WEBVTT - Ep 57 Herpes: Stop the STIgma 0:00:01.240 --> 0:00:04.559 My name is Courtney Brain. I am the founder executive 0:00:04.600 --> 0:00:09.320 director of the nonprofit organization Something Positive for Positive People 0:00:09.560 --> 0:00:12.799 that also has a podcast by the same name, which 0:00:12.840 --> 0:00:16.280 I host. On this podcast, I interview people who are 0:00:16.320 --> 0:00:21.400 living with primarily herpes about their experiences from their diagnosis 0:00:21.440 --> 0:00:26.759 to dating to disclosure. For me, I was diagnosed with 0:00:26.920 --> 0:00:30.720 genital HSV two. I was living with my grandmother at 0:00:30.760 --> 0:00:34.880 the time. I was just out of college, probably twenty three. 0:00:34.960 --> 0:00:36.760 I believe I'm thirty one now, so yeah, it's been 0:00:36.800 --> 0:00:39.800 about eight years. At age twenty three, I wake up 0:00:39.800 --> 0:00:42.239 one morning and I was under the covers. I got 0:00:42.240 --> 0:00:43.760 out of the covers and I was like, whoa, I'm 0:00:43.800 --> 0:00:47.000 really cold, WHOA, I'm really sweaty. At the same time, 0:00:47.040 --> 0:00:49.120 and I get up to go to the restroom for 0:00:49.159 --> 0:00:53.680 the first time, and I go to urinate and I 0:00:53.720 --> 0:00:59.560 look down at my genitals and I scream an obscenity 0:01:00.240 --> 0:01:04.319 say that, and my grandmother comes to the door. My 0:01:04.319 --> 0:01:06.679 grandmother's a nurse. I need to be sure to include 0:01:06.720 --> 0:01:09.880 that part here. She goes, you okay, man. I was like, 0:01:10.280 --> 0:01:12.440 we need to go to the emergency room or somewhere 0:01:12.640 --> 0:01:15.560 right now. And my mom just happened to be over 0:01:15.640 --> 0:01:18.320 this morning, and so my mom drives me to a 0:01:18.400 --> 0:01:21.319 nursing care facility and we're in the waiting room. I'm 0:01:21.360 --> 0:01:24.120 not sure what's going on at this point. Having an 0:01:24.240 --> 0:01:28.120 STD never crossed my mind. So I get in there 0:01:28.360 --> 0:01:32.679 and the doctor looks at me and he goes, all right, 0:01:32.720 --> 0:01:35.560 that looks like herpes, gives me the swab test. He 0:01:35.640 --> 0:01:40.880 gives me treatment for I believe ganrhea and chlamydia, and 0:01:40.920 --> 0:01:46.200 I get tested for the other common STIs at that point, 0:01:46.560 --> 0:01:49.280 and sends me on my way. I get a pamphlet 0:01:49.520 --> 0:01:52.480 that tells me a little bit about herpes and the 0:01:52.560 --> 0:01:58.720 different statistics, and I get home and I immediately start 0:01:59.120 --> 0:02:03.640 messaging tech Facebook, messaging my most recent partners and just 0:02:04.560 --> 0:02:07.080 out of concern that I may have given it to them. 0:02:07.320 --> 0:02:10.120 So my immediate response was, oh man, who else did 0:02:10.160 --> 0:02:12.600 I give this to? It was really weird how I 0:02:12.680 --> 0:02:15.800 worded each message, because it was just, hey, do you 0:02:15.840 --> 0:02:18.440 have herpes? You woudn't happen to have herpes, now, would you? 0:02:18.960 --> 0:02:22.320 And everyone said no. And so you know, you can't 0:02:22.360 --> 0:02:24.560 really dwell on whether or not you know where you 0:02:24.600 --> 0:02:26.400 got it from or how you got it or how 0:02:26.440 --> 0:02:28.120 long you've had it or anything like that. So I 0:02:28.160 --> 0:02:32.919 just kind of had to move forward accordingly with taking 0:02:32.960 --> 0:02:38.440 responsibility for myself. The next five years are a huge 0:02:38.600 --> 0:02:41.960 blur for me because I kind of just stayed in 0:02:42.000 --> 0:02:45.840 my relationships with the women that I disclosed to early 0:02:46.400 --> 0:02:51.040 dating was a trip over these five years, going through 0:02:51.040 --> 0:02:54.240 the process of having to first off understand the virus 0:02:54.560 --> 0:02:57.680 and then have to communicate that to another person because 0:02:57.680 --> 0:03:00.160 I already had my thoughts in my mind that Okay, 0:03:00.240 --> 0:03:03.760 you know, no one wants an STD, nobody wants herpes, 0:03:03.800 --> 0:03:06.880 and nobody wants to put themselves at risk for herpes. 