. I'm saving everything I cut in a Word document, so I'll make sure all the things I cut end up back in the article at some point. I also trimmed a chunk out about how the virus goes latent in the nerves. Since this seems to be the case for all the disorders, I'll go back to the section head and add this information back in there, and clarify things for a particular disorder when needed. Let me know what you think! I'll try to get a handful more disorders done tomorrow. Livitup (talk) 20:08, 29 May 2008 (UTC)
• Up to (but not including) Ocular herpes is done. Please give feedback. :) Livitup (talk) 20:20, 30 May 2008 (UTC)
  • Sorry my responses are taking so long. I'm a little swamped right now!! I rearranged one sentence a tiny bit, but everything else looks grand! I'm happy about you moving chunks of seroprevalence data into epidemiology - it would be much better placed in that section. I can see the same thing is needed for the neonatal section, which is getting a little long. Looking good so far Livitup. Thanks, I greatly appreciate the help!! ~ Ciar ~ _{(Talk to me!)} 20:25, 2 June 2008 (UTC)
    • Es no problemo. I've actually been absent for several days myself... on a much needed "unplugged" vacation. Just wanted to update you that I haven't abandoned you and I'll be back with more sections shortly. Livitup (talk) 16:21, 11 June 2008 (UTC)

• I've written articles about HIV for doctors, and I've written medical articles on other subjects for non-doctors.

My impression of the lead is that the vocabulary is too difficult for the ordinary reader. Believe it or not, there are intelligent, well-educated people who couldn't define "immunocompetent."

I even think the language is too complicated for doctors. The general medical journals would simplify that language, at least in some sections of the journal. (Why say "colloquially" instead of "commonly"?)

When I finish writing something, I go through it word by word, and ask myself, "Is there a more common word that would say the same thing?" Then I go through it sentence by sentence, and ask myself, "Can I rewrite this in a simpler sentence (or two simpler sentences) that would say the same thing?"

BTW, that last edit is incorrect -- about 1/5 of the population is infected with HIV, according to blood tests, although they don't always show symptoms (I guess the article didn't make clear the meaning of "seropositive.") Nbauman (talk) 15:28, 8 June 2008 (UTC)

Hi Nbauman, The article is still a bit substandard when you consider something for FA or real publication quality (and I can say that since I have done a lot of the poor hashing of it recently!) but Livitup is doing a great job whittling the excessive and redundant text down to something comprehensive. I think once that painful job is done, we can start looking at the "complete article" and assess its shortfalls as far as content and readability to a wide audience go. I think it would be great to have your expertise for this process if you are interested in helping out. As for the words you point out, yes, I agree "immunocompetent" is not a word in common use but we should probably introduce it somewhere in the article so readers begin to understand the terminology since it is used a lot around these disease articles on wikipedia. It is, at least, linked in the lead for the time being. Colloquially, however, I do not have a problem with, and have been using this word myself since I was a young teen - and believe me, I'm no English major :o). I think, since "commonly" is used in the following sentence, the word "colloquially" allows a little variation and makes the article read a little more interestingly, don't you think? The last comment you made, I'm uncertain how to answer - are you referring to the anonymous addition (and deletion) of "HSV" infection that occurred here?. Yeah, I can understand how the seroprevalence of HSV infection is confusing. I did begin to introduce that into the epidemiology section - but again, it is not great and needs some other eyes. The HSV seroprevalence/blood test data, I think gets confused by people working in non-herpes viruses - folks I know working in the field actually base the number of people infected with HSV as the same as people with antibodies against the viruses because HSV is not typically cleared from the body (it just hides) - so the difference we need to define and make clear is HSV antibodies may be the same as infection but is not an indicator of "active" disease. Of course, the 1 in 5 HSV positive people only reflects values in the United States - we need to keep this clear too and not give the article too much North American bias. If you have any suggestions on how to define this clearly, please, please, please add it - your contributions would be most welcome and I need all the help I can get!! Thanks, ~ Ciar ~ _{(Talk to me!)} 18:46, 8 June 2008 (UTC)

Just to take one point -- I know that many people believe that variation makes writing more interesting to read, but I object to it in medical writing, where the most important goal is to be clear to the reader (who may be reading it alone at 2am in confusion and panic). In medicine, the terms are precise, and there's a big difference between "incidence" and "prevalence," for example. I try to be safe and use the same word that my source used, unless I'm very familiar with the subject. I once worked in a law firm, where the clear, precise meaning of the language was also very important (when somebody reads a will 20 years later, for example), and they always repeated the same word for the same concept.

