The herpes ahhhgain!


[00:00:00] the Herp. We're gonna talk about the Herp people. I feel like I talk about the Herp a lot, and I'll stop saying the Herp, we'll call it actually what it is, which is herpes hsv, herpes simplex virus. We're talking about, again, because it's super common, super prevalent this week alone. And I've only been in the office Monday and Wednesday and I've seen probably 70 patients without exaggeration and talked to many more, and a good number of them.

We were talking about herpes and they were all shapes and sizes, all creatures, great and small, like young, older. Menopausal, premenopausal, wealthy, not wealthy, black, white, fat, thin like everybody, because herpes is common. So what I say about herpes, here's my herpes, like my thoughts on herpes and my herpes spiel.

First and foremost, first and foremost, please know that it is common, like the data varies, but [00:01:00] anywhere from 20 or 30% to 80% of us carry herpes, depending on if you look at both strains or just one strain. So, In general, multiple strands of the herpes virus because for example, chickenpox. Varicella is a herpes virus.

But for our purposes, we're talking about herpes. And when we say herpes, we mean the virus that causes either cold sores around your mouth or cold sores in your genitals. So there's herpes simplex. Virus one, HSV one and HSV two. HSV one typically causes cold surrounds around your mouth, but you can get them Genitally.

HSV two typically cold causes cold sores, genitally rarely around your mouth. They are incredibly prevalent. Again, 20 to 80%, just depending on what you read, you'll find it's so incredibly prevalent and many of. I'm gonna venture to say most of us don't know that we carry the virus, and that's so important for so many reasons that we'll talk about it in a second.

So first and foremost, we're talking about two [00:02:00] different viral strains of herpes, herpes one, herpes two. You can get herpes one. Genitally meaning oral sex. You gave it to someone. , they can get it. Two very important to know, condoms do not protect you a hundred percent because when you're wearing a condom, it's only covering the shaft of the penis.

And the herpes virus can live all around the base. It can live not just inside the vagina, but outside on all of the labia and all of the vulva outside. So wearing a condom is so important for so many s t I preventions, but it's not gonna a hundred percent protect against herpes. Again, why is that important?

Because you might have had sex with one person with a condom your entire life, and you still could get exposed to herpes, and it does not mean any infidelity. So HSV one and two, very prevalent, one and two, they can be transmitted with or without condoms. They can be transmitted when you have no symptoms.

Asymptomatic shedding, meaning you're carrying the virus, you don't realize you have it, you've never had any symptoms, and you [00:03:00] unwitting. Kindly not because you're doing anything malicious, have sex with someone who either has it and gave it to you because he or she didn't know it, or you gave it to them because you didn't know it even if you were a condom.

Okay? That's really important to know also. But don't we all get tested for it? You might ask. No. In fact, You might know if you're my patient. I am on a bit of a mantle to try to get everyone to get tested. So when I send for s t I testing, I tell everyone we're gonna check for gonorrhea and chlamydia, either from your pap smear, from a vaginal culture, from your urine, and we're gonna do H I V hepatitis, syphilis, and herpes from blood tests.

do you have to find out about herpes? No. You could choose not to. I encourage everyone to, because I think it's good for all of us to know about herpes because if all of us knew about it, then the, the demystification would start to happen and the stigma would be removed because people are so freaked out about herpes because they think they're the only one.

When in reality, I'm telling you, you guys are a dime a dozen, and I mean that in a. again, you know how I've joked that in your doctor's office you don't [00:04:00] wanna be unique other than in your personality when it comes to medical issues, you wanna be common. It's like so common to have herpes. It doesn't freak any of us out.

As doctors, we see it all the time, and I say that in a nice way cuz I get that it freaks you out because if I were 25 or 51 the way I am and I didn't know about it and all of a sudden found out I had it, I'd be freaked out just like you guys are. . This is why I want us to talk about it more. So do you all get tested for it?

