Episode 30: It's time to talk about H...erpes

Dr. Sophia:
Welcome to the Dr. Sophia ObGyn podcast. I'm an ObGyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Hello everyone and welcome to the Dr. Sophia ObGyn podcast. Today I will be speaking on a very touchy subject. The subject is herpes, herpes, herpes.

Touseef Mirza:
People don't even like to say that word.

Dr. Sophia:
They don't even like to say that word. Yeah, I agree with you. And so that is the reason why we had to talk about it. We've just gotta, you know, put a pin in it, burst the bubble, and start talking. As always, I am here with my good friend and co-host Touseef Mirza.

Touseef Mirza:
Hi everyone. So we had done a previous episode on STIs and STDs, and we did talk a little bit about herpes, but we really wanted to take a whole episode to just dig in into this type of STD just because it-

Dr. Sophia:
Just has so many connotations, stigmas, just badness all around it, and it makes people feel so terrible. When they get this diagnosis, the number of patients that I see on a relatively regular basis that I have to kind of give this news to, they really were completely unaware. And I just realized, okay, people just need more education. We need to talk more about it and talk about it in a way that really destigmatizes this virus, this disease, so that people can feel a little bit more empowered to live their lives more normally.

Touseef Mirza:
So let's first start with the basics. So we already said that herpes is a sexually transmitted disease or infection. How would you describe what herpes is? If somebody says, what is herpes?

Dr. Sophia:
Well, first thing actually herpes, not all of herpes is considered sexually transmitted. So let's start there. When we think of herpes, there's type one and type two herpes, or HSV.

Touseef Mirza:
Those are the different types?

Dr. Sophia:
The different types. HSV– it's HSV one or HSV two. When we're thinking about herpes, and herpes type one is what people associate or what we think of as causing cold sore usually affects areas around the mouth. And to be honest with you, most people get herpes type one when they're very young because they probably get it from adults around them. You know, you're a little kid or you know, and adults around you are, oh, you're so cute and they give you a kiss or whatever the case may be in terms of how you get it. Because this is a virus that you get through close contact, whether it is type one or type two.

Touseef Mirza:
So HSV one or herpes type one is not something that is transmitted sexually?

Dr. Sophia:
It was good. Okay. So the caveat, here it is. HSV type one can cause both cold sores and affect the areas around the mouth, but it can also be transmitted genitally or to the genitals from oral to genital contact. And so HSV type one actually is the one that can be both sexual or non-sexual contact.

Touseef Mirza:
But would you say most of the time it is transmitted mostly like orally?

Dr. Sophia:
Yes. Okay. Yes. And that's why it's associated with what we consider and what we, you know, in layman's terms would usually call a cold sore.

Touseef Mirza:
So cold sore is essentially a type of herpes virus?

Dr. Sophia:
Yes. People who get cold sores have HSV.

Touseef Mirza:
All right. So that's HSV one. So what about herpes from a general specific perspective?

Dr. Sophia:
So HSV two is the one that we associate as being general or what we call sexually transmitted. It occurs typically through sexual contact. And the thing is, it doesn't necessarily need to only happen through penetrative sex, it's through close sexual contact because the virus can be shedding and can be an area such as on the labia, it can be on the scrotum. It's not only through, for example, an exchange of bodily fluids, but rather the close contact with the virus.

Touseef Mirza:
So you said the word shedding. What do you mean by that?

Dr. Sophia:
So shedding the virus just means that you have viral particles or, or parts of the virus that your body is kind of eliminating. But that process can be happening whether you have symptoms or not, which is a part of why herpes in general, whether it's type one or type two, is a virus that is so easily spread, number one and number two. And why it's so common because you can spread the virus without having symptoms of the virus.

Touseef Mirza:
Alright. So let's just go back for example. So when we are talking about the virus that is shedding, the virus is basically some cells.

Dr. Sophia:
Some viral particles or viral cells.

Touseef Mirza:
Cells. Sure. Do they typically live in the genital area? Like for a woman, for example, is it inside of her in her cervix?