Then there are foreign speakers. A recent article in the New Scientist pointed out that most people who use English are not native speakers. I know lots of native speakers of French and Norweigian who speak excellent English, but there are others who are still learning it or struggle with it. Sure, they know what "colloquially" means, or they can look it up, but the more syllables you have, and the less-common words you have, the more difficult it is to read. This is especially true when the reader has the burden of trying to understand technical information. When you add the burden of a less common vocabulary to that, it becomes much more difficult to understand. There actually is published research on this, but I think it makes intuitive sense too.

The best example of medical writing for the layman that I know of is the Merck Manual Home Edition. If you want to write clearly for the layman, read that and do what they do. That's what I do.

But even medical journals, like BMJ, edit their magazine to use simpler vocabulary. Even if you're a doctor and you know all this jargon, it's just easier to read simpler language. Nbauman (talk) 20:43, 8 June 2008 (UTC)

I have no dog in this fight; as a copyeditor my role is to make the article conform to the manual of style and rules of English. As such I try very hard not to change the tone or meaning of text I edit. I take this rule particularly to heart when dealing with technical articles where the inferred meaning of a word may change the way a reader interprets a researcher’s work.

What I have been doing is adding wikilinks to words that I think are medically specific or not commonly known by the medical layman–a category I fall into myself. My personal opinion is that linking medical terms is probably an acceptable middle ground for an article where technical terms are required.Livitup (talk) 16:21, 11 June 2008 (UTC)

People often say, "If readers find a word they can't understand, they can just click on the Wikilink." I strongly disagree. The link is usually as difficult to understand as the original article. I always use a specific example, which usually convinces people.

For example, suppose someone wanted to understand what Immunocompetence meant in this article. And they have a good reason for a precise understanding -- you're telling them, "Don't worry, it's not fatal if you're immunocompetent." People can get very worried when they read medical information in Wikipedia. (One woman wrote in one of the Talk pages that when she read the article on -- I think -- multiple sclerosis, she cried.)

Click on Immunocompetence and see what you get:

Immunocompetence is the ability of the body to produce a normal immune response (i.e., antibody production and/or cell-mediated immunity) following exposure to an antigen....

If you parse that sentence, it's ultimately saying, "Immunocompetence is a normal immune response," and if you parse it further, you get "Immunocompetence is immunocompetence." That's not much help.

In order to understand that definition, you have to understand the words:

"immune response"

"antibody"

"cell-mediated immunity"

"antigen"

I've talked to cancer patients, social workers, and other non-specialists who are likely to read my medical articles, and I was surprised to find that even intelligent, well-educated people don't know a lot of words that you or I would take for granted. After those conversations, I would never use phrases like that in an article without defining them, because I know they won't understand them.

If you have no special medicine or biology training, I'll put it to you: Define each of those words without looking them up. Can you tell me off the top of your head exactly what "cell-mediated immunity" is?

Wikilinking is no excuse for not writing an article in easy layman's language in the first place. (I do think that we should follow the everyday terms with technical terms in parenthesis, as the Merck Manual does, so people can learn the technical terms.) Nbauman (talk) 18:55, 11 June 2008 (UTC)

Several issues have been confused during the copyedit process. Certain areas of HSV-1 and HSV-2 have been mixed and some of the references are no longer in the right places. I would suggest that the intro is general info on HSV, and later in the body of the article the details HSV-1 and 2 would be provided. I'll try to put in time next week. I also added somewhat to the immunocompetent page. Let me know if it's clearer.pikipiki (talk) 14:57, 13 June 2008 (UTC)

Please don't take offense, but no, I don't think it's clearer.

Let's start again. What's the most important thing people should know about herpes simplex? How would you say it in the simplest possible sentence? (I think that sentence should have the word "blister" in it.) Nbauman (talk) 18:01, 13 June 2008 (UTC)

I was keenly aware of the risk of mucking the article up during the copyedit process. I have no medical training, and I'm afraid that is showing here. The most I knew about herpes before this is that I don't want to get it. :)

So.... If I'm breaking things, from a factual standpoint, please let me know. What I was trying to do was focus on one particular topic at a time and limit the discussion of a particular topic to the section that addresses that topic. I fear that's where I may have introduced inaccuracies in the text. The article jumped around quite a bit before I started mucking with it, especially in the Disorders section; there was discussion of treatment and epidemiology of each disorder within the section for the disorder itself. But when I get to the epidemiology section I don't know what I am going to do, because a lot of that discusses the rates of infections for specific disorders. ARGH!

