Dr. Google& Hepes: A tutorial


[00:00:00] I promise starting next week, I'm gonna get into a ton of true obstetric and gynecology content, cuz I realize I've been doing a lot of like mind set stuff, which frankly I love, but I'm here to do clinical stuff too. Today though, I do wanna talk about the doctor Google because I feel that sometimes I'm a little bit disparaging of the doctor and I shouldn't be, but I wanna highlight what I mean when I say don't Doctor Google. 

First of all, let me just say Google. I'm deeply appreciative of Google as a platform. I use Google every day. I have to search things every day like everyone else. Of course, I know they are watching me and following me like everybody else. We've just unfortunately succumbeded to that. I do think that unfortunately, because when you search for something, it is unmodulated. 

As we've said before. When people say things to us like, I've done my research, what they really mean, even though they don't say it, is I have Googled other people's opinion. Maybe other people's actual [00:01:00] research, but doing your research means you're actually doing the research, which I don't even do the research. 

I don't have the ability to do the research. I am a medical professional who practices in my office. I do not perform research. Nor do most of you, which is okay, but let's be clear about what we're doing. And it came up because in my office I see these things every, every day, every week, several times a week. 

Now, fewer times a week since I'm in the office less. But we A patient and I had a discussion and we were talking about a potential outbreak of HSV one. So herpes one, which just to give you the background again, HSV one tends to be oral herpes, HSV two. Those are my dogs. Sorry. Tends to be genital herpes. 

There can be cross reaction, meaning many people can get HSV one virus, which is the name of the virus, and instead of getting it orally by cold source, they can get cold sores, genitally, and then it's still called genital herpes, even though it's from the HSV one virus, which is traditionally [00:02:00] considered oral herpes. 

I say that because there's still so much. Miscommunication, misunderstanding, disinformation, and frankly, fear when it comes to herpes. Hence, the reason I will be doing much more content on herpes. In this particular case, this patient had had a kind of nebulous, um, story, meaning she presented like many people do with a lesion. 

When we say lesion, we just mean like a let, let's say you had a little cold sore or an ulceration. That's a lesion, okay? Lesion takes on many different terms in the medical vernacular, but in this case, a herpes lesion would be a cold sore. Or a cold sore genitally. Interestingly, herpes can also cause lesions or ulcerations or cold sores, not necessarily on your vulva or on the shaft of your penis, but in the skin, in the area around it, even as far as your buttocks. 

Your thighs, the inside part of your legs. So sometimes it's a bit confusing. Was it an ingrown hair that you scratched? Was it a mosquito bite? Many of you may remember if you followed me [00:03:00] long enough that I remember our sweet patient who said, every year I get a spider bite exactly in the same spot on my buttocks, and I had to be the one to tell her. 

Actually, that's a herpes lesion. Now in her particular case, and in many. Herpes lesions again, that are on your buttocks, on your vulva, on your penis, on the thighs of your inside, between your legs. Even if it's not technically genital, it can be from HSV one or two. And we kind of classify it as genital herpes. 

And in our world, when you're dealing with obstetrics, you care about it because the baby, as he or she's coming outta the birth canal, can get exposed to a larger dose of the. That can be shed from those little lesions and the baby, even if the baby has had antibodies through mom's circulation. It's not enough antibodies necessarily to stop the baby from getting a herpes infection, and that's why we care very much about herpes. 

We know herpes is very rampant. It's incredibly common, and that's why we instruct people to take [00:04:00] Valcyclovir or acyclovir, which are the anti-retro antivirals. They take them starting at about 35 or 36 weeks of pregnancy prophylactically, meaning preventatively to prevent an outbreak at the time of the delivery so that they don't have to have a C-section. 

Now, let's nugget through. HSV one tends to be oral, but it's very common that you can also get it genitally. When I say very common, it seems to be on the rise. Good news being that when you have HSV one genitally, it tends to be less recurrent, we think, than hsv. Two second thing to note. HSV in general is common, and if you have an outbreak at the time of labor, because that's when your body is under more stress, then simply put nothing horrible, but you would need a C-section. 

