Let's talk about herpes baby!


[00:00:00] Good morning everybody. It's Saturday the 21st, day seven or eight, depending on what you call the first day of our lockdown. I just did a really good video about herpes and then I realized it was 15 minutes and I G T V only last 10, so I'm gonna make this faster and shorter. I wanna talk about herpes.

Why? Because there's a couple of things. First of all, I'm sure you're just tired of hearing about Corona, and I'm no Corona expert, so I'll talk about what I know better, which is herpes and all kinds of gynecology stuff. In addition, it's very apropo right now. First of all, because it is a virus. Because it is a virus that is largely asymptomatic, much like Corona, and because the virus, when we have it, tends to pop up more frequent.

When we're under times of stress, which might be now, so I'm gonna actually just talk about genital herpes right now because that was what made the other one too long. So genital herpes. Genital herpes merely means the herpes virus that is in your genitalia, meaning your vagina, your Volvo, your penis.

Okay? So many people, um, [00:01:00] are exposed to the herpes virus. Most people who are exposed to it don't even know it. The data shows that at least 50% of us carry herpes and they don't really stratify a herpes one are herpes too. But the truth is it's probably one if not both, and that's probably a huge underrepresentation because probably tons of us have it and don't even realize it.

I am one of those people now I realize it cause I finally got tested that I had herpes one because. tons of people that I know had it and I wanted to prove my point to my patients. When I keep saying I might have it, I might have it. Okay, so what is herpes? It is a virus that again, can infect. Millions of us.

Millions of us. Millions of us. And I don't say that to be scary, cuz unlike the coronavirus, the rate of problems from herpes is incredibly small. So it infects at least 50% of us they think. And again, that's the data on both viruses. Let's just say 50% for herpes too, right now, 50% of us can have it. I'm gonna say anecdotally, in my practice it's, I don't know, pretty high.

Like I check a lot of people. How many of us does it affect is a far smaller [00:02:00] portion, meaning there are tons of women and men walking around with herpes cold sores, but there are tons that just never have had it. How would you get it? Is. asymptomatic shedding for the most part. Meaning I believe you guys, when you come to my office, you say, how did I get it?

I didn't have sex with, I mean, I say this to you guys, I know you didn't have sex with some guy with a big caping sore on his penis, right? I know that you unwittingly had sex with either a long-term partner with condoms or someone you met recently with condoms. Not always. I get that. But even if you have had sex with condoms, you can still.

There's two types of virus. There's HSV one and HSV two. HSV one typically is oral. HSV two typically is genital, but you can actually get either Genitally, so. The virus then gets divided into two types of presentations. Really, I would say three. In fact, one is a primary outbreak. A primary outbreak is unfortunately kind of the worst one with regard to discomfort.

That means a patient comes in with multifocal lesions, meaning multiple lesions around her V or vagina. [00:03:00] They're super painful. Um, often with flu achy like symptoms, sometimes lymph nodes being positive, sometimes so many sores that she can't even pee because they're around her urethra. And that is a primary outbreak, we call it, meaning I was recently infected within the previous couple weeks I had sex with someone, or even just very close rubbing of the gen.

And I mean that teenagers rubbing your genitals together is actually a way that you can get virus on your vulva. And I've seen that. And I believe those patients, could they be lying to me, of course, but they have no reason in my office to be lying to me. I'm not their mother. I'm not judging them. I don't care if they've had, I mean, I care if they've had sex, but again, not judging them.

So close genital contact. I mean, again, not like. , you know, my vagina hit the toilet seat and then someone else did, unless they're rubbing it all over. But if you are really rubbing your genitals against someone, or having intercourse with or without a condom, because the virus can live in areas outside of the genitals.

Okay? Meaning on the skin surrounding the penis, and certainly all over the vulva, not [00:04:00] just in the vagina, unlike other STDs like chlamydia only. in the, the urethral tract of the, of the man and in the, um, vagina and cervix of the woman. Okay? So you get it from contact. , you don't realize you've been exposed, and then you get a really aggressive primary outbreak.

That is not the most common presentation, but that is one presentation. So when someone comes to me with a very aggressive multifocal lesions, pain sores, trouble peeing, all that, it's most likely herpes. I can actually culture it if there's Uzi sores, and then I can tell that patient whether it is herpes two or herpes one.

Why would you care if it's herpes one or two? Well, if it's herpes one, the good news is you're less likely to have recurrent. and if it's herpes one, you really could have legitimately gotten it from a long-term partner who unwittingly drank out of someone's cup. Look at my fun cup. Let's just assume I'm always right.

