DEAR DR. DONOHUE: I need some information on herpes. I can’t find much about it. Please answer my questions. 1. Is sex the only way to get it? 2. Do you have to be broken out when you are tested? 3. Do you have to be tested in the first couple of days of the infection? 4. Can a doctor tell you if you have herpes by just looking at it? 5. What does it look like? 6. How often do you break out if you have it? – K.B.

1. Sexual transmission is the most common way to acquire herpes infection. Around 50 million Americans are infected with it, and another one-half to 1 million get it yearly. The genital infection is usually caused by the herpes-2 virus. The herpes-1 virus causes cold sores. The herpes-1 virus can cause a genital infection through oral sex. And, in rare instances, a person could transfer the herpes-1 virus from his or her cold sore to the genital area by touching the cold sore and then touching the genitals.

2. and 3. The most reliable test for herpes infection is a viral culture. That entails swabbing the rash with an applicator and sending the applicator to a lab for viral growth. The best results are obtained when the rash is fresh – in the first few days of infection. There are, however, other herpes tests – a blood test and a test for the virus’s nucleic acid.

4. A doctor can pretty well recognize a herpes rash, but a visual inspection is not absolute proof of infection.

5. The rash is a patch or patches of painful, tiny blisters whose roofs eventually break to form a sore that heals on its own.

6. After the first breakout, a person can have one to five subsequent breakouts a year. Some have none; a few have more.

The herpes booklet describes this infection as well as genital wart infections. Readers can obtain a copy by writing to: Dr. Donohue – No. 1202, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am going to be 84 in two months. My health is very good. I still play competitive softball year-round. I am asking your help with a problem my doctors cannot solve.

My voice is very crackly and sounds terrible. I had a small polyp on my vocal cords, but it went away. I hope you can help. – N.R.

I could list all the causes for voice changes, but I don’t think I’d be doing you much of a favor. I can do you a favor by suggesting that you see an ear, nose and throat doctor or see a second ear, nose and throat doctor if you’ve already seen one. Voice changes that last beyond two weeks demand a thorough search for a cause. Cancer of the larynx (voicebox) is a possibility.

I will mention one cause that sometimes eludes a diagnosis. It’s spasmodic dysphonia. The vocal-cord muscles behave inappropriately and slam shut to produce a weak, whispery, breathy voice. Botox injections can sometimes relieve this condition. It is diagnosed by watching with a scope how the vocal cords work. Ear, nose and throat doctors are the ones best equipped to do such an exam.

DEAR DR. DONOHUE: Ferritin: what is it, what is its normal range, and how important is it in the body? My reading was 5. – J.W.

Ferritin is a protein that serves as a storage bin for iron. Normal values differ in different labs, but commonly employed ones are 12 to 300 ng/ml for men and 10 to 150 for women.

Causes for a low ferritin include blood loss, iron deficiency and pregnancy.

Have you had other lab tests, like a blood count? Anemia follows on the heels of a low ferritin count.

DEAR DR. DONOHUE: I have been a massage therapist for 11 years. I have read your column for that long and am always amazed and a little annoyed that you rarely suggest massage for pain relief. Analgesics and soaks in a hot tub are not the only answer for muscle pain. With a little more emphasis on alternative modalities, our health would improve and our medical costs would not be so great. – M.D.

I’m not against you; I’m for you. I have had massages for aches and pains, and they have worked well for me. I’m a believer.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from