0:03:07.440 --> 0:03:12.080 This is where we begin the origin story of something 0:03:12.120 --> 0:03:17.680 positive for positive people. I begin dating again, and then 0:03:18.040 --> 0:03:20.680 my dating you know, I just kind of got tired 0:03:20.720 --> 0:03:24.800 of keeping this thing to myself because it's really hard 0:03:24.800 --> 0:03:28.880 to talk about, and it was kind of what led 0:03:28.960 --> 0:03:32.679 to my decision making for dating. It wasn't are we compatible, 0:03:32.960 --> 0:03:35.720 It was more so, do you accept the fact that 0:03:35.760 --> 0:03:39.680 I have herpes? Okay? Great? I stumble across a dating 0:03:39.680 --> 0:03:43.640 website for people who are living with herpes, and I 0:03:43.720 --> 0:03:47.840 get on that dating site and herpes isn't on my 0:03:47.960 --> 0:03:51.880 mind because everyone here has it or everyone here knows 0:03:51.920 --> 0:03:55.160 I have it, right, And so I get active in 0:03:55.200 --> 0:04:00.200 the chat rooms, I'm meeting women, I'm dating, and life 0:04:00.200 --> 0:04:01.840 it is great. It's like where was this at for 0:04:01.840 --> 0:04:05.880 the last five years? Right? And in these communities, I 0:04:06.120 --> 0:04:13.520 find that people are saying online forums and blogs that 0:04:13.720 --> 0:04:16.679 this herpes diagnosis is the worst thing that's ever happened 0:04:16.720 --> 0:04:18.440 to them, no one's going to love them, they're never 0:04:18.480 --> 0:04:20.320 going to find a partner, and that they want to 0:04:20.360 --> 0:04:25.040 kill themselves. And that to me. The first couple of 0:04:25.080 --> 0:04:27.640 times I saw it, it wasn't really a big deal. 0:04:27.640 --> 0:04:30.480 It was just kind of like, huh, that's weird. And 0:04:30.520 --> 0:04:33.680 then after someone I had become friends with who was 0:04:33.720 --> 0:04:36.760 in a relationship with a partner who was accepting she 0:04:37.520 --> 0:04:40.839 told me that at some point she had suicide ideation. 0:04:41.440 --> 0:04:44.520 And so when she said it, I think I started 0:04:44.520 --> 0:04:46.839 to notice it a little bit more, a lot more, 0:04:47.400 --> 0:04:51.039 and I felt like I had to do something. And 0:04:51.640 --> 0:04:54.800 so I go to one of my communities and I 0:04:54.920 --> 0:04:57.840 just make a post, and the post was requesting people 0:04:57.960 --> 0:05:01.640 to anonymously share their experience and allow me to record 0:05:01.680 --> 0:05:03.360 it and then just send it to these people who 0:05:03.400 --> 0:05:07.360 are expressing suicide ideation, and so I got one person 0:05:07.440 --> 0:05:12.080 to do it, and her perspective was one. It was 0:05:12.120 --> 0:05:15.520 the exact the first episode of Something Positive for Positive People, 0:05:15.960 --> 0:05:20.200 and over the conversation, we got sad, we got angry, 0:05:20.320 --> 0:05:22.440 we cried a little bit, we laughed a little bit, 0:05:22.680 --> 0:05:24.440 and by the end of it, there was just like 0:05:24.520 --> 0:05:28.799 this neutrality. There a sense of relief more than anything. 0:05:28.839 --> 0:05:33.239 And I think that me witnessing someone who went from 0:05:33.800 --> 0:05:38.320 holding this inside to finally having shared this experience for 0:05:38.360 --> 0:05:43.159 the first time, it really showed me that there's something 0:05:43.200 --> 0:05:46.240 to be said for the power of just expressing these 0:05:46.279 --> 0:05:51.360 experiences that we have. So after I share this recording 0:05:52.240 --> 0:05:54.920 in the group, more people wanted to get involved. So 0:05:54.960 --> 0:05:58.360 it went from that one interview to four to eight 0:05:58.480 --> 0:06:02.680 to sixteen, and so many different people shared so many 0:06:02.720 --> 0:06:06.400 different experiences. There