Unwittingly drank outta someone's. God exposed to the virus orally, gave you oral sex, and then you had a primary outbreak. And again, I have seen that many [00:05:00] times now, if you were in a new relationship and it's herpes too, that also makes sense. You were with someone in the last couple weeks who maybe had been with someone else prior to that.

Anytime now if you're in a long-term relationship. And it cultures positive for herpes too. With multifocal lesions, again, this primary outbreak. , then it's a little more concerning that maybe that person was with someone else. What is far more common that we see is either totally asymptomatic shedding, meaning asymptomatic carriers who just are getting STD blood tests done for H, hiv, V, hepatitis, syphilis, and herpes.

And then I have to call them as they, Hey, turns out you carry the antibodies to H S V one or two or both. Now, does that mean they have it? Yeah, they have it. But does that mean they get. . They're very lucky. Many do not. And then the third group is those patients who come in with just a solitary sore, and either it's their first time they've ever known it and they could have been 70 years old and said, I have a sore.

I don't know what it is. And I've had this happen where that patient turns out to have herpes. And I believe that woman that [00:06:00] she's been in a monogamous relationship her entire life, but it just came out. She was exposed back when she first was with that partner, but it never showed up and something happened.

Stress, things like that could pop up, right? So that is why. Single outbreaks like that, single little lesions, which are really common, do not make me feel like, kind of like my spidey sense of somebody was unfaithful, because that's not how it works. Okay. Now, in addition to having that single lesion, some patients will come in, just say, God, I kind of get this recurrent.

like cut or it looks like a little paper cut on my vulva, and that can actually sometimes be herpes as well. Do we care if it's herpes? The good news is I say to patients, if you don't care, I don't care. If you want me to know, I'll try to culture it and try to get in a virus that the positive culture will come back and tell us what type it is.

But I don't care about it because I care about things that are either D. Herpes is not for the vast majority of us outside of infants or very immunocompromised people, or I care about it because does it represent something that I have to treat like chlamydia because it can scar your [00:07:00] tubes or obviously hiv, hepatitis and syphilis, which can be dangerous, or do I care about it because it means infidelity and in the setting of a monogamous relationship with a new onset solitary lesion, again, not multifocal primary, but solitary lesion.

It does not mean infidelity, so I don't care. And I mean it nicely when I say I don't care. I don't mean I don't care. I mean, I don't really care about the answer because I don't want, um, it to cause undue anxiety. If you care about the answer, then the two things you can do are either get blood tested. Or get culture tested if there's enough virus, if it's a really dried over lesion, the doctor will not be able to get enough of the virus to send it.

Um, and I often will do both just so that we can try to come up with an answer. And it's not always an easy slam dunk answer. Sometimes the culture comes back negative, but the blood test comes back positive for both. And then we don't know what kind of lesion it is. But again, to be clear, I stratify my STD concerns.

Do I need to treat it? Is it dangerous? And does this mean [00:08:00] infidelity? Those are the two reasons I care about it. If I can treat it and it's not dangerous off my list of worries if I don't even need to treat it off my list of worries, but do I have to address infidelity when it comes to things like chlamydia?

Yes. When it comes to things like herpes, often, no. So in a nutshell, cause I only have another minute and a half, herpes has HSV one, HSV two, HSV one can also occur Gen. You get it from skin to skin contact, so it does not have to be penetration, and you could be using a condom and still get it. Women can transmit it to women.

Men can transmit it to men. Men and women can transmit it orally to their partners as well. It can easily be treated if you need, so if you know that you have it and you start to feel that burning and tingling, you can take valcyclovir or Acyclovir a couple times a day for a week, sometimes even just five days, and it will really stop the outbreak from occurring.

That primary multifocal, yucky, bad, painful. Is the only time you'll get it like that. You'll never get it that way again. That's by definition why it's called primary recurring lesions. If they happen, are a little bit sore, a little bit painful. [00:09:00] Most patients will know when they're gonna have it and they take the medication.

It's not scary. It's not dangerous, it's not dirty. It's super common. Um, but the correlation with Corona is interesting in that. You don't actually get lifelong immunity to Corona. They don't think, but you do get lifelong immunity to herpes. So in a way, yay. That herpes is forever. That's a good thing. Okay, this was shorter than my 15 minute one.

There's so much more to say about herpes. So next time we'll also talk about should I be tested without any, any lesions? I think yes and herpes one will talk about more. Okay, hope y'all are okay. Bye.