Another current problem is that we use "HSV-1" and "HSV-2" for the first time in Disorders, but they are never defined before that; there is no section that talks about the virus itself. I think I'll add a sentence or two with a link back to Herpes Simplex to do the heavy lifting for the virus.

This is harder work thank I expected. :) Oh, and if you want to start swapping out medical terminology for language a layman would understand, I won't object. Part of me says that, as an encyclopedia, we can write to a more technical level than we would a newspaper article, but I also see your points, Nbauman. Livitup (talk) 19:04, 16 June 2008 (UTC)

I was always taught that a medical writer or editor had to thorougly understand every word of the copy that he was editing. If you don't understand it you have to find out, by starting with the Merck Manual, if necessary, and reading the original papers until you understand it. We used medical dictionaries very heavily.

Some publishers do use editors who may not know the technical material, but can read it with a non-specialist's eye and tell us whether it's easy for a non-specialist to understand. Those editors make a lot of queries, and by the time they get through with the article, they should understand it as thoroughly as everyone else.

But you can't edit something you don't understand. I can't imagine how you could do it. Nbauman (talk) 22:08, 16 June 2008 (UTC)

Grammar and style are the same whether you are writing about apples or oranges. I'm not saying I don't understand, but I'm not in the medical community, so my level of knowlege is probably just a bit north of the lay-person. That said, I was able to figure out what immunocompenent meant. :) I research where I need to, I ask questions of the authors when needed, and if I doubt myself, I don't make the change. Sure, medical publishers can employ copy editors with medical backgrounds, but for the rest of the non-specialist world, non-experts will have to do. I did OK when I was a features copyeditor, without being a specialist in the civil war, local politics, ballet, opera, or any of the other hundreds of topics that crossed my desk. 194.78.35.170 (talk) 16:16, 17 June 2008 (UTC)

Sorry, I forgot to log in before posting that. :) Livitup (talk) 16:18, 17 June 2008 (UTC)

There's one big difference between medical editing and everything else -- medical editing can be much more important to the reader's life. Someone wrote in Talk that, when she read the article for (I think) multiple sclerosis, she cried, because the life expectancy was so short. Medical writing has to be much more accurate. The stakes are higher. If I get my facts wrong, I can really hurt somebody. Nbauman (talk) 17:50, 17 June 2008 (UTC)

Virus active in saliva?

I didn't see any info on this in the article, but is the HSV-1 active in your saliva at the time of an outbreak or any other time? Most cold sores occur on or around the lips which would be close enough to your mouth to assume your saliva is infected, but if you have a cold sore under or in your nose, or on your cheek, would the virus be present in your saliva as well? Related, during asymptomatic shedding, would it also be present and active in your saliva? If it was in your saliva, then technically you would be able to spread it by coughing or sneezing on someone close enough to inhale the small particles. Is there any research on this anywhere? —Preceding unsigned comment added by 209.66.100.204 (talk) 16:45, 2 June 2008 (UTC)

Yes, HSV-1 is typically spread in childhood and adolescence in undeveloped countries and lower SE circles through non sexual transmission, whereas HSV-2 is almost always associated with sexual transmission. You can search pubmed.gov using the search terms "HSV" or "herpes," "shedding," and "saliva,". One does not need lesions to shed and because 60%-98% of infection is asymptomatic, virus is often shed from the oral cavity (but not from the parotid gland) without any detectable signs and it is subject to certain triggers such as sunlight, stress, and trauma.pikipiki (talk) 14:45, 13 June 2008 (UTC)

Edit of 19 June 2008

"Lexicon" -- do you mean "vocabulary"? Yes, your vocabulary is too technical.

Why say "lesion" instead of "sore"? Why say "alleviate" symptoms instead of "reduce" symptoms? Why say "symptomatic episodes" instead of "symptoms"?

Before you do any more, stop and read the Elements of Style.

A later edition of The Elements of Style had a nice section that told you to use simple, familiar words instead of latinate words, but that edition is still under copyright and not free on the Internet. It's good advice anyway.