are no two experiences that are the same. 0:06:06.640 --> 0:06:12.120 Onto Something Positive for Positive People podcasts, episode archive. People 0:06:12.400 --> 0:06:16.839 expect to hear from people who have gotten herpies by 0:06:17.920 --> 0:06:23.760 being promiscuous and having multiple sex partners and being reckless 0:06:23.760 --> 0:06:27.680 and not taking any precautions and all of those things 0:06:27.680 --> 0:06:31.880 that people by default think of stigma and what people 0:06:31.880 --> 0:06:36.560 with scis look like are completely challenged by so many 0:06:36.600 --> 0:06:39.960 different experiences of everyday people who are living their life 0:06:39.960 --> 0:06:42.560 that you would never hear from simply for the fact 0:06:42.600 --> 0:06:45.039 that they're living their life. These are people who have 0:06:45.120 --> 0:06:47.520 gone on to have families, that they have businesses. These 0:06:47.560 --> 0:06:51.119 are models, These are celebrities. These are athletes, bodybuilders, people 0:06:51.200 --> 0:06:55.560 who have absolutely no reason to come up and say, hey, everybody, 0:06:55.560 --> 0:06:57.920 I have herpes and I don't fall under the stereotypes 0:06:57.960 --> 0:07:00.640 of the stigma. These are the people who are sharing 0:07:00.680 --> 0:07:06.320 their stories from their diagnosis to dating, to disclosure to 0:07:06.360 --> 0:07:10.320 the point where they are now. So I often tell 0:07:10.360 --> 0:07:14.480 people Something Positive for Positive People is not necessarily a 0:07:14.560 --> 0:07:17.920 herpes resource that just happens to be like a secondary 0:07:17.960 --> 0:07:21.800 effect from this actually being at its core a suicide 0:07:21.840 --> 0:07:25.640 prevention resource. It's becoming clear that there is a direct 0:07:25.640 --> 0:07:31.200 connection between this an STI diagnosis as something that triggers 0:07:31.400 --> 0:07:36.240 mental health issues. As a nonprofit organization, the business function 0:07:36.320 --> 0:07:39.720 of Something Positive for Positive People is to not only 0:07:39.800 --> 0:07:44.720 connect people with community resources, but also a therapist in 0:07:44.960 --> 0:07:48.480 the event that they are struggling with stigma or struggling 0:07:48.480 --> 0:07:51.440 with their diagnosis, or connecting them with a sex positive 0:07:51.480 --> 0:07:54.760 therapist who is capable of talking them through that. So 0:07:55.160 --> 0:07:56.720 one of the things that I want to do is 0:07:56.840 --> 0:08:00.000 just put people in position to where they don't necessarily 0:08:00.040 --> 0:08:02.679 really feel the need to come out and combat stigma 0:08:02.760 --> 0:08:05.880 or to like openly make a Facebook status that they 0:08:05.880 --> 0:08:09.440 have herpies like. If that's what people want to do, great, 0:08:09.640 --> 0:08:13.240 but they don't have to do that. This is essentially 0:08:14.080 --> 0:08:18.080 a safe space for people to understand how they want 0:08:18.120 --> 0:08:22.520 to navigate the stigma. I have no intention of destroying stigma, 0:08:22.600 --> 0:08:26.160 eradicating it, or whatever violent word you want to insert 0:08:26.200 --> 0:08:30.280 to stigma. My purpose is to just give people the 0:08:30.360 --> 0:08:34.800 resources to navigate the stigma. It's not going anywhere anytime soon. 0:08:34.960 --> 0:08:38.320 So until we're all on the same page about what 0:08:38.400 --> 0:08:39.960 this is going to look like for us, and we 0:08:40.000 --> 0:08:44.040 get the truth out there, consistent truth about this virus, 0:08:45.400 --> 0:08:48.920 then I think that we can begin to focus more 0:08:49.000 --> 0:08:51.760 so on the important stuff, which is how we process 0:08:51.800 --> 0:08:55.439 it mentally and emotionally, and how we go about communicating 0:08:55.880 --> 0:08:58.679 to the people who need to know about it, and 0:08:58.720 --> 0:09:00.000 how we deal with it ourselves. 