Dr. Sophia:
No, this is my point. My point being that it doesn't, that's why it doesn't necessarily only have to come from penetrative sex. Women can have these lesions in any part of the genital area. So they may experience it on the buttocks, they may experience it on the labia, they may experience it on the perineum, they may experience it around the anus. And when we're talking about what they're experiencing are what we call herpes lesions. And those typically can look like small blisters bumps, little tiny cuts. It's the great masquerader. It can look like anything. Sometimes it resembles so many different things.

Touseef Mirza:
So you're saying that it can be anywhere from the vulva all the way to the back towards the anus, to the buttocks and also inside the woman? Is that what you're saying?

Dr. Sophia:
Yes. It can still be, and it can also be on the surface of her cervix. It can also be on the walls of the vagina. It can also be at the level of her urethra. Oftentimes when people have even urethra. Okay. Even though urethra. Yes. Because oftentimes when people get their initial outbreak, the only reason why they know is because they may have a sensation like they can't pee. And, part of that reason is that peeing is extremely painful. And then that's the first sign that you know, like, wow, something's really wrong, let me go to the doctor or what have you. And then they find out that they were exposed to herpes. So I just wanna take it back a step. First of all, let's think about what are the symptoms of herpes and what does herpes look like?

Like I said, it can be the great masquerader and when it comes to symptoms, again, even that is so vague and it's a part of the reason why most people don't know that they even have it. People who have herpes say that their symptoms can be anywhere from a little bit of itchiness, burning, tingling, pain, or pins and needles. Burning. Ants crawl on them. It's a very odd sensation. They just feel weird, weird. They feel like they're swollen, perhaps, and they're not. So it can feel like so many different things. It can feel like they have a little cut. It can feel like a small ulcer. It can be like a pimple.

Touseef Mirza:
So when you say a pimple, is it more like a little bump?

Dr. Sophia:
Like a pimple would be.

Touseef Mirza:
So I'm thinking about how it looks physically. So it's not, it's not like I just have the vision right now, like poison ivy is a different type of bumps where it's like, it's just spread everywhere,

Dr. Sophia:
No, this is not typically spread everywhere or certainly not in what we call recurrence. It can be spread everywhere and have more, that kind of what you're describing on the initial outbreak where it's kind of all over. And if we're, especially if we're talking about genital herpes where it literally, it can be all over if we're talking about a woman all over her vulva inside of the vagina, at the level of the urethra where she has multiple, what looks like ulcers.

Touseef Mirza:
When you say ulcers, what do you mean by that? What is that?

Dr. Sophia:
Ulcers look like if you had a cut and peeled off the scab.

Touseef Mirza:
Okay. Thanks for the visual.

Dr. Sophia:
Sorry you asked. You asked. I did, but they can be like micro, it can just look like you cut yourself shaving. And this has happened to multiple people. We women shave all the time. So just imagine that herpes can look just as small as that or as big as, you know, little blisters or bumps or pimples clustered, not clustered. Only one. Maybe a couple will band together.

Touseef Mirza:
So that's even like for the first time you ever get it, the first time it could be like zero?

Dr. Sophia:
Or it could be like all over the place.

Touseef Mirza:
Okay. And is it the same thing, like the same type of effect for men as well?

Dr. Sophia:
It can be. They can experience difficulty urinating. They can experience ulcer-like lesions, things that are tender. That's another really key thing is that when you touch it, it hurts. And I will say this, oftentimes when you get the first initial outbreak with herpes or the first exposure, it's because it's a virus. It causes typical viral illness type feelings, which are associated with flu or like a cold. Sometimes people describe the concept of having cold -like symptoms or flu-like symptoms. They feel fatigued, they feel tired, they feel feverish. And then two weeks later they then have these little bumps, ulcers or what have you and whatever area they were exposed to.

Touseef Mirza:
That first part is when the body is trying to fight it off basically.

Dr. Sophia:
Yes, that is correct.

Touseef Mirza:
Okay. That is like, like when we have an infection. When we have the flu.

Dr. Sophia:
That is correct. Okay.

Touseef Mirza:
We know that with herpes, you might still, even if it's not itching, you might still predispose somebody to genital herpes.

