The herp and we all got it!


[00:00:00] Let's talk about her baby B. You know what we're talking about herpes. Do you know why I'm smiling? Because I love talking about her. . That sounds crazy. I know. Do you know why I love talking about herpes? Because I feel like when I get to talk about it with patients, I can sense that they're like, oh, really? 

You mean I'm not like totally disgusting and gross? You mean I'm not like alone? You mean I'm not like, it's so embarrassing and I really think that if we talk about it more, then millions of people, millions of you will feel the same way and you'll all go. Collective sigh of relief. Oh, like everybody has it. 

And the answer is, I say everybody has it. Do I literally mean everybody has it? No, but I mean like a ton of people. And do you know that one of my many dictum is when something is common, then it's probably not that bad. Like when you hear a doctor say, oh yeah, that's really rare. You're kind of like me. 

That's a bummer. But when you hear like, oh wait, we're talking about herpes. Yeah, I see that all the time. Aren't you [00:01:00] comforted? Like it's one of the times in your life where you actually don't wanna be unique as I say it, right? Like I love being unique and standing out, but like not when it comes to my medical stuff. 

And I've stood out a lot when it comes to my medical stuff and I don't like it. So I can try to comfort you guys like I do my own patient popul. By saying it's really common, and again, how common, it actually varies widely depending on what you read. But let's just say the C D C for example, says, and we're talking mostly about genital herpes, which I'm gonna say for herpes two, which is largely genital, but I'm gonna qualify that in a second. 

So herpes two, which is mostly genital, they say about 10 to 15% of us. us, meaning people up to age 49, which is kind of a random stratification cuz by the way, I take care of a ton of patients and when I think of my patients from age 50 to 90, who also have it, we're adding to that percentage. But again, let's just say they said 10 to 15%. 

[00:02:00] So it's like I can't do math. Almost a fifth of people, which I'm gonna round up because they didn't add the over 49 group. So let's say a fifth of us have it. And now here's the further thing. I don't wanna go against the C, d, C, but when they say have it, I don't know how accurate that is because millions of us, you have not been tested for it. 

So you don't actually know if you have it. Okay, let's shake it down. Generally, herpes one occurs around your. , generally herpes two occurs around your genitals generally. I say generally because there's a really complicated discussion we could have about all this, and I could talk about this till I'm blue in the face, but you can actually get herpes one genitally. 

Can you get herpes two orally juries out? I've never seen it. I don't know if any of my colleagues out there who are watching this have seen it. If you have let me know. Okay. How would you get herpes? Well, interestingly, [00:03:00] You get it from skin to skin contact. That does not mean from vaginal penis penetration. 

That means penis to penis, penis to vagina, penis to vulva, vulva to vulva, mouth to vulva. Okay. I think I mentioned all the ways. That I can think of where your skin, and that's important to know because I, I have seen patients who have never had vaginal intercourse. They have never had sex in the traditional sense of a penis in the vagina, and they've still gotten herpes, either from oral sex or from just rubbing. 

Okay. So again, how would you get it generally from sexual contact? How would you know you. Well, one way is, oh my God, I have like all these little Uzi sores all over my vulva, meaning the outside, the labia, and they hurt and I feel like I can't pee that. Ladies is a primary herpes outbreak. That means you were just exposed in the last couple weeks, you got a big dose of the virus, unwittingly you didn't [00:04:00] know it, and hopefully your partner didn't know it. 

And then all of a sudden you get all these sores and they're really, really horribly painful. And sometimes you can't even pee. and you see your doctor and she will help decide if that's what it is. And then she will put you on one of a couple different medications, the ones that sound like Acyclovir Valcyclovir, and that will actually decrease the length of how long you have that outbreak for. 

And then I promise you that for the rest of your life, you will never have an outbreak like that. ever, like ever. The primary outbreak, meaning that I was just exposed recently, is always the worst and good news. Millions of people never have that. In fact, I would estimate that most people I know with herpes, with herpes, meaning they carry the virus, they actually have never had what I just described, that primary outbreak. 

Okay? Now again, if you have that primary outbreak, you go see your. She will look at it and decide if that's what it is, depending on the doctor. Not everyone does this and it's not wrong not to, but I will [00:05:00] often do a couple things just to really cinch the diagnosis. I will culture it because when you do a little culture and it's Uzi, then you actually can send it to the lab and they'll tell you if it's herpes one or herpes two. 

