DEAR DR. DONOHUE: I have a good friend who was diagnosed with lipoprotein(a) after a heart attack. Can you please enlighten us on this? Are there any new treatments for it? – S.M.

ANSWER: In the beginning – and the beginning was not all that long ago – there was only cholesterol. Cholesterol begot LDL cholesterol (the bad kind) and HDL cholesterol (the good kind). Now a new generation of cholesterol has appeared – lipoprotein(a), or Lp(a).

Cholesterol and fat cannot mix with blood. They have to be coated with protein to be transported in it. That’s what lipoproteins are – a combination of fat or cholesterol with a protein coat.

Lp(a) is somewhat similar to LDL cholesterol, the bad cholesterol. It has an additional nasty attribute: It encourages clot formation within arteries. Everyone has some Lp(a), but high levels are a risk for having a heart attack. Although that is true, Lp(a) is a weaker threat for a heart attack than is high total cholesterol or high LDL cholesterol.

Frankly, there are not good directions about what to do for a high Lp(a) level. The prevention of heart attacks still centers on lowering total cholesterol and LDL cholesterol and raising HDL cholesterol.

A diet with lots of fruits, vegetables and whole grains and with less saturated and trans fat is the diet for combating high Lp(a). Exercise helps control it. Aspirin might. Niacin brings it down for some.

DEAR DR. DONOHUE: I am 60 years old. I have been a widow for 15 years. This past year my gynecologist told me I have herpes and that it is a sexually transmitted disease.

I have not had sex for 10 years. About 12 years ago, I went through a period where I had unprotected sex with several partners. The doctor said that the virus can lie dormant for that long.

Since the doctor first told me I have the infection, I have had two more outbreaks, which he treated with valacyclovir. Now he tells me that I should take that medicine every day for one full year. Does this work? It is very expensive. Is there another, cheaper drug I could use? – Anon.

ANSWER: Let me see if I have the story right. You never had any herpes symptoms like a rash, pain or burning, correct? Did the doctor make the diagnosis from evidence on a Pap smear or from simple visual inspection of what looks like herpes? Both methods carry a significant error factor.

While it is possible to have an outbreak of herpes 10 to 12 years after initial infection, it is unusual not to have had any outbreaks during that long time period. If you had Pap smears during that interval, it is also unusual that previous Pap smears did not disclose the presence of the virus.

I cannot explain why it emerged suddenly at this time or why you are having so many outbreaks. Most recurrences occur in the early years of infection.

Ask for a more accurate herpes test. Ask for a viral culture at the next outbreak. Or ask for a test called the polymerase chain reaction, which can detect viral nucleic acid.

If those tests are positive, then valacyclovir can suppress recurrences. Acyclovir and famciclovir can do the same and might be less expensive.

The booklet on herpes and genital warts presents the story of these two common infections in greater detail. To order a copy, write: 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: Our daughter is on thyroid medicine for hypothyroidism. She is also being treated for depression. She stops taking the depression medicine when she feels better. Is her problem depression, hypothyroidism or both? – C.P.

ANSWER: Although depression can be a sign of a sluggish thyroid gland (hypothyroidism), the thyroid medicine should correct it. Her depression is, therefore, a separate problem. She should not stop the depression medicine until her doctor tells her to.

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 www.rbmamall.com.