The answer is largely no. And it's not wrong. You cannot and should not malign your doctor, your family practice doctor, your internist, your ob, G Y N, if he or she has not tested you, because in fact, the c d C guidelines do not advocate for routine screening. I take umbrage with that because I think that if we actually routinely screened it along without the other STIs, we would have more information.

We would have more knowledge, more. Decreases anxiety. Ergo you guys would be less freaked out. But the CDC is not in for the psychological aspects of people. And in fact, the CDC verbiage, I don't remember exactly, but some basically implies that we should not [00:05:00] universally screen because the anxiety provoked by a positive test is so frustrating.

Now while I get that, because I'm the one who has to call patients and be like, Hey, turns out you've been exposed to herpes. I think the anxiety is largely because not everyone gets tested. So again, if everyone got tested, we all talked about it openly. We all made it clear that listen. When you have sex, as I put it, it is an adult endeavor, and with adult endeavors comes some consequences that you can't control.

You can use condoms, you can pick your partners judiciously, but assuming that you are happy with your partner and you don't think that she or he is a dirt bag, then you have to accept that if they've had any sexual history at all, they might have been exposed to herpes. and HPV, by the way, and they might not have been tested.

And even the tests are fraught with just, um, difficulties in our interpretation. Sometimes, like I've had patients who I've seen my own tests, they've come back positive for herpes and a year later their antibodies show up negative because when you're testing for herpes, you're [00:06:00] typically testing the.

antibody response, your body's response to the herpes virus. You can sometimes test the actual sore with a special culture, but it's only gonna come out positive if there's enough of the virus kind of oozing there. So the cultures are not very accurate, and it has to be an open, oozing sore. You can't just blindly culture like vaginal discharge or a dry vulva, it's not gonna work.

So when we're testing for herpes, we're testing indirectly for the antibody response. Now, like I said, many of us carry the virus, but we have. Symptoms. I know that I, for example, have several close contacts in my friends and family world who get cold sores all the time. I figured I probably had the virus and guess what?

I checked and I have antibodies to HSV one, which means I carry the herpes, the oral cold sore virus, I call it, knock on wood. So far I've never had a cold sore. I might get them in the future all of a sudden if my immune system is depressed enough. That herpes, the virus that lives there. Even when I don't shed it [00:07:00] actively because I don't have any sores.

I think I am still asymptomatically shedding it and all of a sudden it can pop up and become a little sore. Plus I can give it to people. We all can give it to each other by using each other's glasses, kissing, sexual contact. So again, what have we learned here? Herpes is common. There are two strains that we're talking about.

The oral strain can also go gen. , you probably have not been tested unless you're one of my patients, in which case you probably have been tested, in which case you might be annoyed that I tested you because now you know about it. But I think it's important for everyone to know about it. If you are dating a man or married to a man, I will venture to guess.

The vast majority of your boyfriends or husbands have not been tested because it's just not something that most people routinely do. So a very common. is, I will have a patient who comes in and says, oh my God, I just found out I have herpes. Or I'm telling them, oh my gosh, it turns out you have herpes. I don't say, oh my gosh, cuz that's too inflammatory.

Oh, it turns out you have herpes. I immediately remind them or tell them, if they don't know that this does not mean infidelity, [00:08:00] that this does not mean that their current partner was with someone else recently. In other words, you could have gotten herpes when you were 18 years old and you first were sexually active even if you had a condom, even if you'd only had sex with two people in your life and it could show up when you're 50, 60, 70, 80.

I have. Multiple times. Any gynecologist who's been practicing more than a year will tell you they have seen these things literally. Right? So you see it later in life. And then you have to remind patients that it doesn't mean that their current partner has cheated invariably, if they go back to that partner and say, turns out I found out I have herpes.

Like, do you have herpes? Or did you know that their partner will always say the same thing? I don't have it. I don't get any outbreaks. You didn't get it from me. Now let's break that. That is not true. You might have it. You might have it and don't know it. You might never have had outbreaks. And if you say back, well, but I mean, I don't have it because I've been tested.