Dr. Sophia:
The thing about herpes is that you can have no symptoms, meaning you're not in pain, you're not having flu-like symptoms, you're not having itchiness, discomfort, tingling. You don't have any signs of a blister, a pimple, a cut, an ulcer, none of those things. But you still have the potential to transmit the virus to someone else. So that is probably one of the key takeaways here in terms of herpes, is the fact that it can be spread, what we call asymptomatically. What does that mean? You have no symptoms at all. And yet you're able to pass it on to someone else. Now granted that's someone else, as someone who is also susceptible to getting it. At the end of the day, viruses are opportunistic and herpes is no different. What does that mean? It means that for the person who may already have herpes, if that person is a very healthy person, they don't really get sick in other ways. They typically may not have any symptoms at all of herpes. It just kind of is happening in their body. They still have it, their bodies are constantly fighting it.

Touseef Mirza:
So it doesn't show up.

Dr. Sophia:
So it doesn't show up, but it doesn't mean that they can't transmit it. And that's where the problem is that people who can have the virus never know that they have it because they never get any symptoms, and yet they are still able to spread the virus.

Touseef Mirza:
And you might all of a sudden start to have symptoms even if for like two, three years you had no symptoms, you had no symptoms.

Dr. Sophia:
It's such a tricky, I'm telling you that little bugger, it's such an a tricky thing because you may have been exposed to herpes, you body mounted zero response in the sense that you had no symptoms, you didn't get a flu-like illness, you didn't get any pain blisters, anything, you didn't have any problems to urinate. You didn't, you didn't get anything. You had no idea. And that was one, two or three partners ago that you were actually exposed to. Now you're, for whatever reason, let's say you do, you get a really nasty cold. You just, you get really kind of torn down with this with some other viral illness. Or even like, you know, like who knows pneumonia, God forbid a week later, all of a sudden you have this weird discomfort, itchiness, pain, even only to find that you have little bumps perhaps around your labia on one side or the other.

Touseef Mirza:
When we say labia, just so everybody's clear, where is the labia

Dr. Sophia:
Part of the vulva? Okay, we're still talking about women's body parts.

Touseef Mirza:
Okay. So where, where is it? Around the vulva,

Dr. Sophia:
The labia? It could be anywhere. The labia are the lips of the vagina, the vulva. It encompasses where we see the clitoris. We have the labia, mada, minora, all those things. So you kind of had the flu a few weeks ago and then now all of a sudden you get this thing. So you kind of like, you're like, ah, this is weird. I feel weird. Maybe I cut myself shaving. Oh, I sat in a public bathroom and that's how I caught it. Well, I must have something because I sat in a public bathroom. Not that's how I caught it. That's definitely, that's not it. It's not how I caught herpes. It's that when they come in and they have some discomfort, symptoms, a little pimple, a little something, and they say, oh, I think something's wrong because I had to use a public restroom

Touseef Mirza:
Just like something's wrong.

Dr. Sophia:
Right, exactly. But this is what I'm saying with how easy it is to be a misnomer. You know, and then later on only to find out, no, that's actually a herpes outbreak that's happening because your immune system went down okay. From the flu that you had a couple of weeks ago. And now that virus, the herpes virus that's been sitting in your blood for two or three years has an opportunity to show itself.

Touseef Mirza:
That was an example. But you don't have to have your immune system down to necessarily have symptoms. Either you could still have it, or the immune system has to be low in order for the herpes virus to present
itself.

Dr. Sophia:
You may not feel like your immune system is down. A person may not feel like they are under the weather, et cetera, or that their body may be run down, but their body on the inside. It is low in terms of perhaps their immune system or their defense mechanism for fighting the virus. That's the reason why it expresses itself, you know, and it doesn't always express itself. Of course, that's exactly what we're saying, that people may have the virus and may never have a symptom ever. Okay. But the virus has an opportunity to show itself, particularly when the immune system is down.

Touseef Mirza:
So how do you know that you, that that's what you have, that you have herpes? Do you have to get a test? Do you have to go? Can you make your own assessment? Do you need to go see the doctor?

