Herpes& HPV- quick word


[00:00:00] So we've been doing a lot of baby and a lot of ovarian cancer stuff and endometriosis. And now I wanna shift gears cause I haven't talked about like two of my favorite subjects. And I say it as if it's like so sweet. But really what we're gonna talk about, especially as all my young patients start coming home from college, , HPV and herpes. 

This is not gonna be a grand HPV and herpes talk because there's so much to talk about. This is gonna be, um, a higher level kind of emotional yet condensed HPV and herpes talk. This is what I mean. Um, this is how I discuss HPV and herpes. In general to my patients in the office. If you are a young woman who has been to me, and we've talked about STIs in general, those of you who don't know STIs are sexually transmitted infections. 

We used to refer to them as sexually transmitted diseases. Disease sounded pejorative and judgey, and so we've [00:01:00] now say s STIs. I have to be honest, it still rolls off my tongue to say S T D because that's how I trained. So I still say S std. So STI I. This is what I say to people in general when I'm speaking about the STIs to women, and ideally I'd love to catch the women prior to embarking on their sexual. 

time because that's the best time to really educate them. So it would go something like this. I don't know if you're having sexual intercourse yet. I don't know if you're sexually active yet. And I really try when I can to be very neutral about, I dunno if you're having any kind of sexual relations with, you know, men or women or boys or girls. 

And I don't wanna be like boys or girls cuz that sounds so diminutive. But sometimes when I'm with someone younger, 16, 17, 18 saying men or women also sounds so. , I don't know. Aggressive, right? So I try to be neutral because I wanna really leave the door open for people to feel comfortable talking about it. 

[00:02:00] We live in a fairly homogenous area. There is a very, very demographic in the city in which I practice, but I draw from some towns that, let's say stacks are very, very, very homogenous and people don't necessarily feel comfortable coming forth if they are having relationships that don't necessarily. as acceptable to the general population, which is too bad, but I want people to feel very comfortable. 

And you out there, whoever you are, you should feel so comfortable talking to your practitioner, whether it's your doctor, your nurse practitioner, your pa, your family practice doctor, your pediatrician. You should feel comfortable talking to them. And if you don't, then that actually means that you should find. 

Because you need to be open with them. They are there to help you. They are not there to judge you. And if you are feeling judged, then either, it means you have to come to terms with the fact that you need to be more open with someone. And if it can't be, Your family member or one of your best friends or a [00:03:00] clergy person or someone that you're close with, then it needs to be your physician. 

Your, again, your np, your pa, but find someone that you're close to, okay. That you can confide in. And if that person doesn't give you confidence, then you need to go find someone else. Because that's important and really, like I would say, even if you can talk openly to your family member or your friend, please talk openly to your doctor. 

It's important. They need to know what they need to help you with. Okay. Back to HPV and herpes. I went off on a tangent. So the reason I focus honestly a little bit more on HPV and herpes than the other STIs is that often they're the most common, right? If you use a condom, if you're having heterosexual. 

You will prevent hiv, hepatitis, and syphilis. Not a hundred percent, but really close to it because hiv, hepatitis and syphilis are largely found in semen blood or if you're getting a blood transfusion, which we're not discussing here. So in the realm of sex, It's found in semen, it's not found on the skin. 

[00:04:00] If you have chlamydia or gonorrhea, again, it's found in semen, right? So the exchange of semen is typically how you can get it. Now can females to females transmit those um entities? Absolutely they can, but it's less common. So again, in situations where people are having heterosexual sex, condoms will largely prevent hiv, hepatitis, sy. 

And gonorrhea and chlamydia. If you are having homosexual sex, condoms will prevent those. If you are having female homosexual sex dental dams, which is essentially like a. Unrolled condom. It's like a piece of latex or non latex type of plastic that will prevent transmission of those things. The likelihood of women using dental dams is really small. 

Females weigh in on this, let me know, but I'll tell you, in my population, it's like, I think in 22 years I've had one patient who's told me she legitimately uses it. Anyone else has kind of looked at me like, what's that? I don't know what you're talking about. Now. Viruses like [00:05:00] herpes and hpv on the other hand, unlike hiv or he. 

live on the skin, and they don't just live on the skin that's on the shaft of the penis or inside the vagina. They live on the vulva. They live outside the vulva, which remember the vulva is the outside of the vagina. The outside part, they live on the skin that's around even like the interior of the thigh, like the thighs. 

They live sometimes on the buttocks. They live all around the outside of the penis and the scrotum. So you can get herpes and hpv, even if you've had one lifetime partner. And even if you said, but Shiva, I used a condom every single time, and I'm gonna say to you, but I believe you. because I know how people get herpes and hpv. 

It happens all the time, and I'm not worried about it. I'm not freaking out about it. Not because it doesn't cause distress, I get it. But I try to purposefully, frequently calmly and like casually say to patients, it's really common. Don't freak out. So I'd like to preemptively tell any of you who have not yet embarked on your sexual livelihood, [00:06:00] please just know. 

