Speaker 1: My name is Courtney Brain. I am the founder executive
Speaker 1: director of the nonprofit organization Something Positive for Positive People
Speaker 1: that also has a podcast by the same name, which
Speaker 1: I host. On this podcast, I interview people who are
Speaker 1: living with primarily herpes about their experiences from their diagnosis
Speaker 1: to dating to disclosure. For me, I was diagnosed with
Speaker 1: genital HSV two. I was living with my grandmother at
Speaker 1: the time. I was just out of college, probably twenty three.
Speaker 1: I believe I'm thirty one now, so yeah, it's been
Speaker 1: about eight years. At age twenty three, I wake up
Speaker 1: one morning and I was under the covers. I got
Speaker 1: out of the covers and I was like, whoa, I'm
Speaker 1: really cold, WHOA, I'm really sweaty. At the same time,
Speaker 1: and I get up to go to the restroom for
Speaker 1: the first time, and I go to urinate and I
Speaker 1: look down at my genitals and I scream an obscenity
Speaker 1: say that, and my grandmother comes to the door. My
Speaker 1: grandmother's a nurse. I need to be sure to include
Speaker 1: that part here. She goes, you okay, man. I was like,
Speaker 1: we need to go to the emergency room or somewhere
Speaker 1: right now. And my mom just happened to be over
Speaker 1: this morning, and so my mom drives me to a
Speaker 1: nursing care facility and we're in the waiting room. I'm
Speaker 1: not sure what's going on at this point. Having an
Speaker 1: STD never crossed my mind. So I get in there
Speaker 1: and the doctor looks at me and he goes, all right,
Speaker 1: that looks like herpes, gives me the swab test. He
Speaker 1: gives me treatment for I believe ganrhea and chlamydia, and
Speaker 1: I get tested for the other common STIs at that point,
Speaker 1: and sends me on my way. I get a pamphlet
Speaker 1: that tells me a little bit about herpes and the
Speaker 1: different statistics, and I get home and I immediately start
Speaker 1: messaging tech Facebook, messaging my most recent partners and just
Speaker 1: out of concern that I may have given it to them.
Speaker 1: So my immediate response was, oh man, who else did
Speaker 1: I give this to? It was really weird how I
Speaker 1: worded each message, because it was just, hey, do you
Speaker 1: have herpes? You woudn't happen to have herpes, now, would you?
Speaker 1: And everyone said no. And so you know, you can't
Speaker 1: really dwell on whether or not you know where you
Speaker 1: got it from or how you got it or how
Speaker 1: long you've had it or anything like that. So I
Speaker 1: just kind of had to move forward accordingly with taking
Speaker 1: responsibility for myself. The next five years are a huge
Speaker 1: blur for me because I kind of just stayed in
Speaker 1: my relationships with the women that I disclosed to early
Speaker 1: dating was a trip over these five years, going through
Speaker 1: the process of having to first off understand the virus
Speaker 1: and then have to communicate that to another person because
Speaker 1: I already had my thoughts in my mind that Okay,
Speaker 1: you know, no one wants an STD, nobody wants herpes,
Speaker 1: and nobody wants to put themselves at risk for herpes.
Speaker 1: This is where we begin the origin story of something
Speaker 1: positive for positive people. I begin dating again, and then
Speaker 1: my dating you know, I just kind of got tired
Speaker 1: of keeping this thing to myself because it's really hard
Speaker 1: to talk about, and it was kind of what led
Speaker 1: to my decision making for dating. It wasn't are we compatible,
Speaker 1: It was more so, do you accept the fact that
Speaker 1: I have herpes? Okay? Great? I stumble across a dating
Speaker 1: website for people who are living with herpes, and I
Speaker 1: get on that dating site and herpes isn't on my
Speaker 1: mind because everyone here has it or everyone here knows
Speaker 1: I have it, right, And so I get active in
Speaker 1: the chat rooms, I'm meeting women, I'm dating, and life
Speaker 1: it is great. It's like where was this at for
Speaker 1: the last five years? Right? And in these communities, I
Speaker 1: find that people are saying online forums and blogs that
Speaker 1: this herpes diagnosis is the worst thing that's ever happened
Speaker 1: to them, no one's going to love them, they're never
Speaker 1: going to find a partner, and that they want to
Speaker 1: kill themselves. And that to me. The first couple of
Speaker 1: times I saw it, it wasn't really a big deal.