Dr. Sophia:
So herpes is tested in a couple of different ways. Primarily we can test herpes through the blood. So it's a simple blood test that one can ask for when they go to their doctors to have, let's say, blood work done for STI testing. The only thing is, is that herpes is not a part of your general, you know, sexually transmitted panel. It's one that you have to ask for usually specifically. And the reason why is because herpes A is an extremely common disease. And unfortunately it's one where we are not able to say, you got this from this particular partner, whoever uses this lab, or the last person that you're sleeping with. That's how you got it. It's not like if someone who has chlamydia that I can say, you likely got this chlamydia within the last 30 days, and it's probably from this partner, whoever this person is that you're with.

Touseef Mirza:
And chlamydia being another sexually, sexually transmitted disease?

Dr. Sophia:
Infection. So the problem with herpes is that you could have been exposed years ago, and only today you're having symptoms. And so it kind of creates a conundrum oftentimes because it's like you now have had, let's say four different partners. You're not even sexually active for the last six months. But meanwhile here you are with an active outbreak and your doctor or you not even having an active outbreak. You're just coming in for your routine testing and you say, Hey, I'd like to have STI testing. I'd like to be tested for herpes as well. Okay, your herpes test comes back positive. And then you're like, how is that possible? I haven't even been sexually active for at least six months. So now you have to backtrack and try to figure out four partners ago, like who, how did I get this.

Touseef Mirza:
Right? So

Dr. Sophia:
Who gave it to me? Who do I go back and talk to? Who did I, you can't just get it. Did I get it 20 years ago? Did I get it two months ago? Did I get it three years ago? Like it's, that is where the complication of giving the diagnosis of herpes, especially when we give the diagnosis just through blood, granted it's still an important thing to know. It might be the thing, you know, with your first sexual encounter or the first time you go to get sexually transmitted disease testing that you ask for it because it's better that you know, the sooner you know. Or to have a baseline to be able to say in 2008 when I had this test done, I did not have this thing. Now I'm testing positive.

Touseef Mirza:
Because even if you don't have symptoms you will, it would still show in your blood work?

Dr. Sophia:
In your blood work if you have a purpose that is correct. If you were exposed to it and if you actually got the virus, then yes, it will show up in your blood whether you're having symptoms or not. Usually in terms of the more ideal situation is in order to really confirm that what you're having is, in fact herpes is when someone does come in with a suspicious lesion or suspicious symptoms and we actually see something that we can test. That is usually a time when doctors say, I'm going to test you for herpes because I suspect that this may be the cause of whatever the symptom. Okay. Because they can see something that they can then test for.

Touseef Mirza:
So is that also blood work or is it different?

Dr. Sophia:
And that would be an actual culture.

Touseef Mirza:
Okay.

Dr. Sophia:
Yeah. And then we can also still, not just by doing culture, but at the same time simultaneously also send blood work. But the goal truly of this particular talk, outside of just education, understanding what herpes is, understanding how it presents, is so that we can take away so much of the shame that is associated with it. The stigma, giving the news that I can tell somebody that they have chlamydia and they're like, oh, really? Like they're so matter of fact with it, but let me say that I, that they have herpes. Oh my God. It's like the world just came crashing down and their life is over. They feel so much shame, guilt, and just defeat. Dirty, dirty, okay. And the real reality is, is that the reason why herpes is so easily spread is because oftentimes when you do have symptoms, by the time you even get to the doctor, like call the office, say, Hey, I am, I'm feeling a little uncomfortable, I'd like to come in and see the doctor.

And then the secretary gives you an appointment, let's say five days later, whatever the symptoms are that you were having, they're gone. And so if you're having symptoms, herpes is not what's on your mind. Then you start to think of other things that seem to make more quote unquote sense. I went to the gym, I stayed in my clothes too long, and I was riding the bike too long. My panties were too tight. And that's how I felt a little uncomfortable. I must have changed the soap that I used and that's why I'm feeling uncomfortable.

Touseef Mirza:
I have a yeast fence infection and it went away.

Dr. Sophia:
I had a yeast infection and it just went away. Yeah. You know, there's just so many ways in which we can justify some of the symptoms that are very vague. Quite frankly, when it comes to herpes, and like I said, by the time you actually get to the doctor, your symptoms can potentially be completely gone. And if they're gone, you may not even remember why you were seeing the doctor in the first place. Or you cancel your appointment, you're like, ah, you see, I, I knew I didn't really need to go.