That if you choose to have sex, even with it's one person for the rest of your life, you may get exposed to herpes or hpv. Now, if that one person has never had sex with anyone else, It's less likely. But if that one person has had oral sex with someone else, then it is possible that that one person could have been exposed to herpes or hpv because you can get oral transmission of her herpes or hpv. 

Again, they're viruses. They can live in our mouth and our throat on our genitals, and you can get transmission through that. So again, you can get asymptomatic shedding, meaning no big cold sore around my mouth, no big cold sore or open weeping wound on your. No sign of H P V because most people don't have any signs or symptoms from H P V, and all of a sudden, lo and behold, you pop up with H P V. 

Okay, so HERPES and H P V I lump them together because they are viruses. That can be transmitted asymptomatically with [00:07:00] no symptoms. That means, and then all of a sudden your partner man or a woman gave it to you. You had no idea, and you have it. You don't even know which partner you had had gotten it from, meaning if you now are married, And you pop up with this, you cannot blame your current partner because you could have gotten it from a former partner. 

This happens all the time, and again, there are so many more granular details and stories and examples we could go into. I'm actually working on a like. It should be three parts, but it could be like 10 part series to transmit about this because there are multiple different situations that become very confusing for patients where like suddenly someone comes in with a new open cold sore. 

Could it be herpes? Yes, it's probably herpes. Is it herpes one or herpes too? Well, it could be either and is it a new onset? Does, was she just exposed? Was she exposed a long time ago? Well, it depends on a multiple variety of factors. Like is it one lesion, is it multiple lesions? All these different ways I could describe it. 

That will help us tell you whether [00:08:00] it's recent exposure, long time. Exposure. Do we think it's herpes one, do we think it's herpes? Two, how do we test for it? So there's a lot of different permutations when it comes to hpv. There's two broad categories. There's the type of HPV that causes abnormal pap smears. 

There's the type of HPV that causes warts. The type that causes abnormal Pap smears might turn into cervical cancer, but that's not so common. So those of us who have the type that causes cervical. We'll not get cervical cancer most likely if we're really compulsive about keeping our immune system strong, meaning no smoking, boosting your immune system by eating a large variety of vegetables and immune boosting foods, keeping your body healthy and going in for your pap smears. 

How often should you your pap smear talk to your doctor? Because there are different varieties of testing regimens based on your person. needs based on your immune system and your age and different factors, right? Why would you need it more frequently or less Frequently, again is based on a variety of factors like age, your immune status, all these different things. 

So you need to talk to your doctor [00:09:00] about it. So do you need to be scared if you have hpv? Lord, no, because What percentage of us have hpv? Say it with me if you've heard me say it. 80 to 90% Lifetime. 80 to 90. Right. So if you're watching this and you're in a room full of 10 people, you're probably not a room full of 10 people during the Covid, but. 

Eight to nine out of the 10 people that you would've been in a room with prior to the pandemic, had it and didn't even know it. Cuz many people are walking around and they never had a pap sear. They didn't know it, or their password came back normal, but they still had it because it didn't make the cells abnormal Again. 

That's a whole nother topic we can talk about is pap smears with regard to HPV because many people have HPV without knowing it. Herpes on the other hand, many people have and they never got tested for it cuz the only way you know you had it is either from an. Or by getting blood tested. Herpes has two, two strains. 

Herpes has many strains by the way, but the herpes we're talking about the oral cold source strain, the genital cold source strain. There can be some cross reactivity. Again, so much to discuss. [00:10:00] But in general, herpes and HPV very common. Herpes and HPV should not be stigmatized. Herpes and HPV are often stigmatized. 

People freak out about them. People feel deeply depressed about them. They're actually multiple, multiple. Instagram handles about this of women, probably men, but you know, in my demographic it's women, women who are trying to debunk and destigmatize and I'm so glad about that. So kudos to all you ladies who are doing it because I think it's great and amazing and I hate being like so brave because it shouldn't have to be brave, but it is brave that you guys are being public about your own, you. 

your own herpes? Um, I think that we should talk about it more openly. I think we should talk about it more frequently. I think that everyone should get tested. That is anathema in our world because the CDC does not encourage testing. Yes, it would be a burden on the system. Yes, it would open a whole Pandora's box. 

I have many feelings about it. I can't say that our public health system, which we have a terrible one of, um, is up to the task. But in theory, I [00:11:00] wish we were, because I think that. would actually decrease huge amount of anxiety. I see daily emotional toll from the burden of herpes and hpv. Um, anyway, those are my thoughts. 

I hope you enjoyed this on this. This is Wednesday morning, booya herpes, hpv. Okay, on a more serious note, there is some serious just stuff going on in the world, Israel and Palestine. Not a pretty picture. Um, it's, it's just not, uh, what's going on with Covid is, I don't know, is it getting better? I guess it's getting better. 

The vaccine, I'm feeling very optimistic on one hand and I'm feeling still really sad and worried about a lot of vaccine misinformation. On the other hand, um, I'm generally loving humanity and feeling angst about humanity. I guess those are my thoughts on this. Wednesday, may. . So there you have it. Those are my nuggets. 

I hope y'all have a great day. Okay? I'm gonna go see some [00:12:00] patience.