Section 9, "Make the paragraph the unit of composition: one paragraph to each topic," would be particularly helpful. Nbauman (talk) 15:32, 19 June 2008 (UTC)

Gosh, I have to agree with Nbauman, the lead was much better before. I'm sorry to say that Pikipiki - I know you meant well. The whole point of having the article copyedited was to reduce the unnecessary detail and jargon, especially from the lead section, which was way too long before the copyedit began, and I think Livitup had done a pretty good job. Other than the inclusion of the two different HSV viruses, do we really need to put all that extra information back into the lead? Detail is supposed to go into the main body of the article, no? ~ Ciar ~ _{(Talk to me!)} 16:04, 19 June 2008 (UTC)

I wasn't going to say it myself, but I agree for the most part.

Otherwise, my status update for today is:

• Disorders—All done, except Neonatal. There were some major changes to that section reciently, and I want to see if you decide to keep them before I edit that section. I had an off-line edit of that section done, using the old version, which I can use to edit it again. Let me know when consensus is reached on that, or if I should just tackle what's there now.
• Recurrences and triggers—Done
• Transmission and prevention—I've done an initial copy edit of this. As part of it, I merged the Asymptomatic Shedding section into this section. I need to go through it again on paper and do a second pass. I think some things don't align perfectly in this section yet.
• I have copyedits done on paper for Diagnosis, Treatment, and Psychological and social effects. I'll upload those Monday.
• I haven't touched Epidemiology yet. :)

A comment on the comments of Nbauman: I tend to agree with you that the entire article could be made to read more simply. I'm reluctant to do that all by myself, as I'm afraid I could change the meaning of something by substituting a "common" word for a technical/medical word. Is a sore the exact same thing as a lesion? I propose to continue on my current path, finish this current copy edit, and then revisit the issue as a whole when the prose is otherwise stable.

Feedback is always welcome. Livitup (talk) 21:05, 20 June 2008 (UTC)

Now you're getting it. Is a "sore" the same thing as a "lesion"? That's exactly the kind of question that continually comes up when anyone tries to edit medical text, and that's why medical editing is so difficult.

The meaning of "lesion" actually depends on the context. I just did a quick text search through the NEJM, and "lesion" is used to refer to lung cancers, multiple sclerosis spots, skin ulcers, areas of abnormal bone thickness, areas of abnormal bone thinness, areas of damage to a chromosome, things that appear on an x-ray that they can't identify, and almost any injury or damage to a specific area.

It's a lot easier to edit these things if you can query the doctor who wrote it, or if you have a doctor or editor nearby that you can ask.

Otherwise, you have to understand the material very well. The best way I've found to understand it is to start with the Merck Manual (which is free online), and read a few review articles, preferably in the New England Journal of Medicine (which is not free). With PubMed, you can find review articles that are free online, although some are easier to understand than others. Some of the easy journals to understand are American Family Physician and the Canadian Medical Association Journal. Articles in JAMA are free after 1 year. Medscape is free and sometimes has good review articles but it's not always that easy for laymen to get through. Same for eMedicine.

Actually, there really is a need on Wikipedia for people who don't understand medicine that well to read medical entries and tell us which articles are too difficult for a layman to understand. That's a big problem. We need people to mediate disputes between editors who want to simplify it and editors who want to make it more technical (or as they would say, "precise"). Nbauman (talk) 06:31, 21 June 2008 (UTC)

June 24...

In the diagnosis section there is the sentence:

"Primary orofacial herpes is readily identified by clinical examination in persons without a previous history of lesions, and with reported contact with an individual with known HSV-1 infection."

Question for the medical team: does the person need to fit both of these conditions (no previous history and reported contact) or either of these conditions (no previous history or reported contact)?

Thanks! Livitup (talk) 18:30, 24 June 2008 (UTC)

It means both in this context. GrahamColm^Talk 18:40, 24 June 2008 (UTC)

OK thanks! Livitup (talk) 18:44, 24 June 2008 (UTC)

• (re)Edited the lead.
• Can someone take a look at this sentence:

"A Tzanck test (smear) can also be performed, although this cannot differentiate between herpes simplex and varicella (chicken pox) (the primary infection of varicella zoster virus (VZV or shingles)."

For one thing you're missing a closing bracket. For a second thing, the latter part of that sentence is awash with brackets anyway. How much of that can be cut out if a Wikilink is added? This is an article about Herpes, not varicella/chicken pox/varicella zoster virus/VZV/shingles. Livitup (talk) 18:44, 24 June 2008 (UTC)

I recommend deleting the whole sentence, (and any reference), this test is not widely used and it does not confirm HSV infection. GrahamColm^Talk 19:38, 24 June 2008 (UTC)

• Treatment contains the following senetnce about Abreva:

"It was the subject of a US nationwide class-action suit in March, 2007 due to the misleading claim that it cut recovery times in half."

