THE billionaire developer-cum-reality TV star, and now potential United States presidential candidate, Donald Trump, has led many state and national polls in the race to be the world’s most powerful man. Love him or loathe him, Trump’s anti-establishment rants have resonated, especially in the nation’s most conservative states.

I don’t have strong feelings on Trump’s policies (or lack thereof), but I admire the man. He is bold, daring and audacious. Perhaps, the straight-talking man is really what we need. In one of his many interviews, he said: “I have made tough decisions, always with an eye towards the bottom line. Perhaps it’s time America was run like a business.”

In the Oxford dictionary, “bottom line” is defined as: “the essential or salient point or the primary and most important consideration”. In a financial report, the bottom line is referred as “the financial report that shows the net profit or loss in a financial venture”.

So, what exactly is the bottom line in health? How do we make rational decisions to draw that line? Would there be any differences in the “bottom line” when men are making decisions regarding sexual risks? How do men assess the “bottom line damages” after the deed is done? This week, we address the “bottom line” faced by a reader.

Dear Dr. G,

My name is Cheng, and I facing the peak of my youth and yet confronting the darkest days of my life. I am 26 years old and have a bright career ahead of me helping in a successful family business.

When I was in University abroad, I had two relationships that eventually did not work out. Now, I have returned to Malaysia and met the love of my life. My girlfriend and I have a sexual relationship and in most instances, we do use protection.

I recently started noticing ulceration on the shaft of my penis.

I started getting worried when the ulceration kept appearing on the same spot.

I checked online and found that this may be due to syphilis or genital herpes.

I went to see a dermatologist who told me it might be herpes, but the blood tests for both herpes and syphilis were negative. Thankfully, the HIV test was negative as well.

My problem is, the ulceration has started again and I am devastated. I really need to know for sure what is happening to me.

Don’t get me wrong. I am not the type who pays for sex. I have just had two sexual relationships with University fellow students in the past. I am sure the risk is absolutely minimal, right? How did I contract herpes? How do I find out with certainty if I have herpes? Do I really have herpes?

I am a businessman; I need to know the “bottom line”. I need to work out for myself what would be the worst case scenario?

Please help.


Genital Herpes is a common sexually transmitted infection that affects both men and women. The Herpes Simplex Virus (HSV) causes genital herpes and it spread primarily through sexual contact. HSV-1 usually causes cold sores, but it can spread to the genitalia through oral sex. HSV-2, is the common pathogen for genital herpes, it is highly contagious and can transmit with or without open sores with skin contact.

After the initial infection, some sufferers have no knowledge of the contagion, as the virus may stay dormant in the body for a long time. Therefore, the exact source of transmission may not always be identifiable. When it does appear, the symptoms are typically pain and itchiness (at least ten days after the exposure) that may be accompanied with blisters. The sores may turn into ulcers that ooze or bleed as a result of a secondary bacterial infection.

Genital eruptions commonly appear on the site infected. For men, the blisters can appear on the penis, buttocks, thigh, scrotum, anus and mouth. For women, the sores are not always visible, but can develop in the vagina, external genitalia and cervix.

Genital herpes manifestation and recurrences are different in different individuals. Younger sufferers may have several outbreaks in a year. For many other people, eruptions are less frequent.

There are many genital lesions that look like herpes. these include syphilis or psoriasis. Blood tests can be carried out to establish the presence or antibodies fighting the past infections. State of the art investigation analyses the samples from the tissue or sores using the PCR technique to determine the presence of the virus.

There is no cure for genital herpes. Anti-viral therapy essentially helps to control symptoms during the eruption, reducing recurrences and minimising the risk of transmission.

The “bottom line” is genital herpes is a sexually transmitted infection. It is also common and non-life threatening. The infection rarely affects other organs such as the urethra or rectum.

The worst-case scenario is the transmission of the virus to new partners or even newborns during the birthing process. However, both transmissions can be prevented by the use of protection and a Caesarean delivery.

The contracting of genital herpes will induce a roller coaster of emotions. These include embarrassment, shame, anger, suspicion and resentment of partners. The reality is Genital Herpes not curable and the identification of the source of infection is rarely possible and mostly unhelpful. Healthy ways to cope with living with the disease are only possible when open and honest communication with partners is established.

Bruce Feiler, the television personality and New York Times columnist, once said: “The Bottom Line: If you want a happier family, bring those skeletons out of the closet”.
So, Dr. G’s Advice is: “Come clean and move on!”

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