It has to be oozy. If it's dry, they won't get any virus out of it. I will send for blood tests because then we can determine now and then in like four to six months if your body has had an antibody response and shown up with the herpes antibody. And I do that more for academic reasons, to really try to teach and instruct patients like, here's what it is, this is how it happened, and now you know you have it and now you're immune to it, but now you can give it to other people. 

So we'll talk about that in a sec. What's a second way you might know you have herpes? Oh, and let me just say, when you have that primary herpes outbreak, it could have been herpes one or herpes two. I've seen them both truly legitimately like multiple times. Like I can't count how many times I've seen that be herpes. 

One meaning an unwitting patient who did not know that her boyfriend or girlfriend had it around her mouth, and maybe the boyfriend and girlfriend didn't even know that they had been exposed to it by unwittingly kissing a family member when [00:06:00] they were. , they harbored the virus. They didn't have any cold sores. 

They didn't think they were able to shed virus, but yes, they a are able and they had oral sex and now the young girl got it. Okay? So that is a common, common scenario. And then if your doctor cultures it, it would show up as herpes one. Or if it was from skin dis skin genital contact, it would show up as herpes two. 

Now that means you have herpes and that means you're gonna carry herpes for the rest of your. , does that mean? Oh my God, herpes is forever in that ominous 1970s PR slogan sort of way. No meaning to me. It just means just like you carry chickenpox for your whole life, you carry herpes for your whole life. 

And I think that if we say it like that, frequently, constantly, casually, we can encourage women and men to understand that, yeah, I get it. Nobody wants herpes, nobody wants anything. That is a, like an ease that you have to talk about with a doctor. But it's like the common part of life. And if you're going to. 

Endeavoring on an adult endeavor like sex, then you have to accept that this is what comes along with it. Okay? So don't be saying to me, oh my God, that [00:07:00] sounds so devastating and gross. If you're devastated, if you're that disgusted, then one answer. One answer, don't have sex, which is okay, you could choose not to have sex. 

It's not the end of the world. You might be too young to B kind of deal with this psychologically. Or you might be older and say, you know what? Stakes are too high. I'm not gonna do it. But if you're enter entering into an adult endeavor, like. With condoms, which do not always protect against a herpes because the herpes virus can live everywhere, not just inside the vagina or on the shaft of the penis, but it can live on the vulva and it can live on the skin around the penis. 

So again, even if you're using a condom every single time, and even if you said, but I've only had sex with one person my whole life, I'm gonna say, I believe you. But I'm also gonna say, don't be devastated about something that is just so. Accept it as a reality. Accept it as just a necessary part of what we. 

Just like every single day when you drive, you know that there's a slight chance you're gonna get into a car accident, but you still do it, but you take precautions and then you accept [00:08:00] what could happen. This is like a small fender bender. It's annoying. You've taken precautions, and here it is. Okay. So again, we've determined that's a primary outbreak. 

What's another way you might know you have herpes? Well, you go in for your doctor's visit and your doctor says, Hey, let's do some S STD tests. STI tests, we call them nowadays, and that means we're gonna do gonorrhea and chlamydia, which we can check either from your pap smear or a vaginal culture or urine culture or, and we're gonna check blood tests for hiv, hepatitis, syphilis, and herpes. 

This is what I say, 50,000 times a day. Two women of all ages by. , this is what I say to them is, I'm pretty sure I'm not gonna call you about h, hiv, hepatitis, or syphilis, because those are pretty rare, but I'll never bet that I'm not gonna call you about herpes because it's just so common. Tons of us carry herpes and we don't even know it. 

To which my patients always reply. I don't have herpes. and then they get my little lecture. And honestly, it's the same thing that a guy might say if a young [00:09:00] woman or older woman says to her newfound partner, Hey, I gotta tell you something. That's a whole nother video, by the way, where I could tell you about like my script as to how to talk about herpes. 

But I'm not gonna give away those secrets yet. So let's say you say to someone, Hey, turns out I have herpes and there's a way I think you should say it, that's casual without making it seem like you've done something gross or. But let's say you say that to your boyfriend and his response is, I don't have herpes. 

You should respond back just like I do with all my patients with. So people can be asymptomatic and still shed virus. Many people have never gotten tested for herpes, even if they went to their doctor and had s t I testing. Many doctors don't check for herpes, not because those doctors are wrong, but because there's a bit of a controversy as to whether or not we should be checking for herpes. 