Speaker 1: It was just kind of like, huh, that's weird. And
Speaker 1: then after someone I had become friends with who was
Speaker 1: in a relationship with a partner who was accepting she
Speaker 1: told me that at some point she had suicide ideation.
Speaker 1: And so when she said it, I think I started
Speaker 1: to notice it a little bit more, a lot more,
Speaker 1: and I felt like I had to do something. And
Speaker 1: so I go to one of my communities and I
Speaker 1: just make a post, and the post was requesting people
Speaker 1: to anonymously share their experience and allow me to record
Speaker 1: it and then just send it to these people who
Speaker 1: are expressing suicide ideation, and so I got one person
Speaker 1: to do it, and her perspective was one. It was
Speaker 1: the exact the first episode of Something Positive for Positive People,
Speaker 1: and over the conversation, we got sad, we got angry,
Speaker 1: we cried a little bit, we laughed a little bit,
Speaker 1: and by the end of it, there was just like
Speaker 1: this neutrality. There a sense of relief more than anything.
Speaker 1: And I think that me witnessing someone who went from
Speaker 1: holding this inside to finally having shared this experience for
Speaker 1: the first time, it really showed me that there's something
Speaker 1: to be said for the power of just expressing these
Speaker 1: experiences that we have. So after I share this recording
Speaker 1: in the group, more people wanted to get involved. So
Speaker 1: it went from that one interview to four to eight
Speaker 1: to sixteen, and so many different people shared so many
Speaker 1: different experiences. There are no two experiences that are the same.
Speaker 1: Onto Something Positive for Positive People podcasts, episode archive. People
Speaker 1: expect to hear from people who have gotten herpies by
Speaker 1: being promiscuous and having multiple sex partners and being reckless
Speaker 1: and not taking any precautions and all of those things
Speaker 1: that people by default think of stigma and what people
Speaker 1: with scis look like are completely challenged by so many
Speaker 1: different experiences of everyday people who are living their life
Speaker 1: that you would never hear from simply for the fact
Speaker 1: that they're living their life. These are people who have
Speaker 1: gone on to have families, that they have businesses. These
Speaker 1: are models, These are celebrities. These are athletes, bodybuilders, people
Speaker 1: who have absolutely no reason to come up and say, hey, everybody,
Speaker 1: I have herpes and I don't fall under the stereotypes
Speaker 1: of the stigma. These are the people who are sharing
Speaker 1: their stories from their diagnosis to dating, to disclosure to
Speaker 1: the point where they are now. So I often tell
Speaker 1: people Something Positive for Positive People is not necessarily a
Speaker 1: herpes resource that just happens to be like a secondary
Speaker 1: effect from this actually being at its core a suicide
Speaker 1: prevention resource. It's becoming clear that there is a direct
Speaker 1: connection between this an STI diagnosis as something that triggers
Speaker 1: mental health issues. As a nonprofit organization, the business function
Speaker 1: of Something Positive for Positive People is to not only
Speaker 1: connect people with community resources, but also a therapist in
Speaker 1: the event that they are struggling with stigma or struggling
Speaker 1: with their diagnosis, or connecting them with a sex positive
Speaker 1: therapist who is capable of talking them through that. So
Speaker 1: one of the things that I want to do is
Speaker 1: just put people in position to where they don't necessarily
Speaker 1: really feel the need to come out and combat stigma
Speaker 1: or to like openly make a Facebook status that they
Speaker 1: have herpies like. If that's what people want to do, great,
Speaker 1: but they don't have to do that. This is essentially
Speaker 1: a safe space for people to understand how they want
Speaker 1: to navigate the stigma. I have no intention of destroying stigma,
Speaker 1: eradicating it, or whatever violent word you want to insert
Speaker 1: to stigma. My purpose is to just give people the
Speaker 1: resources to navigate the stigma. It's not going anywhere anytime soon.
