{"id":2283,"date":"2012-01-04T17:55:58","date_gmt":"2012-01-04T22:55:58","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=2283"},"modified":"2015-06-04T15:15:13","modified_gmt":"2015-06-04T19:15:13","slug":"herpes-treatment-peds","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/herpes-treatment-peds\/2012\/01\/04\/","title":{"rendered":"How Does Herpes Treatment Trigger a Positive Test for Performance-Enhancing Drugs?"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2012\/01\/9884318_blog1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-2299\" title=\"baseball\" alt=\"\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2012\/01\/9884318_blog1.jpg\" width=\"240\" height=\"160\" \/><\/a>Here&#8217;s my guess on how many of this blog&#8217;s readers know the following &#8220;facts&#8221;:<\/p>\n<ul>\n<li>Acyclovir and related drugs are used to treat herpes: nearly <strong>100%<\/strong><\/li>\n<li><a href=\"http:\/\/www.baseball-reference.com\/players\/b\/braunry02.shtml\" target=\"_blank\">Ryan Braun<\/a>, superstar left fielder for the Milwaukee Brewers, is facing a 50 game suspension for testing positive for elevated levels of a &#8220;banned substance&#8221;, most likely testosterone: <strong>10%<\/strong><\/li>\n<li>Braun has disputed the results, stating that it&#8217;s a false-positive caused by treatment he&#8217;s receiving for a &#8220;<a href=\"http:\/\/mlb.mlb.com\/news\/article.jsp?ymd=20111219&amp;content_id=26195328&amp;vkey=news_mlb&amp;c_id=mlb\" target=\"_blank\">private medical issue&#8221;<\/a>: <strong>1%<\/strong><\/li>\n<li>That medical issue is widely <a href=\"http:\/\/www.tmz.com\/2011\/12\/30\/ryan-braun-steroid-allegations-ped-talks\/#.TwMH4jU7VBl\" target=\"_blank\">rumored to be herpes<\/a>: <strong>0.01%<\/strong><\/li>\n<\/ul>\n<p>Now I should mention that I am a huge Ryan Braun fan, not only because of his stellar play, and his nickname (&#8220;The Hebrew Hammer&#8221;, one Braun shares with <a href=\"http:\/\/en.wikipedia.org\/wiki\/Hank_Greenberg\" target=\"_blank\">Hammerin&#8217; Hank Greenberg<\/a>), but also because he bears an uncanny <a href=\"http:\/\/www.topnews.in\/ryan-braun-grammy-nominations-concert-live-2107670\" target=\"_blank\">resemblance<\/a> to <a href=\"http:\/\/www.exposay.com\/matt-sax-54th-annual-drama-desk-awards---arrivals\/p\/30622\/1\/?f=Matt+Sax\" target=\"_blank\">my nephew<\/a>.<\/p>\n<p>But it&#8217;s that last bullet point I can&#8217;t quite figure out &#8212; treatment of herpes is incredibly safe. How in the world would it lead to an elevated level of testosterone?<\/p>\n<p>Turns out, it doesn&#8217;t.<\/p>\n<p>But a quick search of &#8220;acyclovir&#8221; and &#8220;testosterone&#8221;, plus a perusal of an actual book &#8212; the irreplacable <a href=\"http:\/\/www.amazon.com\/Kucers-Use-Antibiotics-Two-Set\/dp\/0340927674\/ref=sr_1_2?s=books&amp;ie=UTF8&amp;qid=1325601748&amp;sr=1-2\" target=\"_blank\"><em>The Use of Antibiotics<\/em> <\/a>&#8212; finds that there are some obscure\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18303185\" target=\"_blank\">animal studies<\/a> suggesting that anti-herpes drugs could do the reverse, i.e., <em>lower<\/em> testosterone levels.<\/p>\n<p>From the book:<\/p>\n<blockquote><p>Dose-related testicular atrophy and abnormalities of spermatogenesis were noted in mice, rats and dogs treated on repeated occasions with either famciclovir or penciclovir &#8230;<\/p><\/blockquote>\n<p>All of which leads me to the very speculative conclusion that <em>some <\/em>doctors could be providing testosterone supplementation to their patients receiving anti-herpes therapy.<\/p>\n<p>Which is, frankly, a completely bogus indication, way more &#8220;out there&#8221; as a practice than the typical <a href=\"https:\/\/www.google.com\/search?ix=hca&amp;sourceid=chrome&amp;ie=UTF-8&amp;q=define+off-label+use#hl=en&amp;q=off+label+use&amp;tbs=dfn:1&amp;tbo=u&amp;sa=X&amp;ei=UhEDT-G1Eefd0QHVvoGyDw&amp;ved=0CCEQkQ4&amp;bav=on.2,or.r_gc.r_pw.r_cp.,cf.osb&amp;fp=a1bc1589ec616832&amp;biw=1268&amp;bih=783\" target=\"_blank\">off-label use<\/a> of approved medications.<\/p>\n<p>But that&#8217;s the only way I can connect the dots here.<\/p>\n<p>In other words, s<em>omething&#8217;s <\/em>not right &#8212; the test result, the diagnosis, the prescribing practice &#8212; we just don&#8217;t know what that is yet.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Here&#8217;s my guess on how many of this blog&#8217;s readers know the following &#8220;facts&#8221;: Acyclovir and related drugs are used to treat herpes: nearly 100% Ryan Braun, superstar left fielder for the Milwaukee Brewers, is facing a 50 game suspension for testing positive for elevated levels of a &#8220;banned substance&#8221;, most likely testosterone: 10% Braun [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,8],"tags":[37,102,346,418,822,969],"class_list":["post-2283","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-patient-care","tag-acyclovir","tag-baseball","tag-famciclovir","tag-herpes","tag-ryan-braun","tag-valacyclovir"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2283","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=2283"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2283\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=2283"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=2283"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=2283"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}