0:09:00.040 --> 0:09:46.760 Yes, you just heard from the amazing Courtney Bram who 0:09:46.840 --> 0:09:50.400 is the creator and host and editor and producer and 0:09:50.559 --> 0:09:54.880 everything of the nonprofit organization and podcast Something Positive for 0:09:54.960 --> 0:09:59.040 Positive People. You can find s p f PP wherever 0:09:59.120 --> 0:10:03.120 you get your podcast, and also on SPFPP dot org 0:10:03.320 --> 0:10:05.880 or something Positive for Positive People dot org. 0:10:06.480 --> 0:10:09.920 Hi, I'm erin Welsh and I'm erin allman Updyke. 0:10:09.800 --> 0:10:11.760 And this is this podcast will kill you. 0:10:12.240 --> 0:10:16.240 And today you've probably guessed we're talking about herpes. 0:10:16.760 --> 0:10:19.160 Yes, HSV one and HSV two. 0:10:19.600 --> 0:10:22.600 That's herpes simplex virus one and two. 0:10:23.880 --> 0:10:27.160 Hmm. It's going to be a really great episode, in 0:10:27.280 --> 0:10:31.280 part because, in addition to our incredible guest Courtney, we 0:10:31.440 --> 0:10:35.720 also had the wonderful opportunity to chat with doctor Aina Park, 0:10:36.080 --> 0:10:39.280 who is Associate Professor at UC San Francisco School of 0:10:39.320 --> 0:10:42.320 Medicine as well as medical Consultant in the Division of 0:10:42.480 --> 0:10:46.000 STD Prevention at the CDC, and we chatted with her 0:10:46.080 --> 0:10:50.000 about her upcoming book titled Strange Bedfellows. It's an incredible 0:10:50.000 --> 0:10:55.120 book and you guys are gonna love this interview. So Aerin, 0:10:55.200 --> 0:10:58.400 should we jump to important business matters? 0:10:58.559 --> 0:11:01.560 Oh? Yes, it is what time? Oh it's quarantiny time? 0:11:02.120 --> 0:11:04.440 It is What are we drinking this week? 0:11:04.840 --> 0:11:08.960 This week we're drinking the simplex sour ooa yum. 0:11:09.440 --> 0:11:12.079 And what is in the simplex sour. 0:11:12.320 --> 0:11:15.600 Well aarin as you can probably describe better than meat, 0:11:15.640 --> 0:11:17.920 It's a bourbon slush. 0:11:18.200 --> 0:11:19.679 Ryeah, it's a bourbon slush. 0:11:19.800 --> 0:11:22.280 It's a Kentucky It's a very Kentucky drink. 0:11:22.920 --> 0:11:26.000 It's so delicious. I feel like it's great the last 0:11:26.040 --> 0:11:29.520 sort of throes of summer here as we as we 0:11:29.559 --> 0:11:32.920 wave goodbye to the beautiful sun and greenery that's been 0:11:32.960 --> 0:11:36.559 all around me here in Chicago and anyway. So, what's 0:11:36.600 --> 0:11:40.640 in a bourbon slush? It is essentially black tea sugar, 0:11:40.880 --> 0:11:45.160 frozen lemonade, frozen orange juice, bourbon ginger ale. I will 0:11:45.160 --> 0:11:47.520 warn you that it does take a bit of prep 0:11:47.640 --> 0:11:49.480 in that you make a big batch of it and 0:11:49.520 --> 0:11:52.800 you have to freeze it sometimes overnight, but it's totally 0:11:52.840 --> 0:11:54.119 worth it because it's delicious. 0:11:54.400 --> 0:11:56.920 And we will post the full recipe for that quarantine 0:11:57.080 --> 0:11:59.600 as well as our non alcoholic place, ba Rita on 0:11:59.640 --> 0:12:02.040 our website. This podcast will kill you dot Com and 0:12:02.160 --> 0:12:03.680 all of our social media channels. 0:12:04.160 --> 0:12:08.880 Awesome, All right, Well, should we dive right into the episode. 0:12:09.480 --> 0:12:36.400 Let's dive in right after this break. So HSV herpes 0:12:36.559 --> 0:12:41.199 simplex virus, easy enough, we can learn a lot about 0:12:41.440 --> 0:12:44.959 this disease just from the name. We're dealing with the virus, 0:12:45.640 --> 0:12:50.880 specifically a DNA virus in the family herpes via day. 0:12:51.320 --> 0:12:55.240 That's right. This is a massive family of viruses, not 0:12:55.400 --> 0:12:58.880 just the two that we're talking about today. People are 0:12:58.920 --> 0:13:02.440 probably very familiar with a whole bunch of these herpes viruses, okay, 0:13:02.480 --> 0:13:05.240 because they're very famous, and many of them cause disease 0:13:05.240 --> 0:13:09.760 in humans, not just HSV one and HSV two. Do 0:13:09.800 --> 0:13:12.199 you know some of them are and you probably do well. 0:13:12.240 --> 0:13:17.400 There's herpsaster, Yeah, that causes chicken pox and shingles. 