Touseef Mirza:
So is that like one of the reasons why, like you, you, you said that before, is that it's, it's very common. It's very common because it spreads because most people don't really realize that they have it because symptoms are gone and then they might have new partners and then it gets spread that way.

Dr. Sophia:
That's exactly how STDs work. People don't know, realize that they have something, they realize, they don't realize that they may have been exposed, and then they spread it without knowing that they're spreading it. So this is clearly not intentional. . And oftentimes people tend to even be exposed to STIs, especially something like herpes in their very first or second sexual encounters. Oftentimes. And part of the reason for that is . Is because it's your quote unquote first love. It's your quote unquote, you know, those first kind of sexual experiences tend to be with people that you think you can trust or that you know, quote unquote, you know them so well. Those first sexual encounters oftentimes are people who do not use protection, unfortunately. And this is why sexually transmitted diseases spread. And herpes in particular. . The other reason is because condoms only protect you 50% of the time from herpes. So to add fuel to fire, okay, you do the right thing, you do protect yourself and, you know, practice safe sex and you get it anyway. . Because of the fact that it can live in other parts of your genitalia, it can, you can become exposed through other parts of the genitalia, not only through penetrative sex. And so that is the reason why even wearing a condom though, definitely better than not, let's be clear, it protects you at least 50% of the time. . Okay. But of course there's that other 50% that you may still be exposed to.

Touseef Mirza:
It actually means that anybody can have herpes

Dr. Sophia:
Anybody,

Touseef Mirza:
Even if they've never had a symptom. I mean, that's the bottom line.

Dr. Sophia:
Yes. That is the bottom line.

Touseef Mirza:
So we have to almost assume that when we are having a new partner, or even with the same partner for that matter, that anybody can, even if they say, oh, you know, I'm clean, everything's fine. I guess the only way that we know that they're the person is completely do not have herpes or yourself is if you get tested regularly.

Dr. Sophia:
Negative. That is correct. It just stresses the importance of sex. You know, this is why I say this is healthcare. This is just healthy care, taking care of oneself, self-care. Self-care is getting healthcare. Getting healthcare is checked on a routine basis. And that can be kind of arbitrary. I mean, I like to say on an at least annual basis, but for some people it might be every six months. To go and have an STD check. You know, and I say this, especially even with the older population. So that's another problem is that people as they get older, again, tend to become a little bit more relaxed with sexual safe sex practices. You know, as people get older, you know, even up in their fifties, sixties, people who are in nursing homes or in, you know, senior living, at the end of the day, people are living longer, they have a lot of vitality, and they are getting busy.

Touseef Mirza:
It's true. There are senior homes now. They're all hanging out together.

Dr. Sophia:
Having all kinds of outbreaks in senior homes, not just of herpes, syphilis, chlamydia, gonorrhea, HIV. Its not just one thing. And the real reason I think again, is because they're no longer worried about pregnancy. So someone who's, you know, early is just postmenopausal or what have you, and they've, they're in their second act of life and they've met their new second partner, the person of their dreams. And they, again, like the people in the beginning when they're first getting started in a sexual life, they said they were clean, they've never had anything.

Touseef Mirza:
Which might have been true.

Dr. Sophia:
It's just again, that quote-unquote just blind trust and how we interact in these different times of our lives. So the thing I would say is that where herpes is concerned is getting regular testing and you may get pushback. Your physicians may be like, Why do you need to get tested for that? If you're not having a, why Do you wanna know why, why, why do you need to get tested? And you say, because I wanna know, because I don't wanna be the conduit for spreading this thing. If I have it, I wanna know. Because at the end of the day, herpes is a virus that is not curable, but certainly it is a manageable disease. It is one that has treatment options that make it so that you are less likely to spread the virus. And that's important.

Touseef Mirza:
So lemme ask you this, like, if you are showing symptoms, if you are having some lesions or if you have some sensations of pain versus not having it, what is the tendency of transmission one versus the other? Like, do you have a tendency to transmit it more? You are more likely to have an outbreak?

Dr. Sophia:
When you're having an outbreak, you're definitely much more likely to spread the virus. And so prevention of outbreaks will decrease your transmission of the virus.

