Dear doctor

Scared to start a family

Q After recent work-related stress, my husband developed a rash on the shaft of his penis, along with neuralgia and tingling in the penis and soreness in the scrotum. One doctor said it was thrush but a second said the symptoms pointed to genital herpes. I have had cold sores round my mouth but we have been careful to avoid oral sex when I had the sores. We had hoped to start a family this year but are now afraid to. Please advise us what to do next.

A It may have been genital herpes, which causes tiny blisters, often heralded by burning of the skin, swollen glands and feeling unwell. Persistent pain after they have healed is unusual and your husband may like to try lignocaine gel. If it was herpes, it may have been your husband's first attack, or a recurrence triggered by stress. He may have caught herpes during oral sex even if you didn't have a cold sore at the time because the virus can persist even if no blisters are apparent.

If you have never had genital herpes, you can have a blood test to check that you have antibodies to both types of the virus. It can be dangerous for a baby to be delivered vaginally if you are having a first attack of herpes, but if you have antibodies in your bloodstream already, it means you won't have a first attack when you give birth. You need to ask your GP to refer you to a specialist genito-urinary or sexually transmitted diseases clinic. After a few basic tests, you should be reassured and ready to try for that pregnancy.

For more info, call the Herpes Virus Association on 020-7609 9061.

I want my immunity back

Q I have myeloma, cancer of the blood cells, which has been successfully treated with chemotherapy and an autologous stem cell transplant from my own bone marrow. My blood counts have largely recovered but I am rarely without a heavy respiratory infection. Oral antibiotics are a help but I feel my immune system has been devastated and wonder what I can do to help it recover.

A Professor Grant Prentice, haematologist at the Royal Free Hospital, says that myeloma affects your immune system because it attacks plasma cells in the bone marrow. Myeloma causes bone pain, anaemia and kidney damage. Chemotherapy, radiotherapy and autologous marrow transplants aim to halt the progress of the disease. Allogenic transplants from a donor can offer a cure. After a transplant such as yours, immunity may be further impaired for up to a year. However, after that, if your disease is in remission, you should bounce back. Meanwhile, don't smoke, eat a balanced diet and exercise. Professor Prentice does not advise extra supplements or a special diet. If you develop a serious viral illness like shingles, you may be knocked for six so seek urgent expert help.

Three jabs or one?

Q We have a daughter who has just turned one. With that date came an invitation for the MMR jab. We have heard that the vaccines are available in their constituent parts and would be happier to pursue this option. Could you tell me whether these vaccines are available individually?

A I don't think giving three separate jabs instead of one is kind to your child, or scientifically valid. The proposed link between autism and MMR hasn't been supported by other studies. Worries about measles and Crohn's disease have been largely disproved. Moreover, there is no evidence to suggest that giving the three components (measles, mumps, rubella) separately makes them safer. You can get the rubella jab in this country but the mumps jab on its own is less effective than the strain in MMR, and the measles is not available at all. I think the jabs should be offered separately to those that want it; but I would choose the single MMR.

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