Tha herp ahhhgain!


[00:00:00] All right, we're gonna talk about my other favorite virus, herpes. I know, doesn't this sound funny that like, I love talking about HPV and herpes, but I love talking about them because they need to be talked about. Here's why. There's a lot of misconception, there's a lot of angst, and as I say, frequently, there's a disproportionate amount of, um, upsetting news for patients when they think. 

Herpes and hpv, and many women will use the same vernacular as I always say, oh my God, I would be devastated if I found out I have herpes. Or, oh my God, this is the worst news ever. Which PS there is so much worse news in the world, . I know that sounds like I'm being silly or like blowing it off and I'm not. 

I'm addressing it because I so want to be able to decrease your anxiety if you hear or have heard that you have HPV or herpes. We talked about HPV the other day. Now we're gonna talk about herpes. This is what [00:01:00] happens frequently in my office. Educated, healthy, kind, nice women of all demographics, I shouldn't even say. 

Educated, some educated, some not educated. Some wealthy, some not wealthy, some black, some white, some Hispanic, some Portuguese, some Iranian. They sometimes are single. Sometimes they're married, sometimes they're widowed. Sometimes they have more than one partner. Sometimes they have a female partner. 

Sometimes they have a male partner. Sometimes they have multiple partners that all permutations will come. with varying stages of herpes, and when I say varying stages, I'll describe what I mean in a second, but every single one of them, regardless by the way of their level of education, Seems to have the same sentiment, which is, oh my God, this is horrible. 

And that just means to me, you guys didn't learn the right stuff. Not your fault, and we didn't teach you the right stuff. I'm gonna also say, not our fault, . It's no one's fault. It's just again, the system is broken and does not help us teach you effectively. So I'm all teach you right now. So when I say varying stages, this is what I mean. 

I'll go through a couple of scenarios. You might [00:02:00] not know that you carry herpes, the actual c d C guidelines. Do not encourage routine screening for herpes, the way they encourage routine screening for other STIs, sexually transmitted infections, for example, gonorrhea, chlamydia, hiv, hepatitis, and syphilis. 

We should be routinely screening for those. They're very clear Screening protocols that we offer patients. Herpes is actually not encouraged. I have many feelings about that. , which I'll say quickly here, I think that we should be testing for it, but I understand why we don't. We don't test for it routinely because there's so much misconception because it causes so much angst and because actually there is very little risk and harm associated with herpes. 

There's not no risk, but there's very little risk as opposed to H I V, hepatitis, syphilis, gonorrhea, and chlamydia. There can be harm from all those. The harm from herpes is largely, um, Your feelings emotionally, , and your sensation if you have an outbreak, but those can be treated and therefore screening for it, meaning asymptomatic population who doesn't [00:03:00] have any symptoms. 

Screening opens a can of worms, so I validate the CDC C'S description of why they have no screening. I acknowledge it. That said, I would argue. That there is so much unnecessary anxiety and often depression that is associated with herpes. I have heard in just my own practice, thousands of women say things like, no one is ever gonna wanna date me. 

This is the worst new, I mean things that are really psychologically disproportionate to the actual entity. And so I would argue that if we did a better job with educating and maybe screening so that we actually acknowledged the RO of huge number of people who have herpes, then there would. less of an emotional toll and maybe we would do a better job at educating so that there would be more prevention for herpes. 

Cause there's a little bit of prevention that you could do for herpes. Not a lot, but a little. So just so you understand, that's why it is not routinely tested. For many of your doctors even, who are amazing doctors, do not screen for it. [00:04:00] Not because they're ignoring you, but because the guidelines don't E. 

You need to know that. Just digest that. And that's for you as a woman, you as a man, you, as a trans, you as whatever gender or sex you are, um, you ascribe to, you are assigned to you decide. you are not being screened for it, most likely cuz that's the guideline. Now in certain doctors, like I tend to talk about it with my patients a lot cuz I feel really strongly about it. 

Cause I've seen so much psychological damage. So a common thing is a patient of mine is going for her s d I testing or other doctors who do decide to screen for it and then without any symptoms. They are told that they. Have H have herpes, or as I say, they carry the herpes virus. I like to say it like that cuz you have herpes sounds. 