Touseef Mirza:
If you're not having those symptoms and automatically, the spreading or the shedding is reduced versus if you're having an outbreak.

Dr. Sophia:
When you're having an outbreak, you're actively having viral shedding. Absolutely.

Touseef Mirza:
Okay. So that increases the chance of transmission.

Dr. Sophia:
Definitely increases the chance of transmission.

Touseef Mirza:
Okay. So that's number one. Right? So we talked about number one, get tested. Number two, if you're having any symptoms not to engage in sexual activity, what would be number three?

Dr. Sophia:
If you do know you have herpes and you are in a relationship and both you and your partner have been tested and you know that your partner does not have it, then maybe that's a conversation that you have about whether or not you should be on suppressive therapy. What does that mean? When you take an antiviral, something that works specifically against the herpes virus in order to suppress it so that it's not shedding actively in your body, it decreases the transmission of herpes to your partner who may not have it.

Touseef Mirza:
Is that something that you take just continually?

Dr. Sophia:
Continuously? You take it every day, especially if you're regularly engaging in sexual activity. So if you're someone who's not sexually active, then no, you don't need to be on that therapy unless you're someone who, you know, for some people they get outbreaks often. Some people don't get them at all. For people who get them often, again, just because of the discomfort they may feel or the, you know, the symptoms that they may have. If they're having an outbreak so that they're not feeling it, then yes, they may need to be on what we call suppressive therapy. This is why I'm so glad we're having the conversation, because it's just so many different angles when it comes to this thing. Okay.

Touseef Mirza:
It's the jack of all trades.

Dr. Sophia:
It's just the jack of all trades of sexually transmitted infections . And it's annoying in so many ways, but it's also, I promise, manageable. And moreover, I really wanna take away the feeling of stigma. Dirty, just shame and guilt that comes along with it. So you're having an outbreak, you feel the symptoms coming on. And the funny thing is, when it comes to herpes, you can have what we call a prodrome, A prodrome is the symptoms before the symptoms. The symptoms before the signs. So let's say you may feel tingly, itchy, burning, your skin may feel a little hot in that area, but you don't have any blisters, you don't have any ulcers, you don't have any pimples like bumps. You, you don't have any of those things. But your body is telling you, Hey, I'm fighting something. That would be the time to start taking your antiviral.

Dr. Sophia:
That would be the time to start taking your herpes treatment. Why? Because that would help prevent the outbreak. Now if you're someone who doesn't really get outbreaks or you may not recognize the quote unquote prodrome, and you only see perhaps when the blisters come, it's as soon as you see the sign or the symptom, you start taking the medicine. And that will help it to not last as long. Typically lasts anywhere from 3, 5, 7 days and then it's gone. If you take the antivirals, it can help it to last, you know, a few days less. So, for example, if you were gonna have an outbreak and it was gonna last five days, maybe it only lasts two.

Touseef Mirza:
When you have a patient and you realize that you have to tell them that they have herpes, what is usually their reaction?

Dr. Sophia:
I usually start by saying, I do have something I need to tell you. It may upset you, but I'm here to let you know that this is not your fault. This does not mean that something's wrong with you, that you're dirty, that you're promiscuous, that you're sleeping around, because these are all the myths and the stigmas that surround herpes specifically as it's like the STD of dirty.

You know what I mean? . And so I usually start the conversation and prefer it there. Then I go into the fact that herpes is a virus. It's a virus like so many other viruses that we're exposed to on a regular basis. I don't wanna diminish it and make it as small per se as let's say the common cold. I do like people to feel like, you're gonna get over it, it's gonna be okay. And the same way when you, if you had a cold, you'd be like, okay, I know I'm gonna be sick for a couple of days and then I'm gonna be better. And I'd like to at least give people something tangible to work with in the sense that if you're having an outbreak, yes, you may feel uncomfortable, you'll feel that way for a few days and then you'll be better. This is not a virus that has any long-term effects on your body or that's going to kill you even. Because I do think that people definitely think that when they get a diagnosis of herpes, that it means that it, I going to die from this?
And, people really are concerned. And so it's important for us to express and understand and educate and say, okay, yes, unfortunately, herpes is a non-curable disease, but it certainly is not one that's going to kill you.