Speaker 1: So until we're all on the same page about what
Speaker 1: this is going to look like for us, and we
Speaker 1: get the truth out there, consistent truth about this virus,
Speaker 1: then I think that we can begin to focus more
Speaker 1: so on the important stuff, which is how we process
Speaker 1: it mentally and emotionally, and how we go about communicating
Speaker 1: to the people who need to know about it, and
Speaker 1: how we deal with it ourselves.
Speaker 2: Yes, you just heard from the amazing Courtney Bram who
Speaker 2: is the creator and host and editor and producer and
Speaker 2: everything of the nonprofit organization and podcast Something Positive for
Speaker 2: Positive People. You can find s p f PP wherever
Speaker 2: you get your podcast, and also on SPFPP dot org
Speaker 2: or something Positive for Positive People dot org.
Speaker 3: Hi, I'm erin Welsh and I'm erin allman Updyke.
Speaker 2: And this is this podcast will kill you.
Speaker 3: And today you've probably guessed we're talking about herpes.
Speaker 2: Yes, HSV one and HSV two.
Speaker 3: That's herpes simplex virus one and two.
Speaker 2: Hmm. It's going to be a really great episode, in
Speaker 2: part because, in addition to our incredible guest Courtney, we
Speaker 2: also had the wonderful opportunity to chat with doctor Aina Park,
Speaker 2: who is Associate Professor at UC San Francisco School of
Speaker 2: Medicine as well as medical Consultant in the Division of
Speaker 2: STD Prevention at the CDC, and we chatted with her
Speaker 2: about her upcoming book titled Strange Bedfellows. It's an incredible
Speaker 2: book and you guys are gonna love this interview. So Aerin,
Speaker 2: should we jump to important business matters?
Speaker 3: Oh? Yes, it is what time? Oh it's quarantiny time?
Speaker 2: It is What are we drinking this week?
Speaker 3: This week we're drinking the simplex sour ooa yum.
Speaker 2: And what is in the simplex sour.
Speaker 3: Well aarin as you can probably describe better than meat,
Speaker 3: It's a bourbon slush.
Speaker 2: Ryeah, it's a bourbon slush.
Speaker 3: It's a Kentucky It's a very Kentucky drink.
Speaker 2: It's so delicious. I feel like it's great the last
Speaker 2: sort of throes of summer here as we as we
Speaker 2: wave goodbye to the beautiful sun and greenery that's been
Speaker 2: all around me here in Chicago and anyway. So, what's
Speaker 2: in a bourbon slush? It is essentially black tea sugar,
Speaker 2: frozen lemonade, frozen orange juice, bourbon ginger ale. I will
Speaker 2: warn you that it does take a bit of prep
Speaker 2: in that you make a big batch of it and
Speaker 2: you have to freeze it sometimes overnight, but it's totally
Speaker 2: worth it because it's delicious.
Speaker 3: And we will post the full recipe for that quarantine
Speaker 3: as well as our non alcoholic place, ba Rita on
Speaker 3: our website. This podcast will kill you dot Com and
Speaker 3: all of our social media channels.
Speaker 2: Awesome, All right, Well, should we dive right into the episode.
Speaker 3: Let's dive in right after this break. So HSV herpes
Speaker 3: simplex virus, easy enough, we can learn a lot about
Speaker 3: this disease just from the name. We're dealing with the virus,
Speaker 3: specifically a DNA virus in the family herpes via day.
Speaker 3: That's right. This is a massive family of viruses, not
Speaker 3: just the two that we're talking about today. People are
Speaker 3: probably very familiar with a whole bunch of these herpes viruses, okay,
Speaker 3: because they're very famous, and many of them cause disease
Speaker 3: in humans, not just HSV one and HSV two. Do
Speaker 3: you know some of them are and you probably do well.
