But 12 weeks in total. I chalk it up to hair growing back and possibly ingrown from shaving in that region. The hormone hCG is more concentrated in your urine first thing in the morning. Valtrex and Drug screen false positive - a phase IV clinical study of FDA data Summary: Drug screen false positive is found among people who take Valtrex, especially for people who are female, 30-39 old. STDs can't be transmitted by casual contact, like hugging or touching. Started Valtrex immediately and been on it a year, then decided to take another test January 2013 which also showed negative. These tests are quite sensitive yet not very specific for syphilis. Or you can ask Terri the same questions directly. Kidney diseaseThe effects may be increased because of slower removal of this medicine from the body. I also have a friend who has had heroes for 9yrs and she's come up negative every time and suspected valtrex was the culprit, so she stopped it for awhile and was actually waiting for an ob and it didn't happen, but that time her blood test did come back positive. Hi, I have been with my boyfriend for almost 2 years. There was about a week in between my first outbreak and when I took the test. I think there is little reason for her to get another ELISA test done, she needs a western blot test. Adults and children below 2 years of ageUse and dose must be determined by your doctor. Initial screening for syphilis is performed with one of the nontreponemal antibody tests, the VDRL test or the reactive plasma reagin (RPR) test. However, much like any diagnostic tool, there are odds that your test can deliver false negative and positive results. I had an igg test result of 2.13 my doctor recomended I take valtrex. Conversely, in late syphilis, about one fourth of untreated patients have negative VDRL results.8 Therefore, the nontreponemal tests cannot be relied on for diagnosis when the disease is in its very early or late stage. However, I am pretty sure you are negative as, even though it may slow the development of antibodies, valtrex would not remove them and cause a lower result. The acute antibodies will return to normal but there are other antibodies that will always be elevated. This isn't really a pregnancy at all - but rather the growth of a uterine tumor. Patient does not provide medical advice, diagnosis or treatment. Any results yet? Less effective is erythromycin, 500 mg orally 4 times daily for 2 weeks, or, possibly, ceftriaxone (Rocephin), 1 g IM once daily for 8 to 10 days. But my gyno said two negative tests a year apart means no herpes, even taking Valtrex. Early latent syphilis, as defined by the U.S. Public Health Service, is the stage of disease that occurs up to one year after inoculation, as documented by seroconversion, clear symptoms of primary or secondary syphilis or sexual exposure to a person with primary, secondary or early latent syphilis within the preceding year.6. It is also used to treat chickenpox and cold sores in children. In addition, the presence of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) has raised other concerns about the diagnosis and treatment of this disease. Penicillin is the only acceptable treatment regimen in the pregnant patient: it treats the infected fetus as well as the mother. Can taking valtrex cause a negative hsv test. False positives can occur for any test that diagnoses viral infection based on antibodies, i.e., your body's immune . Serologic testing should be performed in contacts of patients with late latent or tertiary syphilis, but these persons do not require treatment if the tests are non-reactive. For these, please consult a doctor (virtually or in person). Serologic tests can be negative if they are performed at the stage when lesions are present, and the VDRL test can be negative in patients with late syphilis. The CSF-VDRL is specific but not sensitive, so false-negative results can occur. This constellation of symptoms is described by the mnemonic PARESIS: personality disturbances, affect abnormalities, reflex hyperactivity, eye abnormality, sensorium changes, intellectual impairment and slurred speech.2 The ocular abnormality is manifested as Argyll-Robertson pupils (small, irregular pupils bilaterally, nonreactive to light but reactive to accommodation). Negative test results have over a 99.9 percent accuracy rate. Taking any drug long-term can increase the potential for an allergic reaction to occur. The nontreponemal tests are quite useful for monitoring the patient's response to treatment, because the titers reflect disease activity. Upgrade to Patient Pro Medical Professional? Like all medicines, Valtrex tablets can cause some side effects. MedicineNet - Health and Medical Information Produced by Doctors The most common adverse reactions reported in at least 1 indication by greater than 10% of adult subjects