0:13:17.520 --> 0:13:18.000 Mm hm. 0:13:20.080 --> 0:13:23.520 Is CMV one, yeah, it is Cida megalovirus is a 0:13:23.559 --> 0:13:30.200 herpes virus EBV Yeah. Ebstein bar, which causes mononucleosis, is 0:13:30.240 --> 0:13:32.480 also a herpes virus. 0:13:32.679 --> 0:13:33.400 That's all that I have. 0:13:33.840 --> 0:13:37.599 Great job the airin that was very impressive. Also, Caposi's 0:13:37.600 --> 0:13:42.880 sarcoma is caused by a herpes virus HHV eight, and 0:13:42.920 --> 0:13:46.920 then rosiola or sixth disease, which is common in small children, 0:13:46.960 --> 0:13:50.839 can be caused by HHV six or sometimes seven. And 0:13:50.880 --> 0:13:54.800 then there are also hundreds of other herpes viruses that 0:13:54.920 --> 0:14:02.280 cause disease in other animals. Other mammals, but also birds, fish, molluscs, amphibians, reptiles, 0:14:02.360 --> 0:14:04.120 everybody's got herpes viruses. 0:14:04.240 --> 0:14:06.040 Oh my gosh, Erin, I think I have that same 0:14:06.120 --> 0:14:07.920 exact sentence in my notes. 0:14:10.280 --> 0:14:11.319 That's awesome. 0:14:12.679 --> 0:14:14.880 Because I think I even put in molluscs and I 0:14:15.000 --> 0:14:16.760 was like, whoa, because when. 0:14:16.679 --> 0:14:19.560 I saw that, I was like, I'm sorry, molluscs really 0:14:20.280 --> 0:14:24.600 little clams with herpes. I love it. So, yeah, this 0:14:24.720 --> 0:14:27.880 is a very big family of viruses. But today we 0:14:27.920 --> 0:14:32.720 are focusing just on Herpes simplex, which is HSV one 0:14:32.840 --> 0:14:40.240 and HSV two. So let's get specific on HSV. Transmission 0:14:40.280 --> 0:14:45.160 of HSV is pretty straightforward across the board. HSV one 0:14:45.200 --> 0:14:48.640 and HSV two are transmitted the same way. It's from 0:14:48.760 --> 0:14:52.440 mucus membrane to mucus membrane or from skin to skin, 0:14:52.840 --> 0:14:57.360 easy enough. HSV can enter through any break in the skin. 0:14:57.520 --> 0:14:59.760 You can get it really anywhere, literally anywhere. 0:15:00.120 --> 0:15:01.040 Yeah. 0:15:01.320 --> 0:15:04.360 So in general, the incubation period, so the time from 0:15:04.360 --> 0:15:07.880 when you first get infected to when you show symptoms, 0:15:08.360 --> 0:15:11.680 is about four days, but it can range from like 0:15:11.840 --> 0:15:14.680 as little as two days to twelve days. I even 0:15:14.720 --> 0:15:18.720 saw up to a month in some cases. But one 0:15:18.720 --> 0:15:21.720 of the most important things about HSV infections is that 0:15:21.920 --> 0:15:26.440 a large proportion of them are actually completely asymptomatic. Right, 0:15:27.160 --> 0:15:30.360 So you can get infected with HSV one or HSV 0:15:30.440 --> 0:15:34.000 two and never show any symptoms of it. And that 0:15:34.080 --> 0:15:37.960 doesn't necessarily mean that you aren't infectious to other people, 0:15:38.960 --> 0:15:41.520 because you can still be shedding virus even if you 0:15:41.560 --> 0:15:45.480 never knew that you were infected. Right, So let's go 0:15:45.600 --> 0:15:53.160 through the symptoms in a primary infection. Most often, if 0:15:53.160 --> 0:15:56.720 you have any symptoms, about forty percent of the time, 0:15:57.000 --> 0:16:01.360 you'll also have systemic symptoms, so you'll have fever, you'll 0:16:01.400 --> 0:16:05.600 have headache, you'll have body aches, those kind of general 0:16:05.720 --> 0:16:10.920 like viral illness type symptoms. The two most commonplaces to 0:16:10.960 --> 0:16:13.640 get infected with HSV one and two are either the 0:16:13.640 --> 0:16:17.720 mouth or the genitals. So if it's a genital infection, 0:16:17.880 --> 0:16:20.840 you can have kind of like UTI type symptoms. If 0:16:20.920 --> 0:16:25.800 the urethra is involved, so urethritis