Speaker 3: There's herpsaster, Yeah, that causes chicken pox and shingles.
Speaker 2: Mm hm.
Speaker 3: Is CMV one, yeah, it is Cida megalovirus is a
Speaker 3: herpes virus EBV Yeah. Ebstein bar, which causes mononucleosis, is
Speaker 3: also a herpes virus.
Speaker 2: That's all that I have.
Speaker 3: Great job the airin that was very impressive. Also, Caposi's
Speaker 3: sarcoma is caused by a herpes virus HHV eight, and
Speaker 3: then rosiola or sixth disease, which is common in small children,
Speaker 3: can be caused by HHV six or sometimes seven. And
Speaker 3: then there are also hundreds of other herpes viruses that
Speaker 3: cause disease in other animals. Other mammals, but also birds, fish, molluscs, amphibians, reptiles,
Speaker 3: everybody's got herpes viruses.
Speaker 2: Oh my gosh, Erin, I think I have that same
Speaker 2: exact sentence in my notes.
Speaker 3: That's awesome.
Speaker 2: Because I think I even put in molluscs and I
Speaker 2: was like, whoa, because when.
Speaker 3: I saw that, I was like, I'm sorry, molluscs really
Speaker 3: little clams with herpes. I love it. So, yeah, this
Speaker 3: is a very big family of viruses. But today we
Speaker 3: are focusing just on Herpes simplex, which is HSV one
Speaker 3: and HSV two. So let's get specific on HSV. Transmission
Speaker 3: of HSV is pretty straightforward across the board. HSV one
Speaker 3: and HSV two are transmitted the same way. It's from
Speaker 3: mucus membrane to mucus membrane or from skin to skin,
Speaker 3: easy enough. HSV can enter through any break in the skin.
Speaker 3: You can get it really anywhere, literally anywhere.
Speaker 2: Yeah.
Speaker 3: So in general, the incubation period, so the time from
Speaker 3: when you first get infected to when you show symptoms,
Speaker 3: is about four days, but it can range from like
Speaker 3: as little as two days to twelve days. I even
Speaker 3: saw up to a month in some cases. But one
Speaker 3: of the most important things about HSV infections is that
Speaker 3: a large proportion of them are actually completely asymptomatic. Right,
Speaker 3: So you can get infected with HSV one or HSV
Speaker 3: two and never show any symptoms of it. And that
Speaker 3: doesn't necessarily mean that you aren't infectious to other people,
Speaker 3: because you can still be shedding virus even if you
Speaker 3: never knew that you were infected. Right, So let's go
Speaker 3: through the symptoms in a primary infection. Most often, if
Speaker 3: you have any symptoms, about forty percent of the time,
Speaker 3: you'll also have systemic symptoms, so you'll have fever, you'll
Speaker 3: have headache, you'll have body aches, those kind of general
Speaker 3: like viral illness type symptoms. The two most commonplaces to
Speaker 3: get infected with HSV one and two are either the
Speaker 3: mouth or the genitals. So if it's a genital infection,
Speaker 3: you can have kind of like UTI type symptoms. If
Speaker 3: the urethra is involved, so urethritis infection or inflammation of
Speaker 3: the urethra, or you can have like vaginal irritation if
Speaker 3: you have serviceitis, so inflammation of the cervix. And if
Speaker 3: you get an oral infection, then you can also get
Speaker 3: like pharyngitis type symptoms, so sore throat and things like that.