So whatever you have, whatever sounds terrible, right? But the fact is that means you have it. That means you carry it, that means you've been exposed to it. These are all the same thing. It means that at some point in your life, you had skin to skin contact, not even [00:05:00] necessarily penis in the vagina, just skin to skin contact. 

with someone who carried herpes. Maybe they didn't know it, and then your body saw the virus just like it might see chickenpox, and then it created antibodies to the virus because that's what we're testing for when we test for herpes In your blood tests, we're testing for the antibodies. Okay, so again, let's go back. 

You went in, you see Shiva Govani. She says, oh, should we do screening for STIs? Here's what we're screening for. And I say to patients, we're gonna test for herpes if you. , there's a decent chance that you carry it cuz maybe 50% of us carry it without knowing it. Even if you've never had symptoms, even if you said you've had sex with one person with a condom every single time. 

I will say to you, I believe you, but there's a chill, still a chance you carry it because skin to skin. . Even the skin outside of the condom, even the skin outside on your vulva can harbor the, the herpes virus without you knowing it. The best way I can convince you that this is true. Two things. One is, as I joke, most of us who [00:06:00] have herpes, I say us because all of us could have it. 

Most us who have herpes did not have intercourse with someone with a big gaping sore on their genitals. They, we just didn't. Right. People don't do that. Maybe they do, but most people probably. Second way to convince you is that there are two general forms of herpes that you know of. There's actually many strains of herpes chicken pxs are herpes virus. 

But the two strains we're talking about herpes one because it's often is the culprit for cold sore virus, herpes. I call it herpes two. Cold sore. I mean, um, cold sore virus, genital herpes, right? So herpes one, HSV one, HSV two. Does anyone in your family or do any of your friends get cold sores? I'm sure they do. 

And if you've seen in with a cold sore and then their cold sores gone and then you kiss them hello at Christmas, or you drink out of their glass at dinner, you think you're not gonna get the virus. And guess what? Your body is gonna be exposed to the HSV one virus. Even though there is no active cold sore, your body's then gonna recognize the virus and create antibodies against the virus. 

So why is that [00:07:00] important? Well, first of all, because we all could be walking around having been exposed to herpes one or herpes two without know. Because there are asymptomatic shedding of the viral particles from our skin around our mouth and our genitals. Second, the reason that's important is because that means, the good news is now you've been exposed to it. 

You have antibodies against it. You could get re-exposed, you could kiss 10 more people with cold sores or herpes. You're not gonna get, you're not gonna get herpes again cuz you've been exposed and you have antibodies. It's as if you've had a vaccine against herpes. Now does that mean you have herpes and you're gonna get cold sores, genitally, or. 

The good news is for many people, no, I know that several people, I'm very close to have oral cold tour virus, herpes. I see their cold tours, we've talked about it. I've medicated many of them myself as their doctor. And guess what? I've kissed so many of them cuz they're my friends, they're my family. Do I get cold sores? 

Knock on wood, I happen not to. But have I been exposed to the virus? Probably yes. Right? . Why does that matter? Again, first of all, so if you [00:08:00] preemptively know it, you don't freak out when you hear about it from your crazy blonde doctor. Two, because you should know that you could be giving it to other people. 

Does that mean you should walk around paranoid and never touch anyone? Of course not. This is what comes, acro comes along with being an adult where you recognize life has certain amount of risks. The risk of getting herpes from kissing people, getting herpes, from having intercourse with people is there. 

You don't need to be freaked out because the likelihood of that herpes causing. is very small. Physical harm from herpes in a normal immune competent person is very small. Now, there are people with immune compromise. Infants, people, uh, who have HIV or aids who have a significant immune compromise among people who have, for example, on chemotherapy, they could actually get a very significant herpes outbreak outside of that. 

Most people, if they get her. They will either body will recognize that, give you antibodies, never have an outbreak if you're lucky, but you can still shed it and give it to other people. Whether or not you know, you carry it, you could, whether or not you use [00:09:00] condoms. Second, many people end up having a sore and not a crazy outbreak sore. 

So again, when I say the spectrum, that first spectrum person was unwittingly, comes in just for s t I testing, finds out that she's been exposed. That's one person. Second person comes to see. There's two forms of outbreaks that we see. It's a little confusing, but hear me out. There's the primary outbreak and there's the just average recurrent outbreak. 

