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Herpes again (why yes!)

[00:00:00] Do you see my eyes? They're. I'm tired, . Um, I sometimes feel like a broken record to myself though apparently y'all haven't heard me say the same thing over and over again cuz they keep saying it. So like tonight, tonight it's almost 8:00 PM and I just caught off the phone with a conversation with a wonderful patient who I've known forever. 

About the herpes, so we're gonna talk about it again. Here's how I break down herpes, and we have so many permutations we could discuss with herpes, but in a nutshell, there's herpes simplex one, herpes simplex two, so it's HSV one, HSV two. There's multiple other ones, but those are the ones we're talking about for today. 

Those are the ones that will typically cause oral cold sores or genital cold source. Now, you can get HSV one oral cold, sore, herpes virus. I call it genitally, right? So you can actually get a cold sore, and if your doctor does a culture a little swab, if [00:01:00] it's. Uzi, then she might call and say, Hey, as it turns out, it's HSV one and not HSV two. 

Cuz HSV one is more commonly oral. HSV two is more commonly genital. Now does that matter? Yes or no? I would say it kind of matters cuz patients just like to hear HSV One more because they associate it with oral cold sores, which everyone. Including like as I joke, all of our grandmothers. Um, also it seems that HSV one tends to recur less frequently. 

Meaning if you have an HSV one lesion, genitally, maybe some data would say you're gonna get it less recurrent. And I think I see that anecdotally. The truth is that I can say with confidence to patients that many of us carry the virus, we carry the. And we never get a cold source ever here or there, ever, ever, ever. 

In fact, some of the data would say that at least 50% of us, I would say that's an underestimate, maybe carry it. And many of us don't know it. And I'd say it's an underestimate because millions of women don't get checked for it. Millions of men don't [00:02:00] get checked for it, which is what I'm gonna talk about in a second. 

In fact, the CDC guidelines do not advocate for screening for herpes. When you are doing STI screens, we should be screening for gonorrhea, chla. , hiv, hepatitis, syphilis, not herpes. I don't agree with the guidelines. I don't make the guidelines. The guidelines are there for a good reason because we're gonna be increasing cost and anxiety without actually needing to treat. 

Cuz you don't treat herpes unless you're symptomatic. Now I would say because I have a loftier goal for us, I think it actually increases more anxiety because we don't test for it because then we don't talk about it enough and then you guys all think when you hear about it that it's something dreadful when in. 

Many people, probably the majority of us carry one or the other or both and never have symptoms. So in this particular case, for example, I call a patient to say, Hey, because I do screen for it and I tell my patients I'm gonna screen for it unless they don't wanna know. In which case I'm happy not to do it. 

But I call to say, Hey, turns out you've been exposed. Now, in her particular case, I know the timeline because we had checked. [00:03:00] sometime in the, the last six to eight months, we checked her again. She has not been with anyone but this person. And so we know where she probably got it from, but that's not always the case. 

And what she said to me if she's watching, she knows we'll be talking about it, um, is, but he said he doesn't have anything. And I said, I agree. I bet he did say that. And by the way, I don't think he's lying. This does not mean he cheated. This does not mean he lied. The. That most men do not know they carry it because they don't get tested for it, right? 

Some men get tested for herpes, but many men go to their primary care doctor who does s t I testing, which atest is hiv, hepatitis, syphilis, and gonorrhea and chlamydia. Not even that thorough necessarily, but those at least, so they often don't get tested and they don't even know that they don't have it. 

So they're not lying to necessarily, they just don't know enough to know that they didn't get tested. So they think. I've been told my STI I panel is negative and I don't have any symptoms. Ergo, I don't have herpes, which is wrong. By the way, many of you as women think the same thing. Not your fault. You haven't been [00:04:00] educated on it. 

So you think I went to my gynecologist, we did STI testing. I assume ST I testing encompasses all the sts. And I don't have symptoms naturally. I assume I don't have herpes. Again, wrong, because your doctor might have been following guidelines appropriately and not tested you for herpes. She might have then assumed that you knew that you didn't get tested for herpes. 

You have no symptoms, so you assume you're negative. You also might say, but I use condoms every single time I was with so-and-so, or every single person I was ever with, and I'd still say, I believe you, because the virus can live outside of the area of the condom. If a condom goes on a penis, the virus can live all around and all around the vulva, not just in the vagina where the penis is. 

Okay? Plus you can get it from oral sex, plus you can get it just from skin to skin contact, female to female, male to male. So it's very common. It is by and large, not dangerous. It is very unlikely that people know that they carry it when they carry it, because many people are [00:05:00] asymptomatic. You can transmit it by asymptomatic shedding. 

So even if you're with someone who let's say, knows he has it. And he says, but I don't have a sore. We can have sex. The answer is you could have sex, but asymptomatic shedding, he might give it to you whether or not he knows it. Now, if you use condoms and you take daily prophylaxis of Valtrex, it is less likely that you'll give it to someone. 

But even that's not a sure thing. Now is that terrible and scary? No, because the truth is the majority of us who carry it are not gonna have any symptoms from it or side effects. Even if we have symptoms, we're annoyed. It's yucky, it's uncomfortable. That's it. There are some immunocompromised people, infants in particular, people for example, with HIV who might have more significant side effects or symptoms from herpes for sure. 

So we have to be cautious about that. There are certainly. Um, people out there who would advocate and vocalize that herpes can be a culprit in far more than we believe. I don't wanna say they're wrong, but I would say according to traditional medical [00:06:00] data, we don't agree with that line of reasoning. That is in the more integrative, um, eastern world beliefs, that herpes is actually the culprit or core, just like Epstein bar virus of many of our chronic illnesses. 

Again, yet to be born out in the data. So I don't necessarily ascribe to it because what I see. , millions of us have it, and we don't have any side effects or issues from it. So again, do I think any of you have it? Probably because any of us might have it asymptomatic. Do I think that means that the person you're with cheated or that you had, you know, too much sex and you should have been more careful? 

No, no, no, because your partner might not have cheated because the, the virus can stay there for decades. You might have used condoms you might not have. And even if you use condoms, you can still get it. And the good news is you're likely not gonna have any problems long-term. Can you get pregnant with herpes? 

Yes. Is it gonna harm the baby? No. Provided you don't have an active lesion in your vulva or vagina or labia at the time of vaginal delivery, if you did simple answer, then you [00:07:00] have a C-section and you will take Valtrex once a day, starting at 35 or 36 weeks to help suppress the likelihood of an outbreak. 

So that is it in a nutshell. Don't freak out. Herpes coming. Peace out people.