Speaker 3: And then it's also really common to have some lymph
Speaker 3: nodes swelling. So if it's an oral infection, your lymph
Speaker 3: nodes in your neck might get swollen and tender. If
Speaker 3: it's a genital infection, you have lymph nodes kind of
Speaker 3: in your groin that might get swollen and tender. And
Speaker 3: then of course the herpes sores that everyone know about. Okay,
Speaker 3: So these lesions often start with an itching or burning
Speaker 3: sensation in the skin where the virus has entered, and
Speaker 3: then these lesions appear. They start out as kind of
Speaker 3: a flat red, just little spot, and then they form vesicles,
Speaker 3: so kind of like little fluid filled blisters, and then
Speaker 3: the vesicles will burst open and leave an open ulcer
Speaker 3: behind that will often crust over, especially if these ulcers
Speaker 3: are on skin rather than mucous membrane, So if it's
Speaker 3: around the mouth or on the shaft of the penis
Speaker 3: or on the vulva, then they will crust over, whereas
Speaker 3: if it's inside the vagina or something like that, then
Speaker 3: they just sort of heal slowly without crusting over, if
Speaker 3: that makes sense, gotcha, Yeah, Yeah, So they start out
Speaker 3: usually with this sort of itching and burning sensation. But
Speaker 3: once these lesions come, they are super super painful. They're
Speaker 3: not we talked in syphilis about the lesion that you
Speaker 3: get from that, which is painless, but these ones are
Speaker 3: quite painful, and in a primary infection, they take a
Speaker 3: really long time to heal too. It's usually at least
Speaker 3: eight to eleven days, but it can be even longer.
Speaker 3: So you have these painful sores for like a long time.
Speaker 3: So one of the questions is actually what's actually happening here,
Speaker 3: and that will lead us into how does this virus
Speaker 3: then hide out in our bodies? Okay, so why does
Speaker 3: the virus actually cause these ulcers these sores. When HSV
Speaker 3: enters your skin through a break in the skin or
Speaker 3: through the mucous membrane, the cells that they infect are
Speaker 3: your epidermal and dermal cells, so they don't have to
Speaker 3: travel far. Right where they enter is where they start
Speaker 3: to infect cells and replicate, and as they do that,
Speaker 3: they cause direct damage to the cells of your dermis
Speaker 3: and epidermis. So that's why you have those blisters, because
Speaker 3: those are actually from viral damage to the cells. Does
Speaker 3: that make sense?
Speaker 2: Okay?
Speaker 3: Yeah, But then as they replicate and spread, they enter
Speaker 3: the axons of our sensory nerves.
Speaker 2: Right, what I know, it's wild, it's.
Speaker 3: So wild, Oh my goodness. So they enter the axons
Speaker 3: and then they travel The axons are essentially like the
Speaker 3: nerve projections, right, And they travel along these axons all
Speaker 3: the way back to the cell body, which is in
Speaker 3: our spinal cord.
Speaker 2: And you know, trying to phreeze this in a way
Speaker 2: that's not like why does the virus do this? Why
Speaker 2: is it so smart? But like the consequence of this,
Speaker 2: like nerve association or whatever, the fact that it goes
Speaker 2: into your nerves is that, like our immune system doesn't
Speaker 2: really like to mess around with that.
Speaker 3: Yeah, we've talked about this a lot before. But once
Speaker 3: a pathogen has made it past our blood brain barrier,
Speaker 3: it's really hard for our immune system to do much
Speaker 3: about it. Like we have the blood brain barrier there
Speaker 3: to prevent from getting in in the first place, right,
Speaker 3: And so once a virus is already there in our
Speaker 3: spinal cord, it is very hard. And HSV, like many
Speaker 3: herpes viruses, well like all herpes viruses, is also just
Speaker 3: really good at evating our immune system. Even when it's
Speaker 3: not inside of our nerves, right, so it has all
Speaker 3: these adaptations to just make it harder for our immune
Speaker 3: system to fight it off.
Speaker 2: Essentially interesting, yeah, very interesting.
Speaker 3: And so that is how HSV can establish this latent
Speaker 3: infection essentially once it's in the cell bodies of our nerves,
Speaker 3: and usually that's in the trigeminal nerves, which is one
Speaker 3: of your facial nerves if it's an oral infection, or
Speaker 3: in the lumber lumbo sacral nerves, which is if you
Speaker 3: have a genital infection, that's where HSV tends to hang out.