It's not dangerous. It's not something that bothers you if you're not symptomatic. So why should we? Increasing anxiety and increasing the cost to the system. Some doctors might say, I personally would say that I've seen the flip side of [00:10:00] it, which is that it causes a disproportionate amount of anxiety and stress and often depression when people find out they have herpes, which still. 

Confounds me because I can't say enough how confident it is and I can't say enough how much. If I'm your gynecologist and I don't think it's a big deal. Please, please, please don't be so sad about it. But because I've seen that I actually very strongly think that we should all be tested for herpes at all ages so that we all know who really carries it, so that we realize how C it is so that we stop freaking out about it, and I maintain that. 

If from a young age when you're first sexually active, you and your partner consistently get tested every six to 12 months. Then all of us will kind of know when we've been exposed. We've know, will know. age range and and time range where we've been exposed. And we won't have to look back and be like, oh, was it that guy? 

Was it this person? Did my husband cheat? What happened? Because that is how it is right now, and that's not good. So again, the second way you would find out is because you went to your doctor and you got tested and you had no [00:11:00] symptoms, and your doctor calls you and says, Hey, turns out you have the antibodies to herpes. 

That's what we're testing for is the actual antibodies to which patients will say to me, does that mean I have it? and my response is well have, it is a funny term, have it sounds like I have herpes, like it's something horrible. So the answer is, yeah, you have it, but it really just what means? I was exposed to herpes, my body created antibodies. 

I was lucky enough, I never had any symptoms. I've never had an outbreak. I didn't have that primary outbreak that I heard about. That's so painful. I was just lucky. But will I get it in the future? Meaning will I have an outbreak in the future? And the answer is maybe, in other words, millions, probably billions of people live their entire life having been exposed to herpes and never having an outbreak. 

Whereas millions were exposed when they were, let's say 20, and then don't have an outbreak until they're. 55 where they notice a teeny little sore, they're not even sure what it is. They go see the doctor and the doctor has to say things like, Hey, so here's the deal. I think it's [00:12:00] probably herpes. We're gonna test for it, and then I have to go into my hole. 

Herpes can last in our body for. Decades for our entire life without showing up. So this does not mean a sign of infidelity. In other words, ladies, if you've been in my office, you know that. I'll say to you, if I'm telling you that this is herpes, and this is like a teeny little like single lesion. , you did not get cheated on. 

This is something you could have carried forever, and there's no way we would've known unless everyone starts getting tested, in which case we'd all know from the beginning. But again, if it's a multifocal, really painful, what we call a primary herpes outbreak, that's different. That means recent exposure. 

And then if it's herpes one, again, it doesn't mean infidelity. If it's herpes two, there's a little bit more of a question because you only get that from skin to skin genital rubbing. Okay. But again, if you get that single little outbreak where you're not even sure what it is, just feels like a sore. 

Maybe you scratch yourself, you're not sure. That's something that can also easily be treated. So those are some of the facts about herpes. We could talk even more about. The fact that, for example, [00:13:00] having herpes two might be a little protective against herpes one because the virus is cross-react and part of of, of how your body responds to them. 

We could talk about what you should do as far as treatment. Do you need treatment? We should talk about the fact that I tell my college girls, Hey, get all your friends together in every six to 12 months. Go get STI testing so that you guys know what's going on. And I'm pretty sure like maybe one in 21 years has listened to me. 

you know who you are. So there's so much more we could talk about, including my script as to how I think you should kind of discuss herpes without it being Mia Culpa, I did something wrong and I'm dirty. As opposed to like, Hey, these are the facts, and I'm here to educate you on herpes because you as my future partner, need to know just as much as I do my parting words, ladies. 

And guides. If you're here is this, please don't feel like herpes is a terrible stigma. We all have it, and again, we all, I don't mean everyone, but many of us have it. It is not something dirty. It does not mean you were a slut. It does not mean you slept around. It might mean that you didn't use condoms, but you very well could have. 

And most importantly, [00:14:00] you're not sick. This can be managed, so if we all talk about it again more openly, we will all know the facts about herpes. So it's National Herpes Awareness Day. Spread the word, spread this video. I'll talk more about it cuz I got more to say. That is all. I hope you're all having a great day. 

It's a rainy Tuesday here today. Bye.