Touseef Mirza:
I think it's very unfortunate the way that herpes has been like the pun of the jokes in, in culture and sort of making fun of people who have that. They don't really talk about that when you talk about gonorrhea or chlamydia. Herpes is the one that keeps coming up and it makes it more of a heavier subject for people because of that. It's so interesting because when you really just look at it objectively,

Dr. Sophia:
Yes.

Touseef Mirza:
When you look at it objectively, nobody's freaking out or saying somebody's dirty when they see somebody having a cold sore. Right. They just say, oh, you know, you shouldn't like to kiss me. You know?

Dr. Sophia:
That's it. That's correct.

Touseef Mirza:
But meanwhile, it's the same type of virus. It's just another strain of it and it's like night and day. And that I think we need to realize the ridiculousness of that.

Dr. Sophia:
It's even in the same family as the chickenpox. The chickenpox, which if you're of a certain age, you got it as a kid. 'cause You know, Jimmy in third grade Got it. And then the whole third grade got it. You know, like I remember that. I remember getting chickenpox when I was eight . And guess what? When you have had the chickenpox, that chickenpox virus stays in your body forever and it has the potential to be activated. So guess what, when it's reactivated, we call it shingles and no, nobody wants shingles. It's very painful, it's very uncomfortable. It usually shows up as painful blisters. Okay. Because it's in the same family. They have some of the same symptoms. And at the end of the day, just like chickenpox, herpes can be annoying, itchy, blistering, painful, et cetera. And it shows up when your immune system is low.

Touseef Mirza:
Right. But you're not feeling dirty when you have shingles.

Dr. Sophia:
You're absolutely right. Nobody feels dirty when they have shingles. Right. And this is why we're having the conversation.

Touseef Mirza:
Right. And also cold sources. Yeah. It might feel a little embarrassing to have it, but again, it's not like you feel like that level of guilt or shame or shame. So this is, I mean, at the end of the day, I think the reason why I'm just like bringing this up over and over is it's just in our minds, it's not reality.

Dr. Sophia:
Well, it's not reality in the sense of it doesn't have to be the worst thing ever.

Touseef Mirza:
Exactly.

Dr. Sophia:
It's manageable. It does happen. No, nobody wants it. Just like, I did not want chicken pox when I was in the third grade. I'm not trying to downplay this. It's more so to make it understandable and for people to realize that this is a livable condition that can be managed. That, and if you know about it, how to protect yourself and others in a very responsible way.

Touseef Mirza:
If somebody is having a hard time with the diagnosis of having herpes,

Dr. Sophia:
The first thing I tell them is, check your partner or before you get into a new relationship, if you're someone, because that's usually the place where they have the hardest time. Someone who knows that they actually have herpes already and they're now going into a new relationship. How do they tell their new partner or future partner that they have herpes? And the first thing I say is get them tested. Unfortunately, it actually is relatively common. So the possibility that your partner may already have it, and again, be in that group of people who don't know. Because so many people who have herpes or have been exposed to herpes never get symptoms, never get tested, and never know. And so if you have it, the first thing I always say is, make
sure your partner is tested before you move into a new sexual relationship.

Touseef Mirza:
Okay. So let's say that the other person gets tested and doesn't have it. What happens?

Dr. Sophia:
They need to definitely disclose the fact that they have it, and then it's a conversation. I've seen it. This is definitely not what I'm advocating, but I've definitely seen it where two people decide that they want to be together and they, and, and then the person who doesn't have it says, if I get it, I get it. And if I don't, I don't, you're the person I wanna be with. How big of a deal is this? I may never even have a symptom or outbreak. I really want to be with you.

That's a conversation that then becomes truly a private conversation. I do my part, I'm trying to prevent the disease from being spread. That is the point. With information and being informative and making sure that patients get tested and talking to them openly about it and having, and helping to empower them to have these types of hard conversations with their partners, et cetera. But ultimately it's up to them. And for some people, they're like, oh, I can get a little something. It sounds like it's not really that big of a deal. If I get it, I get it. If I don't, I don't. I'm nobody's judge. I simply give information.

Touseef Mirza:
And what about the second situation? If the other person tested positive?