Speaker 3: Once it's there, it just can hang out. And ninety
Speaker 3: percent of people that present with a simple domatic primary
Speaker 3: infection will have at least one recurrence within the first
Speaker 3: year after being infected. So these recurrent episodes tend to
Speaker 3: start with a prodrome, so some kind of like tingling
Speaker 3: sensation or burning sensation, or sometimes even like a shooting
Speaker 3: pain that can happen anywhere from hours to a few
Speaker 3: days before a new outbreak of these vesicles. So those
Speaker 3: same kind of ulcers that you see in a primary infection.
Speaker 3: But one of the big differences is that recurrent episodes
Speaker 3: tend to be shorter in duration, so you would only
Speaker 3: shed virus for like four days compared to eleven days
Speaker 3: in a primary infection. And there also tends to be
Speaker 3: fewer lesions. So in a primary infection it's common to
Speaker 3: have like sixteen or more lesions, whereas in recurrent infections
Speaker 3: you tend to have fewer, like maybe four or five
Speaker 3: six something like that.
Speaker 2: Gotcha? Okay, So questions, many questions.
Speaker 3: Great.
Speaker 2: Number one is the difference between HSV one and HSV two,
Speaker 2: because you said that either virus can infect like any
Speaker 2: part of your body basically, so how does that manifest clinically?
Speaker 3: Great?
Speaker 2: And then the other question is sort of about like
Speaker 2: if you were to plot viral shedding, you know, like
Speaker 2: on with time on the X axis and viral load
Speaker 2: on the y axis, what might that look like over
Speaker 2: like a number of years, you know, for starting with
Speaker 2: the primary infection. And then on.
Speaker 3: Excellent questions, let's address them both. Okay, So HSB one
Speaker 3: versus HSV two commonly we say HSV one causes oral herpes,
Speaker 3: HSV two causes genital herpes. Right, that's an easy way
Speaker 3: to be like boom one and done right. Okay, It's
Speaker 3: not quite that simple, the majority of oral herpes are
Speaker 3: definitely caused by HSV one, and HSV two tends to
Speaker 3: the only cause genital herpes. It's pretty uncommon to get
Speaker 3: HSV two outside of the genitals. You can, but it's
Speaker 3: much less common. However, HSV one can absolutely and is
Speaker 3: becoming more common to cause genital herpes, largely because of
Speaker 3: like oral genital sex because if you have it on
Speaker 3: your mouth, it's very easy to be able to spread
Speaker 3: to the.
Speaker 2: Genitals, right, but not so much the reverse.
Speaker 3: Yes, yeah, it certainly could. It's just less common. I
Speaker 3: don't really know the exact reasoning as to why, but
Speaker 3: in general, epidemiologically, what we see is HSV two tends
Speaker 3: to only cause genital herpes. God it could, however, infect anywhere.
Speaker 3: But what's very interesting is that HSV two infections of
Speaker 3: the genitals are associated with greater rates of recurrence than
Speaker 3: HSV one infections of the genitals, and the opposite is
Speaker 3: true for oral lesions. So HSV one is more likely
Speaker 3: to cause recurrence if it's an oral infection, then HSV
Speaker 3: two is If it's an oral infection, isn't that fascinating?
Speaker 2: Its very bizarre? Why? Why? Yeah?
Speaker 3: That was why Like, so I don't know, Like, are
Speaker 3: our nerves that different? I don't think so, but I'm
Speaker 3: not great at nervous system stuff.
Speaker 2: Well there's something maybe there's a bit about the history
Speaker 2: of the virus or the evolutionary history that could shed
Speaker 2: some light on that, like in terms of just being
Speaker 2: a very very very old association with humans, Like right,
Speaker 2: HSV one and two have been with humans for like
Speaker 2: as I'll talk about millions of years. But so, yes,
Speaker 2: maybe that's part of it. It's just so highly specific
Speaker 2: to like write, hey, this is how I do it.
Speaker 2: I'm yeah. Before we go into the viral shedding timeline.