I don't know about this—I work in the UK. GrahamColm^Talk 19:38, 24 June 2008 (UTC)

Was the drug's manufacturer (Avanir Pharmaceuticals) the defendant? I can look that up myself if nobody else responds before the next time I look at the article. I would like to reword that sentence, but I'm missing something. Otherwise Diagnosis and Treatment are both done. Livitup (talk) 19:25, 24 June 2008 (UTC)

As of June 30...

I have done what I consider my final pass through this article. I have uploaded all my work up to Transmission and prevention. I have on-paper edits for the rest of the article, which I will try to upload tomorrow. Livitup (talk) 19:05, 30 June 2008 (UTC)

Copyedit Complete

Well, it took more than "tomorrow", but I finally uploaded all my changes to the article, and I consider it about as completely copyedited as I can make it.

My parting suggestion would be to strip some sections of the article out into thier own articles. I'm thinking mainly of the Epidemiology sections—they could become one article Epidemiology of Herpes Simplex. If you want any help writing a summary to include in the main artilce, I'd be happy to work on it; just ping me on my talk page.

It's been fun and educational. Sorry it took so long in the end, and I hope you're happy with my contributions. Best of luck and happy editing. (Oh, and please let me know if the article makes it to FA.) Livitup (talk) 19:45, 8 July 2008 (UTC)

Thank you so much!! It is definitely an improvement - now we can see the stuff that needs to be fixed and referenced. I agree that sub-articles are needed. The neonatal section is getting huge and can probably stand alone. Maybe if I ever get any free time I might tackle it :) Good luck with the your next copy-editing job....I'm sure it will be a breeze compared to this one huh!!!! ~ Ciar ~ _{(Talk to me!)} 17:15, 9 July 2008 (UTC)

Epidemiology: North America: United States

The first two paragraphs of this section are very confusing with the use of the term "seronegative." For example, the sentence "Women that are seropositive for only one type of HSV are only half as likely to transmit HSV as the seronegative mother" seems nonsensical unless it is clarified that this seronegative person is indeed infected with the virus. Perhaps "infected, but still seronegative" or "infected, but not yet seroconverted" or something along that line would clarify. As it is, it appears to say that a seronegative mother (implying uninfected, without clarification) is more likely to transmit a virus that she does not have than someone who has the virus.

Dr.Luke.sc (talk) 16:03, 12 August 2008 (UTC)

Hi Dr.Luke.sc, Thanks for pointing out the issues that need fixing - this article is not quite done and still needs improvement, so your comments are much appreciated. I have reworded the paragraph a little to (hopefully) make more sense out of it. Feel free to reword if your language skills are better than mine :)

Best wishes, ~ Ciar ~ _{(Talk to me!)} 17:11, 12 August 2008 (UTC)

Hello ~ Ciar ~ Thanks. It is much better now. Yesterday, I made a minor change in the next paragraph and combined the two, as the latter appeared to be a concluding disclosure of the former. Another thought: does that much discussion of immunological mechanics actually belong there, or should

A seronegative mother that contracts HSV at this time has up to a 57% chance of conveying the infection to her baby during childbirth, since insufficient time will have occurred for the generation of protective antibodies before the birth of the child, whereas a woman seropositive for both HSV-1 and HSV-2 has around a 1-3% chance of transmitting infection to her infant.[70] Women that are seropositive for only one type of HSV are only half as likely to transmit HSV as infected seronegative mothers.

be a part of Transmission and prevention? Please have a look at what I just changed and see what you think.

Best regards, Dr.Luke.sc (talk) 15:19, 13 August 2008 (UTC)

Is this wrong?

From the section on neonatal herpes: "The resulting increase in the number of young women becoming sexually active while HSV-1 seronegative has contributed to increased HSV-1 genital herpes rates..." ...I was under the impression that they were getting the virus from someone and they're not all lesbians. Shouldn't it be young people/adolescents? I'm completely ignorant about biostatistics, it just struck me as possibly unintentionally POV. 70.181.43.249 (talk) 15:55, 3 October 2008 (UTC)

This article should mention that an estimated 17% of people in the northeastern United States got herpes from Misty McCullough.