The answer is you probably weren't tested for herpes. No, I got tested for everything my doctor told me. He tested me for STDs. Yes, but my doctor, the [00:09:00] gynecologist told me that you as the man probably didn't get tested for herpes unless you specifically asked, or unless your doctor specifically told you they were testing you for herpes because it's just so common.

Another common scenario is someone has a recent partner, a new partner, six months to a year, and all of a sudden, This pr, the, a patient of mine, for example, will have an outbreak. Now again, they've had a recent partner. That partner could have been with someone in the past. None of this means infidelity.

None of this means that the new boyfriend was, you know, crappy or a dirtbag or lying. Cuz let's assume that that boyfriend literally did not know that he had it. So we cannot be angry. We cannot malign people for this. It's different than if someone knows it and knowingly does not tell you that. Improper and unethical because if you know that you carry herpes, it is your duty and your ethical burden to ensure that you try to minimize the exposure to other people.

How would you do that? Do you have to stay abstinent for the rest of your life? Of course not. Why would you do that when probably 50% of us carry it anyway? What you should [00:10:00] and can do is first and foremost, have a conversation with your new partner. Have you been tested for herpes? And if they say yes, I hate to say this, but I would push and probe a little bit and say, are you sure?

Cuz you might not realize that even when your doctor says they're testing you for STIs, they don't often check, check for herpes. Let's look at the results together. And that's not because you shouldn't trust them, that's because you have to understand that they probably just don't know. So first and foremost, after ask if they've been tested, because if they haven't, they should get tested.

They might carry it. If they carry it and you carry it, then you're not giving it back and forth to each. That's number one. Number two, let's say they did ca, they did get tested. They don't carry it, and you do, and we're talking about herpes two here. Let's say you carry herpes two. They do not. How do you decrease transmission condoms?

but it doesn't completely eliminate it, but it decreases it. And taking one dose prophylactically of Valcyclovir, acyclovir Famciclovir, which is the antivirals that we use for the herpes virus, right? So if you took one pill a [00:11:00] day, that is prophylaxis and that will help further decrease. So condoms. One dose a day of the prophylaxis, the likelihood of them getting it is far less, but not zero.

I guarantee you ladies, that the majority of men you meet, if they're a good guy, they're not gonna run from this. And if they do run, the minute they hear you say that you have herpes, that is a litmus test for that guy not being the right guy. So if you have a kind and gentle and calm, Conversation where you are in a position of having understood what we're talking about, and you are in a position to educate your new partner or boyfriend or old partner or boyfriend.

If you're just finding out about this and you're freaked out, you need to make it clear to them that you're finding out about it now, but this is something you both probably carried and you won't be able to say who gave it to whom. So in those situations, you have to understand it so that you can be calm.

You have to make sure that you're conveying the right information and then you come up with a shared decision. Now, I get it. I'm not that old fashioned, and I know that things happen in the heat of the moment, and if that's happened and you haven't disclosed it, [00:12:00] I don't suggest beating yourself up over it.

But I do think it's worth coming up with a plan ahead of time. And in an ideal world, you're having intercourse with people that you have actually had a conversation with and discussed STIs with, and certainly at the very least are using condoms. , okay. That's just scratching the surface about herpes. I mean, I could literally talk about this for three more hours and probably not be able to review all the possibilities.

Um, at some point in the next maybe week, we'll talk about what happens if you have your first outbreak versus your primary outbreak, because the first outbreak is different than a primary outbreak. I'm gonna let that sit there and marinate so you guys can ask me questions about it. Um, and we need to just talk about, again, testing.

Like swab testing, meaning the culture testing versus blood tests. There is no vaccine for it. You probably know we have to talk about a lot of different details just about what kind of script, like how do you talk about this with future partners who you've never met before, when you think that they're gonna like, I'll leave and [00:13:00] never date you again, and I can be here to tell you.

I have tons of patients who thought that and now they're happily monogamously in relationships with great people. Okay. You can tell I have a lot of feelings about herpes. Right. Okay. Okay. Bye.