Dr. Sophia:
If two people, both people have it, then they have it. There's no, I'm gonna now give it to you.. You already have it. You're not gonna give it to me. I already have it.. So do what you do.

Touseef Mirza:
Alright. Do you find that over the years that the stigma around it, when you tell your patients has decreased, increased, or has stayed the same?

Dr. Sophia:
I kind of feel like it's stayed the same. I don't really see it as something that's increased or decreased. I definitely feel like it kind of has an even kind of pulse to it. There's a bucket of people who don't even know what herpes is. For others, when I say, you know, I think what you're describing may be a herpes outbreak, they are incomplete. They're like, I don't know what you're talking about Dr. Lubin, that's not even possible. You know, and then automatically put up the defenses. And then for others I say, I think you may be having, you know, a herpes outbreak, and they're like, huh, is this something that happens before I may, I think I may have had this before. And then that starts to cause a whole backtrack of, is that the thing I get every time, like a couple of times a year before my period?

Touseef Mirza:
Is there usually an increased frequency of having it before a period?

Dr. Sophia:
Yes. It's an interesting question, and it is a thing. And the reason why is because, like I said, anytime our immune system goes down even a little bit gives the virus an opportunity to show itself. When women are menstruating, your body is saying, I need to rest and recover during this time of menses. And your immune system is down a little bit. And so the time leading up to menses, yes. Oftentimes, women tend to have outbreaks right around that time.

Touseef Mirza:
So when people find out that they have it, when you tell them, is it more about the guilt upon themselves

Dr. Sophia:
Who gave it to them? Did they just get it? You know, that's usually the first set of questions. And unfortunately, like I said, it's the one thing I'm like, I can't tell you who gave it to you. I don't know how you got it. I don't know when you got it. It's so different from something like, let's say gonorrhea. Because of gonorrhea, you typically will have symptoms within seven to 10 days of being exposed.

And those symptoms are very annoying and they also don't just go away. Therefore you're more likely to seek care and then be diagnosed with it and then get treated for it. So it's a lot easier if you're exposed, you're exposed, you get symptoms within a certain amount of time, you go with a doctor, you know, and then you can backtrack, well, I know I was with such and such person two weeks ago, that's where I got this gonorrhea from.

Touseef Mirza:
It's more direct.

Dr. Sophia:
It's a lot more direct in terms of being able to have a sense of where.

Touseef Mirza:
How?

Dr. Sophia:
Or have a sense of resolve. Right. Of an understanding where herpes is concerned. Unfortunately, it just doesn't come that way.

Touseef Mirza:
It's the ambiguous STI.

Dr. Sophia:
It's so ambiguous. Oh. I mean honestly it's the hardest conversation that I have on a weekly basis really. It really is. It's the hardest conversation because I have to then help someone build them back up to who they were when they first walked into my office versus who they are walking out of my office now with this news and it's trying to keep them the same. You're not a different person. You are a person who now has this and we can manage it. And it's not your fault. It doesn't make you dirty, it doesn't make you unable to have children. Of course there's the implications of whether or not, oh, now that I have herpes, that means I can never have kids. No, that's absolutely not true. So it requires a lot of care, which is fine because that's the kind of person I am and the kind of care that I like to provide my patients anyway. But it's hard to watch. It's hard to see sometimes.

Touseef Mirza:
So if somebody out there has had it or has had it and has not had the type of care that you mentioned, what could you say to them, like if they need to hear it from a caring OBGYN doctor, health practitioner.

Dr. Sophia:
The bottom line is that if you get a diagnosis of herpes, you need to know that you are going to be okay. You're going to be okay. You are not at fault. You are still whole, you are still beautiful. You can still have a sexual life. You definitely do not have to feel ashamed and you'll be okay. The point here was definitely not to sugarcoat. The point here was to encourage people to feel like they are still themselves, despite having this kind of a diagnosis. You are okay. It's okay. You're gonna be fine. And life doesn't have to end. Life will go on in an equally beautiful way for you. And that you just need to embrace your body, embrace yourself. Thank you for listening to this. Very interesting, difficult, curiously, a little, a little messy, a little ambiguous, a little bit of everything kind of episode. We appreciate having you here today. Thank you so much for listening.

This is General Medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.