infection or inflammation of 0:16:25.840 --> 0:16:30.440 the urethra, or you can have like vaginal irritation if 0:16:30.480 --> 0:16:35.000 you have serviceitis, so inflammation of the cervix. And if 0:16:35.000 --> 0:16:37.320 you get an oral infection, then you can also get 0:16:37.320 --> 0:16:40.400 like pharyngitis type symptoms, so sore throat and things like that. 0:16:41.000 --> 0:16:43.240 And then it's also really common to have some lymph 0:16:43.240 --> 0:16:46.760 nodes swelling. So if it's an oral infection, your lymph 0:16:46.840 --> 0:16:49.200 nodes in your neck might get swollen and tender. If 0:16:49.200 --> 0:16:51.600 it's a genital infection, you have lymph nodes kind of 0:16:51.600 --> 0:16:55.000 in your groin that might get swollen and tender. And 0:16:55.040 --> 0:17:00.960 then of course the herpes sores that everyone know about. Okay, 0:17:01.960 --> 0:17:05.159 So these lesions often start with an itching or burning 0:17:05.240 --> 0:17:09.320 sensation in the skin where the virus has entered, and 0:17:09.359 --> 0:17:11.720 then these lesions appear. They start out as kind of 0:17:11.720 --> 0:17:17.240 a flat red, just little spot, and then they form vesicles, 0:17:17.400 --> 0:17:20.800 so kind of like little fluid filled blisters, and then 0:17:20.840 --> 0:17:23.760 the vesicles will burst open and leave an open ulcer 0:17:23.840 --> 0:17:28.600 behind that will often crust over, especially if these ulcers 0:17:28.640 --> 0:17:32.360 are on skin rather than mucous membrane, So if it's 0:17:32.400 --> 0:17:34.679 around the mouth or on the shaft of the penis 0:17:34.760 --> 0:17:37.640 or on the vulva, then they will crust over, whereas 0:17:37.640 --> 0:17:40.600 if it's inside the vagina or something like that, then 0:17:40.640 --> 0:17:44.720 they just sort of heal slowly without crusting over, if 0:17:44.760 --> 0:17:48.160 that makes sense, gotcha, Yeah, Yeah, So they start out 0:17:48.320 --> 0:17:50.679 usually with this sort of itching and burning sensation. But 0:17:50.760 --> 0:17:54.520 once these lesions come, they are super super painful. They're 0:17:54.560 --> 0:17:57.560 not we talked in syphilis about the lesion that you 0:17:57.600 --> 0:18:01.159 get from that, which is painless, but these ones are 0:18:01.240 --> 0:18:04.840 quite painful, and in a primary infection, they take a 0:18:04.880 --> 0:18:07.920 really long time to heal too. It's usually at least 0:18:07.960 --> 0:18:10.520 eight to eleven days, but it can be even longer. 0:18:10.600 --> 0:18:13.600 So you have these painful sores for like a long time. 0:18:14.840 --> 0:18:18.200 So one of the questions is actually what's actually happening here, 0:18:18.480 --> 0:18:21.679 and that will lead us into how does this virus 0:18:21.720 --> 0:18:26.000 then hide out in our bodies? Okay, so why does 0:18:26.200 --> 0:18:31.440 the virus actually cause these ulcers these sores. When HSV 0:18:32.400 --> 0:18:34.560 enters your skin through a break in the skin or 0:18:34.560 --> 0:18:37.640 through the mucous membrane, the cells that they infect are 0:18:37.880 --> 0:18:40.159 your epidermal and dermal cells, so they don't have to 0:18:40.200 --> 0:18:43.200 travel far. Right where they enter is where they start 0:18:43.240 --> 0:18:46.880 to infect cells and replicate, and as they do that, 0:18:46.920 --> 0:18:50.320 they cause direct damage to the cells of your dermis 0:18:50.320 --> 0:18:53.280 and epidermis. So that's why you have those blisters, because 0:18:53.280 --> 0:18:57.120 those are actually from viral damage to the cells. Does 0:18:57.160 --> 0:18:57.680 that make sense? 0:18:57.800 --> 0:18:58.159 Okay? 0:18:58.400 --> 0:19:02.760 Yeah, But then as they replicate and spread, they enter 0:19:02.920 --> 0:19:06.560 the axons of our sensory nerves. 