So how do we prevent that? Is prophylactically giving anyone who's had any lesions. Longer, um, background about it, but you should talk to your doctor if you've had any herpes lesions, genitally, because then you would take prophylaxis from 35 or 36 weeks on, and again, it's genital, whether it's HSV one or two.[00:05:00]  

Now, in this particular patient's case, she had her very first outbreak, meaning she had no knowledge that she had herpes, and she had this lesion, um, in her thigh Essentially, it. Not something that I saw. It was described to me in my practice, it sounded like it could be herpes, and the net effect was that we all agreed that it would make most sense for her to take the val, excuse me, valcyclovir prophylactically in this pregnancy to prevent an outbreak so that she can deliver vaginally. 

Now, here's where I talk about the Google. She was really appropriate and said to me, well, I Googled. herpes, and that was my first outbreak, and what I Googled is that probably it wasn't herpes because Google says that your first outbreak is going to be really painful in a lot of different spots, and you're gonna feel globally sick and it's gonna probably recur and take longer to resolve. 

None of those happened. In my case, I had that one spot and it went away within a couple days, to which I responded. [00:06:00] You are correct that that might not have been herpes, but this is a perfect example of how and why. Couldn't take us down the wrong path. And it's not Google's fault. It's any search engine or anything that you read without someone, um, appropriately modulating it to you. 

Herpes is confusing. Herpes has what is called a primary outbreak. A primary outbreak is very specifically defined as you were just recently exposed to the virus, right? Either through genital contact or oral contact. You were exposed to the virus, and within a couple days or max, a couple. You had your body's response to it, which showed up not just as creating antibodies, but actually as a herpes infection where you had multiple lesions. 

General flu-like illness, sometimes lymph nodes, and again, that will be the worst outbreak for anyone who ever has had an outbreak, and that is a primary outbreak. Now, here's where it gets confusing. You might never have a primary outbreak. Many people, in fact, probably the majority of people [00:07:00] get exposed to herpes asymptomatically. 

They don't know it. They have no outbreak. They have no primary outbreak. Their body sees the virus, creates antibodies against it, keeps some of the virus on their skin or in their mucosa, and they can shed the virus. And then at some point in their life, maybe like when they're 50, 60, 70, 2030. Any age they will have what they say is, oh, this is the first time I've ever had it. 

Right. Their first time that they've had it, but they were exposed a long time ago, is not a primary outbreak. So you see how it's confusing. Again, a primary outbreak is very specifically timed as recent exposure and a much more significant, um, presentation of the illness. Okay. You'll never have a primary outbreak outbreak more than once, and you very well might carry herpes and have your first outbreak, which means your first one little sore, and it's not a primary outbreak, but you see how that would be confusing if you just read about it and [00:08:00] you see how this patient very innocently and very appropriately said, I don't think it was herpes, because what they described is not what I had. 

So all this to say, I hope you learned about herpes. I hope you understand why we, as doctors say, just don't doctor Google it, because it will undo some of the information we're giving. We're trying to give you very good information to the degree that we can, does every doctor do it? No. Does every doctor do it? 

Well? No. Do some doctors talk too much and confuse you? Yes, but we are trying, and if we don't do a good job, then ask us to clarify as opposed to merely believing what is read the way it's read. Okay. Same example I often give is if you look up, I have a headache, what could it be? Well, the Google is gonna tell you it could be dehydration. 

It could be a lack of caffeine. It could be any new glasses. It could be allergies, it could be a tumor, and it could be an. All of which are true, but when you see them all equally weighted, now you're thinking, I didn't have my caffeine, but I'm pretty sure I'm dying of a brain aneurysm. When in reality your doctor would say, well, did you have your caffeine? 

Are you dehydrated? Did you have allergies? Did you get new glasses? [00:09:00] And in your, in your doctor's mind, she is actually ruling out an aneurysm. And she's actually ruling out a brain tumor indirectly by assessing the likelihood, your risk factors, maybe certain physical things that she's netted out from you. 

So she can do that without listing them to you. Okay? So that is my little Diddy about the Google and about the herpes. So I did a two for one there, people. Okay. Enjoy your night.