The primary outbreak means I recently got exposed like in the last week or two or three weeks. It's a little bit longer maybe, but very recent exposure to the virus, whether or not I knew it. Again, I didn't rub up against a gaping cold sore, I just kissed someone or had intercourse with a condom. There's skin that had asymptomatic shedding of the virus rubbed up against mine and then I suddenly felt fluey, achy, maybe swollen lymph nodes in my pelvis along my groin, maybe in inability to pee cuz I'm in so much pain from multiple.[00:10:00]  

on my vva. Okay. And the hallmark of that is multifocal source. So what looked like cold sores down there? Multiple. That is recent exposure and what we label a primary outbreak. Right. You were just exposed and you got it. How can your doctor tell? Well, first of all, an astute doctor usually can tell by looking at it, but also that we can culture the actual sore if we get enough of the viral particle and the culture will come back positive for HSV one or two because you can either get it from genital contact or oral to genital contact. 

So you could never have had intercourse, genital to gen. You could just have had someone give you oral sex and you can get their oral cold sore virus, herpes genitally. We see that all the time. How would you know which one again, the only way is a culture of the open sore and then the culture will come back with HSV one or two. 

At that point, if you get your blood tested that day, you might very well show up with no antibodies yet because your body saw the virus, [00:11:00] but it didn't yet mount antibodies. So sometimes you need to have this discussion with your doctor. Your doctor makes the supposition that it's herpes. Maybe she cultures it and gets you the type specific if she can. 

Not every place has the ability to do that because it's a test that you send out to certain labs, and then if she sends you for blood work that day, what she should be saying. This might come back negative for herpes. It doesn't mean it's not herpes. It means we should retest in three to six months, and then we'll see that your antibodies have shown up. 

Just like with the Covid vaccine, you don't get antibodies right away. Okay? The second person, which is so much more common is the happy unwitting. I've been in a relationship for 10, 20, 30, 40 years, or. Classically, I use this example, a widower who's had her husband unfortunately passed away 10 years ago. 

She hasn't had intercourse in 10 years, right? And only had one prior partner that was him. She comes in with what maybe looks like a teeny little cold sort init, Italy or. More confusing. A little fisher, a little cut. I keep getting this cut. Or the famous case I always think of as the sweet, wonderful person who said to me, I keep getting a spider bite in the same place [00:12:00] every year. 

Right on my buttocks. Not even your genitals, your buttocks and your doctor can astutely again, describe to you the situation calmly culture it if she can. If there's enough of Uzi stuff coming. and what she can then say is, because this is a unifocal, not multifocal, just one little sore, it just cropped up. 

You don't have any of the other symptoms like achy fluidy, chili, lymph nodes, all you have is that one sore. You were probably exposed to herpes, who knows when? A year ago, 10 years ago, 20 years ago, 30 years ago. . Even if you had sex with one person one time with condoms, or only had oral sex with one person, one time, you could have been exposed. 

Your body saw it. Your body harbored the virus. It never showed up. It never had an outbreak. You never got blood tested for it, and now it's suddenly popping up because you were more stressed. You got waxed that caused some local irritation and stress. All these different things that again, can allow the virus that's living there that you could have been giving it to other people, by the way, to just pop up as a unifocal, small [00:13:00] little. 

that is not a primary outbreak. Even though that's your first, you say to her, I've never had this before. This is my first. I believe you. It is your first, but it's not a primary outbreak. Primary outbreak. Recent exposure, multifocal feels horrible. You'll only have one of those in your life at most, and most people have none of those primary outbreaks. 

Most people will either have no symptoms at all or have occasionally one, maybe two. They'll kind of tell like, Ooh, it feels like a tingling or burning, just like around their mouth. If you talk to people with cold sores, and that's it. And again, the good news is if that happens, it might never happen again, or it just might happen occasionally where you feel it, you know it, you take the medication and then once you've taken the medication for two to three days, it stops it from popping up. 

We need to have a whole nother discussion about the medication and prophylaxis. How to re, how to decrease transmission to other people. We need to have a very clear conversation about herpes one versus herpes two, the cross reactivity, all those different things. First and foremost, I want you guys to go back to what I said at the beginning, which is herpes is common. 

[00:14:00] Don't freak out about it. Don't be devastated by it. Don't let it get into your mind and make you feel like it's the worst thing ever. Cuz guess what? There's so many worse things. If at least 50% of us carry it, it can't be that bad. Okay? All right. I hope this helped.