0:19:07.920 --> 0:19:11.320 Right, what I know, it's wild, it's. 0:19:11.160 --> 0:19:15.840 So wild, Oh my goodness. So they enter the axons 0:19:15.920 --> 0:19:18.520 and then they travel The axons are essentially like the 0:19:18.560 --> 0:19:23.200 nerve projections, right, And they travel along these axons all 0:19:23.320 --> 0:19:26.680 the way back to the cell body, which is in 0:19:26.760 --> 0:19:27.720 our spinal cord. 0:19:28.280 --> 0:19:31.520 And you know, trying to phreeze this in a way 0:19:31.560 --> 0:19:33.680 that's not like why does the virus do this? Why 0:19:33.760 --> 0:19:38.520 is it so smart? But like the consequence of this, 0:19:39.359 --> 0:19:42.520 like nerve association or whatever, the fact that it goes 0:19:42.520 --> 0:19:46.000 into your nerves is that, like our immune system doesn't 0:19:46.040 --> 0:19:47.399 really like to mess around with that. 0:19:48.080 --> 0:19:50.359 Yeah, we've talked about this a lot before. But once 0:19:51.040 --> 0:19:53.680 a pathogen has made it past our blood brain barrier, 0:19:54.040 --> 0:19:56.400 it's really hard for our immune system to do much 0:19:56.440 --> 0:19:58.920 about it. Like we have the blood brain barrier there 0:19:59.000 --> 0:20:02.400 to prevent from getting in in the first place, right, 0:20:03.160 --> 0:20:06.280 And so once a virus is already there in our 0:20:06.320 --> 0:20:10.560 spinal cord, it is very hard. And HSV, like many 0:20:10.560 --> 0:20:13.960 herpes viruses, well like all herpes viruses, is also just 0:20:14.040 --> 0:20:16.960 really good at evating our immune system. Even when it's 0:20:17.000 --> 0:20:20.080 not inside of our nerves, right, so it has all 0:20:20.080 --> 0:20:23.720 these adaptations to just make it harder for our immune 0:20:23.720 --> 0:20:25.600 system to fight it off. 0:20:25.760 --> 0:20:29.440 Essentially interesting, yeah, very interesting. 0:20:29.560 --> 0:20:33.240 And so that is how HSV can establish this latent 0:20:33.520 --> 0:20:37.560 infection essentially once it's in the cell bodies of our nerves, 0:20:38.040 --> 0:20:41.360 and usually that's in the trigeminal nerves, which is one 0:20:41.359 --> 0:20:44.520 of your facial nerves if it's an oral infection, or 0:20:44.560 --> 0:20:48.879 in the lumber lumbo sacral nerves, which is if you 0:20:48.920 --> 0:20:52.520 have a genital infection, that's where HSV tends to hang out. 0:20:53.560 --> 0:20:57.520 Once it's there, it just can hang out. And ninety 0:20:57.560 --> 0:21:01.240 percent of people that present with a simple domatic primary 0:21:01.240 --> 0:21:05.320 infection will have at least one recurrence within the first 0:21:05.480 --> 0:21:10.800 year after being infected. So these recurrent episodes tend to 0:21:10.840 --> 0:21:14.200 start with a prodrome, so some kind of like tingling 0:21:14.280 --> 0:21:18.080 sensation or burning sensation, or sometimes even like a shooting 0:21:18.200 --> 0:21:22.600 pain that can happen anywhere from hours to a few 0:21:22.680 --> 0:21:27.560 days before a new outbreak of these vesicles. So those 0:21:27.600 --> 0:21:30.400 same kind of ulcers that you see in a primary infection. 0:21:31.240 --> 0:21:34.160 But one of the big differences is that recurrent episodes 0:21:34.200 --> 0:21:37.880 tend to be shorter in duration, so you would only 0:21:37.920 --> 0:21:41.480 shed virus for like four days compared to eleven days 0:21:41.520 --> 0:21:44.199 in a primary infection. And there also tends to be 0:21:44.320 --> 0:21:47.359 fewer lesions. So in a primary infection it's common to 0:21:47.359 --> 0:21:53.240 have like sixteen or more lesions, whereas in recurrent infections 0:21:53.240 --> 0:21:55.320 you tend to have fewer, like maybe four or five 0:21:55.440 --> 0:21:56.520 six something like that. 0:21:56.800 --> 0:22:00.920 Gotcha? Okay, So questions, many questions. 0:22:01.200 --> 0:22:01.480 Great. 0:22:01.800 --> 0:22:05.920 Number one is the difference between HSV one and HSV two, 0:22:06.160 --> 0:22:10.120 because you said that either virus can infect like any 0:22:10.160 --> 0:22:14.520 part of your body basically, so how does that manifest clinically? 