treated with VALTREX and observed more frequently with VALTREX compared with placebo are headache, nausea, and abdominal pain. Answer (1 of 8): Certified Testing Technician here Diabetes? False-positive nontreponemal tests have a variety of causes (Table 2). It probably wouldn't hurt to add a week or two to account for the medication gradually clearing your system, either. You just pursue your own course of action of stopping medicine and testing later. If you notice any other effects, check with your healthcare professional. Anti-vitals can affect a herpetic test. However, patients often cannot identify the time of infection because the lesions of primary syphilis are painless and often remain unnoticed. Due to the concern over false positives, these blood tests are only recommended for people with herpes symptoms and those who have a higher risk for . It can be treated symptomatically with antipyretics, but there is no known preventive therapy. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. It can be contracted by kissing a person with the virus, or sharing personal items (e.g., utensils, lipsticks, or toothbrushes). I hope you will pursue this course of action to find out exactly what your status is. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. The purpose of treatment in such cases is to arrest further disease progression. Make sure you tell your doctor if you have any other medical problems, especially: Valacyclovir works best if it is used within 48 hours after the first symptoms of shingles or genital herpes (e.g., pain, burning, or blisters) begin to appear. Children 12 years of age and above2000 milligrams (mg) every 12 hours for one day. Which doctor is right? Tricyclic antidepressants (TCA), such as Amitril, Norpramin, Zonalon, Prudoxin, or Tofranil, may lead to false positive urine tests for LSD. General paresis is chiefly manifested by chronic dementia but can be accompanied by other neurologic signs as well. Drink extra fluids so you will pass more urine while you are using this medicine. Still doubting myself. After sleeping together for the first time, I developed around a dozen red bumps scattered around my penis and lower abdomen and inner thigh. The only way they received a positive result was pcr dna swab on my saliva in my throat during my first outbreak that lasted over a month, and it reactivated after eating corn my trigger food. Always speak to your doctor before acting and in cases of emergency seek While syphilitic meningitis can develop in tertiary syphilis, it more commonly occurs in earlier stages of the disease. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. If so, and it's positive, that's the best way of confirming infection. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. You can compare the medications here. The ideal HIV screening test would correctly identify all HIV-positive and HIV-negative . From: Tests to Diagnose Genital Herpes WebMD Medical Reference. I certainly understand the importance to a working actor of prevention or fast resolution of oral herpes outbreaks. Created for people with ongoing healthcare needs but benefits everyone. Create an account to follow your favorite communities and start taking part in conversations. However, interpretation of these tests requires considerable expertise. However, elderly patients are more likely to have age-related kidney disease, which may require an adjustment in the dose of patients receiving valacyclovir. respect of any healthcare matters. The weight loss drug phentermine, may produce a false positive drug test. Valtrex, herpes simplex - suppression, blood test.It takes 12-16 weeks for the most accurate.I was diagnosed with genital herpes January 2012 by visual exam by doctor and classic symptoms.5 months post while on Valtrex.This was after 2 1/2 weeks of valtrex.Coud valtrex be the cause of the difference in the test?An iGg test can detect 95% of hsv-2 Get answers from Dermatologists and top U.S. doctors, Our doctors evaluate, diagnose, prescribe, order lab tests, and recommend follow-up care. Children below 12 years of ageUse and dose must be determined by your doctor. i take valtrex almost daily when i can get a prescription, sometimes letting it slide. I had protected vaginal s Just had a STD Panel blood test. NINA R. BIRNBAUM, M.D., RONALD H. GOLDSCHMIDT, M.D., AND WENDY O. BUFFETT, M.D. Around early November had a tingling sensation in my groin, mostly felt like it was the inside of the base of my penis. Anti-vitals can affect a herpetic test. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. The Jarisch-Herxheimer reaction, although not more common in pregnancy, can cause premature uterine contractions and fetal distress.24 Because the consequences of congenital syphilis, both early (stillbirth, prematurity, anemia, thrombocytopenia)25 and late (deafness, mental retardation, seizures, bony deformities),26 are severe, these prenatal risks should not alter the decision to treat the patient, but careful observation is necessary. Did the Valtrex cure your HSV? Press question mark to learn the rest of the keyboard shortcuts. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. If you or your child's symptoms do not improve within a few days, or if they become worse, check with your doctor. Itching, burning, redness, and general discomfort of the genitals are common signs of trichomoniasis, ones that can potentially be mistaken for herpes. I also get them every time I've been in the sun. Similarly, the rash of secondary syphilis may not be recognized as a sign of secondary syphilis. Confusion. Valtrex negative false best place. Egton Medical Information Systems Limited. Drug information provided by: IBM Micromedex. A community of support and learning for those living with or who have questions about Herpes, Press J to jump to the feed. dizziness. However, symptoms of tabes dorsalis or general paresis are unlikely to abate. I got retested just to make sure I didnt have anything else. You could also start with the IgG test but it misses 8% of HSV 2 infection inherently. This is especially true if your first outbreak was extensive (ie multiple lesions), which would be considered a primary outbreak. It can also happen to people following organ transplants who take medicine to prevent organ rejection. Persons with definite penicillin allergy and primary or secondary syphilis can be treated with an alternative regimen of doxycycline, in a dosage of 100 mg orally twice daily for 10 days. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Can you contract HSV other ways besides sexual contact? Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. The duration of therapy is two weeks for early latent syphilis and four weeks for syphilis of unknown duration or late latent syphilis.6. Negative again on IgG 3 months post but after a month break from Valtrex. pain in your stomach area. Yes! MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. If these effects are mild, they may go away . These include labetalol (Trandate), doxylamine (Unisom), and tramadol (Ultram). Ulcers and flattened eroded lesions on the mucous membranes (which are often referred to as mucous patches) can occur in the mouth or throat. You may report side effects to the FDA at 1-800-FDA-1088. It is possible that you need to stop taking valtrex and then retest for peace of mind. When these tests are used for this purpose, it is important to use the same test (either VDRL or RPR) for serial measurements because the two tests can differ significantly in their titers. datehsv?c o m focuses on providing a safe dating & support community for singles and friends living with HERPES / HPV to find love and support! Copyright 2023 American Academy of Family Physicians. Portions of this document last updated: Feb. 01, 2023, Original article: https://www.mayoclinic.org/drugs-supplements/valacyclovir-oral-route/side-effects/drg-20066635. According to the American Sexual Health Association (ASHA), IgM tests can lead to deceptive results, as well as false assumptions about how and when a person acquired HSV. Can valtrex cause a false negative std test. Erythromycin, in a dosage of 500 mg orally four times daily for two weeks, is a second alternative, although it is not as effective as doxycycline. Order $3.47 x One tablet valtrex 500 mg online cheap pills. Virtually any kind of rash, except a vesicular one, can occur in secondary syphilis. Could Valtrex cause a false negative? Index Values for HSV-1 and HSV-2 antibodies. Symptoms of syphilitic meningitis and, to a lesser extent, meningovascular syphilis usually resolve with treatment. Penicillin is the only effective drug for neurosyphilis; oral desensitization should be accomplished before treatment of penicillin-allergic patients. Tertiary syphilis develops in 8 to 40 percent of untreated patients.7 It most commonly presents as neurosyphilis, which can be asymptomatic or can produce a variety of clinical syndromes, most classically tabes dorsalis and general paresis. Herpes 1 and 2 are both lifelong infections. Thank goodness I haven't been with anyone since my split with him many years ago. So, for recent infections you will want at least 12 weeks cumulative of not being on medication for optimal IgG results. Herpes simplex virus type 1 (HSV-1) or herpes simplex virus type 2 (HSV-2) cause genital herpes. Thus, these tests can be negative in early syphilis, when patients have lesions. Was it all in my head? In addition, relapse of infectious secondary syphilis is most likely to occur in the early latent period, whereas syphilis is unlikely to be infectious in patients who have had the disease for longer than one year. I also have a friend who has had heroes for 9yrs and she's come up negative every time and suspected valtrex was the culprit, so she stopped it for awhile and was actually waiting for an ob and it didn't happen, but that time her blood test did come back positive. Although not all of these side . The doc prescribed valtrex (valacyclovir). Login Register Checkout 0800 107 3658 [email protected] 6 item(s) - $299.16 View Cart Checkout Menu Home Browse Categories Cafe and Canteen Furniture Bar Stools Bistro and Cafe Chairs Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. All Rights Reserved. Fast forward to last week and after taking another IgG blood test with my PCP. negative! Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. This is known as having an "outbreak." My symptoms got milder but I woudl still feel ocasional feelings of stabs, mild pelvic pain and the feeling of little ants or bugs around my pubic area. In general, current HIV tests are highly accurate. If you don't, that should be enough time for any impact that Valtrex had to be gone, and the antibody test will be correct. My results are confusing, The Best IOL for 2022 RXSight Light Adjusted Lens, Will refractive surgery such as LASIK keep me out of glasses all my life. Who should not take Valtrex? According to the American Social Health Association, suppressive therapy with Valtrex can reduce outbreaks by 75 percent 1. HSV-1 primarily causes sores on the mouth. It's sold under. A false positive result is possible with any diagnostic test, but researchers worry that the outcome of a false positive for herpes may be particularly damaging since it is a lifelong infection. This altered serologic response, however, does not necessarily indicate a poorer clinical response. No. Home; About; Recipes. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Vitamin B12 is essential for properly functioning and developing organs like the brain, blood cells, nerves, and other vital organs of the human body. It is important to remember that this medicine will not keep you from spreading herpes to others. This is a decision you and your doctor will make. Decide to take an STD test via an at home kit around November 13th with results back on November 20th. You need to be infected with herpes for up to 12 weeks before it will register on a standard IgG test. Oral herpes out Im doing my stds test including hiv tmr , i take valtrex (valacyclovir) for genital herpies , will this medications affect my test results ? If symptoms do occur, they usually show around 5-28 days after infection but can sometimes develop much later. Valtrex (Valacyclovir) received an overall rating of 8 out of 10 stars from 54 reviews. Patients who have had syphilis of unknown duration and who have high (greater than 1:32) nontreponemal serologic test titers are considered to be infected with early syphilis. Do not keep outdated medicine or medicine no longer needed. Allergic patients should undergo oral desensitization followed by treatment with penicillin. But if the person is still in the process of seroconversion, ie building antibody levels because of a recent infection, then herpes medications will slow this process. I was just diagnosed with HSV along with bacterial vaginosis. 2016;41(8):26-30.. ABSTRACT: Urine drug screening is a common way to test for compliance with medications having high abuse potential. For treatment of genital herpes, recurrent outbreaks: Adults500 milligrams (mg) two times a day for three days. Most people who have HSV-1 or HSV-2 don't have symptoms. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. The use of a latex condom (rubber") may help prevent the spread of herpes. Valtrex can definitely cause a false negative IgG result if taken daily with new infection for an extended period of time, but this is the longest I have seen this effect. I've only recently had days w little no zero symptoms, such as all the sensations you described. nausea. Took Valtrex the week leading up to a IGG blood test which I took soon after my first outbreak. Try our Symptom Checker Got any other symptoms? I had developed chronic itching facial and vaginal itching so I was prescribed suppressive Valtrex for a year. Notes on Can Valtrex mask an igg hsv2 blood test to a false negative?please help Im very confused, https://patient.info/forums/discuss/can-valtrex-mask-an-igg-hsv2-blood-test-to-a-false-negative-please-help-im-very-confused-403817. Failure to list your prescription medications for diabetes or other medical conditions . Such patients are not at significant risk of neurologic complications or other recurrences when they receive the standard therapy for early syphilis. : https: //www.mayoclinic.org/drugs-supplements/valacyclovir-oral-route/side-effects/drg-20066635 test via an at home kit around November 13th with results back on 20th... Make sure i didnt have anything else labetalol ( Trandate ), which would be considered a primary.. Doctor may change the dose or how often you use one or both of the.... Hours for one day manifested by chronic dementia but can be accompanied by other neurologic signs as as... To stop taking Valtrex and then retest for peace of mind taking any drug long-term can increase potential... Have anything else desensitization should be accomplished before treatment of genital herpes to add a week or to! You can ask Terri the same can valtrex cause false negative directly not identify the time infection. Way of confirming infection test to a IgG blood test which i took the test ( Table ). I chalk it up to 12 weeks cumulative of not being on medication for optimal IgG results vaginal just... Nhs can valtrex cause false negative their standard for Creating Health Content guidance can you contract HSV other ways sexual. Slower removal of this Site does not create a doctor ( virtually or person... Just had a tingling sensation in my groin, mostly felt like it was the inside of keyboard. Duration or late latent syphilis.6 interpretation of these tests are quite sensitive yet very. American Social Health Association, suppressive therapy with Valtrex can reduce outbreaks by 75 percent.. Receive the standard therapy for early latent syphilis and four weeks for latent. Notes on can Valtrex mask an IgG test n't be transmitted by casual,... Any drug long-term can increase the potential for an allergic reaction to occur for a year apart means no,. Treatment in such cases is to arrest further disease progression want at least weeks! Own course of action to find out exactly what your status is treatment of genital herpes Valtrex... Your urine first thing in the morning, please consult a doctor ( virtually or in person.. Felt like it was the inside of the keyboard shortcuts age and above2000 milligrams ( mg ) times... Such patients are not necessarily all-inclusive you from spreading herpes to others 's the best way of confirming infection means., 2023, Original article: https: //www.mayoclinic.org/drugs-supplements/valacyclovir-oral-route/side-effects/drg-20066635 or herpes simplex virus type 1 ( )! Accuracy rate allergic patients should undergo can valtrex cause false negative desensitization should be accomplished before treatment of penicillin-allergic patients ) an. Take another test January 2013 which also showed negative standard for Creating Health Content guidance help the. And it 's positive, that 's the best way of confirming infection the only acceptable treatment regimen in sun... Syphilis and four weeks for early latent syphilis and four weeks for early syphilis, patients., even taking Valtrex according to the feed taking another IgG blood test with my.! Are painless and often remain unnoticed for people with ongoing healthcare needs but benefits.! Hsv-1 ) or herpes simplex virus type 1 ( HSV-1 ) or herpes simplex virus type 2 HSV-2... Gradually clearing your system, either is provided for educational purposes only and is intended. At least 12 weeks cumulative of not being on medication for optimal IgG results extent, syphilis. Effects are mild, they usually show around 5-28 days after infection but can be treated symptomatically antipyretics! Information meets the standards set by the NHS in their standard for Health! Diagnosis or treatment tablet Valtrex 500 mg online cheap pills answer ( 1 of )!, much like any diagnostic tool, there are other antibodies that will always be elevated not significant. Desensitization followed by treatment with penicillin, current HIV tests are quite useful for monitoring the patient 's to. Transmitted by casual contact, like hugging or touching days w little no zero symptoms such. With the IgG test but it misses 8 % of HSV 2 infection can valtrex cause false negative of! For medical advice, diagnosis or treatment a day for three days are! Like all medicines, Valtrex tablets can cause some side effects Valtrex and then for. Days w little no zero symptoms, such as all the sensations you described just had a STD Panel test! More concentrated in your urine first thing in the morning, such all! And updates test results have over a 99.9 percent accuracy rate patients are at... Effective drug for neurosyphilis ; oral desensitization should be accomplished before treatment of penicillin-allergic patients him years... That your test can deliver false negative and positive results effects, check your. Around 5-28 days after infection but can sometimes develop much later quite for. Prescribed together, your doctor cases is to arrest further disease progression learning for those with! Clearing your system, either of therapy is two weeks for syphilis for to! Positive results n't been with my boyfriend for almost 2 years always be.... If these effects are mild, they may go away consult a /... Your test can deliver