0:22:15.119 --> 0:22:15.359 Great? 0:22:15.400 --> 0:22:18.400 And then the other question is sort of about like 0:22:18.480 --> 0:22:22.399 if you were to plot viral shedding, you know, like 0:22:22.480 --> 0:22:26.320 on with time on the X axis and viral load 0:22:26.359 --> 0:22:29.600 on the y axis, what might that look like over 0:22:29.800 --> 0:22:32.639 like a number of years, you know, for starting with 0:22:32.640 --> 0:22:34.120 the primary infection. And then on. 0:22:34.640 --> 0:22:38.480 Excellent questions, let's address them both. Okay, So HSB one 0:22:38.640 --> 0:22:43.640 versus HSV two commonly we say HSV one causes oral herpes, 0:22:43.760 --> 0:22:46.880 HSV two causes genital herpes. Right, that's an easy way 0:22:46.920 --> 0:22:49.920 to be like boom one and done right. Okay, It's 0:22:49.960 --> 0:22:53.960 not quite that simple, the majority of oral herpes are 0:22:54.160 --> 0:22:59.679 definitely caused by HSV one, and HSV two tends to 0:23:00.160 --> 0:23:03.240 the only cause genital herpes. It's pretty uncommon to get 0:23:03.400 --> 0:23:07.360 HSV two outside of the genitals. You can, but it's 0:23:07.480 --> 0:23:11.480 much less common. However, HSV one can absolutely and is 0:23:11.520 --> 0:23:16.359 becoming more common to cause genital herpes, largely because of 0:23:16.440 --> 0:23:18.720 like oral genital sex because if you have it on 0:23:18.760 --> 0:23:20.680 your mouth, it's very easy to be able to spread 0:23:20.680 --> 0:23:20.920 to the. 0:23:20.880 --> 0:23:23.560 Genitals, right, but not so much the reverse. 0:23:24.520 --> 0:23:28.440 Yes, yeah, it certainly could. It's just less common. I 0:23:28.720 --> 0:23:31.760 don't really know the exact reasoning as to why, but 0:23:31.920 --> 0:23:35.760 in general, epidemiologically, what we see is HSV two tends 0:23:35.760 --> 0:23:39.480 to only cause genital herpes. God it could, however, infect anywhere. 0:23:40.119 --> 0:23:44.760 But what's very interesting is that HSV two infections of 0:23:44.800 --> 0:23:50.560 the genitals are associated with greater rates of recurrence than 0:23:50.760 --> 0:23:55.399 HSV one infections of the genitals, and the opposite is 0:23:55.480 --> 0:23:59.600 true for oral lesions. So HSV one is more likely 0:23:59.640 --> 0:24:03.520 to cause recurrence if it's an oral infection, then HSV 0:24:03.640 --> 0:24:07.080 two is If it's an oral infection, isn't that fascinating? 0:24:07.080 --> 0:24:11.280 Its very bizarre? Why? Why? Yeah? 0:24:11.320 --> 0:24:16.160 That was why Like, so I don't know, Like, are 0:24:16.160 --> 0:24:18.680 our nerves that different? I don't think so, but I'm 0:24:18.720 --> 0:24:20.919 not great at nervous system stuff. 0:24:21.160 --> 0:24:24.080 Well there's something maybe there's a bit about the history 0:24:24.119 --> 0:24:27.120 of the virus or the evolutionary history that could shed 0:24:27.160 --> 0:24:29.440 some light on that, like in terms of just being 0:24:29.480 --> 0:24:34.320 a very very very old association with humans, Like right, 0:24:34.840 --> 0:24:37.639 HSV one and two have been with humans for like 0:24:37.840 --> 0:24:41.040 as I'll talk about millions of years. But so, yes, 0:24:41.160 --> 0:24:43.679 maybe that's part of it. It's just so highly specific 0:24:43.760 --> 0:24:45.560 to like write, hey, this is how I do it. 0:24:45.600 --> 0:24:52.600 I'm yeah. Before we go into the viral shedding timeline. 0:24:53.600 --> 0:24:58.120 Another question about HSV one and HSV two concurrent infections, 0:24:58.119 --> 0:25:01.200 like can you be infected with both HSB and HSV 0:25:01.320 --> 0:25:05.600 two and could you have like oral herbies caused by 0:25:05.600 --> 0:25:07.360 both HSV one and HSV two. 0:25:08.040 --> 0:25:12.000 Great question. Absolutely, you can be co infected. It's not 0:25:12.119 --> 0:25:14.880 uncommon to be co infected with HSV one and HSV two. 0:25:16.080 --> 0:25:18.600 I know that you for example, if you have oral 0:25:18.800 --> 0:25:24.679