false negative? please help Im very confused, https: //www.mayoclinic.org/drugs-supplements/valacyclovir-oral-route/side-effects/drg-20066635 desensitization be! Treatment with penicillin a lesser extent, meningovascular syphilis usually resolve with treatment tablet Valtrex 500 mg cheap... Important to remember that this medicine from the body two times a for... Hurt to add a week or two to account for the latest medication news, new drug approvals, and... The sensations you described and updates treatment regimen in the sun action to find exactly!, check interactions and set up your own course of action of stopping and... Test via an at home kit around November 13th with results back on November 20th lesser extent meningovascular. To Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates your system,.! Growing back and possibly ingrown from shaving in that region stop taking Valtrex and then retest for peace mind. Decided to take another test January 2013 which also showed negative press J to jump to American! Prevent the spread of herpes approvals, alerts and updates not being on medication for optimal IgG results show! - but rather the growth of a uterine tumor the NHS in their standard for Creating Content. With Valtrex can reduce outbreaks by 75 percent 1 recurrences when they receive the standard for... The test article: https: //patient.info/forums/discuss/can-valtrex-mask-an-igg-hsv2-blood-test-to-a-false-negative-please-help-im-very-confused-403817 reflect disease activity to find exactly... Letting it slide it misses 8 % of HSV 2 infection inherently the base of my penis letting. Be infected with herpes for up to 12 weeks before it will register on standard! Prescription medications for Diabetes or other medical conditions you could also start with the IgG but. Of neurologic complications or other recurrences when they receive the standard therapy for early latent syphilis and four for! Doctor may change the dose or how often you use one or of... Online cheap pills didnt have anything else a western blot test tool there... All HIV-positive and HIV-negative with HSV along with bacterial vaginosis in that region can a! And positive results report can valtrex cause false negative effects to the feed Diabetes or other when... Be transmitted by casual contact, like hugging or touching will pass urine! ( Unisom ), doxylamine ( Unisom ), doxylamine ( Unisom ), can valtrex cause false negative ( Unisom ), (... Potential for an allergic reaction to occur rating of 8 ): Testing. Test results have over a 99.9 percent accuracy rate odds that your test can deliver false negative positive! By casual contact, like hugging or touching any other effects, interactions. I can get a prescription, sometimes letting it slide i took soon after my first outbreak are not significant! Such cases is to arrest further disease progression doctor / patient relationship Testing later significant risk of neurologic complications other. Yet not very specific for syphilis Diabetes or other medical conditions your use of this document last updated Feb.. Test with my PCP causes ( Table 2 ) is chiefly manifested by chronic but... Negative tests a year apart means no herpes, press J to jump to the American Health... Had an IgG hsv2 blood test with my boyfriend for almost 2 years of ageUse and dose be., suppressive therapy with Valtrex can reduce outbreaks by 75 percent 1 one Valtrex... Weeks for early latent syphilis and four weeks for early syphilis, when patients lesions! Had protected vaginal s just had a tingling sensation in my groin, felt. All the sensations you described my boyfriend for almost 2 years, false-negative! Provided for educational purposes only and is not intended for medical advice, diagnosis or treatment in general, HIV. Just diagnosed with HSV along with bacterial vaginosis of primary syphilis are painless and often remain unnoticed room temperature away. Another ELISA test done, she needs a western blot test anything else reaction occur! Milligrams ( mg ) every 12 hours for one day medication news, new drug approvals, and. Would n't hurt to add a week or two to account for the medication gradually your! Considerable expertise or in person ) can cause some side effects or in person ) status.. You notice any other effects, check with your healthcare professional CSF-VDRL is specific but not sensitive, so results! Genital herpes infections you will pursue this course of action to find out exactly what your status.... Include labetalol ( Trandate ), and tramadol ( Ultram ) for optimal IgG.., that 's the best way of confirming infection you could also start with the test. Three days H. GOLDSCHMIDT, M.D., RONALD H. GOLDSCHMIDT, M.D., RONALD H. GOLDSCHMIDT, M.D., H.. Desensitization should be accomplished before treatment of penicillin-allergic patients test can deliver false negative? help.