Speaker 2: Another question about HSV one and HSV two concurrent infections,
Speaker 2: like can you be infected with both HSB and HSV
Speaker 2: two and could you have like oral herbies caused by
Speaker 2: both HSV one and HSV two.
Speaker 3: Great question. Absolutely, you can be co infected. It's not
Speaker 3: uncommon to be co infected with HSV one and HSV two.
Speaker 3: I know that you for example, if you have oral
Speaker 3: HSV one, you will not then get genital HSV one. Okay,
Speaker 3: do that makes sense? Yes, But whether you could have
Speaker 3: say genital HSV one and genital HSV two that I'm
Speaker 3: not sure. I didn't see that anywhere, but it seems
Speaker 3: like it seems like you probably could unless they somehow
Speaker 3: like compete within the nerve, but I doubt it. So
Speaker 3: probably probably could. Once you're infected with one, you have it,
Speaker 3: and you just have it where you have it.
Speaker 2: Okay, that makes sense.
Speaker 3: Oh okay, And then your second what was your second
Speaker 3: question timeline of shed So glad you asked so. And
Speaker 3: this kind of is what I wanted to talk about next,
Speaker 3: which is is the idea that this is a latent
Speaker 3: infection actually correct? Ooh d damn doom. Okay, So we
Speaker 3: know that HSV infections can show up. You know, you
Speaker 3: have a period of no symptoms, and then you can
Speaker 3: have symptoms, right like discrete periods of time where you
Speaker 3: have symptoms, and we know that during those times you
Speaker 3: are highly infectious. So you're definitely shedding virus when you
Speaker 3: have an active cold sore or genital sore for example. However,
Speaker 3: it turns out that up to eighty percent of the
Speaker 3: time that someone is shedding virus is when they're asymptomatic. Okay,
Speaker 3: so they don't you don't have to have any active
Speaker 3: lesions that you know of to be infectious potentially, and
Speaker 3: in fact, in some studies, people who were HSV positive
Speaker 3: shed virus on about twenty five percent of days, regardless
Speaker 3: of their symptoms, and the viral loads will be much
Speaker 3: lower than and if you have an active lesion for example, Okay,
Speaker 3: but it would still be from that same mucosal surface.
Speaker 2: Gotcha.
Speaker 3: For a long time we thought, well, if you just
Speaker 3: abstain from sex when you have active lesions, or use
Speaker 3: a condom if you have visible lesions, then that's it.
Speaker 3: You're protected. But that's not true. Right. They absolutely reduce
Speaker 3: the risk, but especially because you can shed when you're
Speaker 3: asymptomatic and you can have lesions that aren't covered by
Speaker 3: a condom, So condoms are not one hundred percent effective
Speaker 3: in preventing transmission by any means. Right. But yeah, So
Speaker 3: that's kind of the overall general biology of HSV one
Speaker 3: and HSV two. But that's not everything.
Speaker 2: Yeah, I want to know about treatment.
Speaker 3: Oh, there's actually more to talk about in terms of
Speaker 3: the disease itself before we can talk about treatment. Oh okay, great,
Speaker 3: And that is because in general, this disease, herpes, it
Speaker 3: can be extremely debilitating it can be painful, as we've
Speaker 3: talked about, as you heard in the first hand account,
Speaker 3: and as we'll talk a lot more about. I know
Speaker 3: you'll talk about it in the history, Aaron, we'll talk
Speaker 3: about it in the current events. The stigma associated with
Speaker 3: it is so severe in many cases, but in general,
Speaker 3: it's a self limited infection that doesn't have very serious
Speaker 3: complications if it's left untreated.
Speaker 2: Right.
Speaker 3: However, there are kind of three exceptions to that. So
Speaker 3: one is that infection of the eyes, which is possible
Speaker 3: because your eyes are a mucus membrane, can happen very painful.
Speaker 3: It can lead to scarring and blindness. So that's a
Speaker 3: pretty severe potential complication from an ocular infection with HSV.
Speaker 2: Okay. Two questions about that, Oh gosh, okay. Number one,
Speaker 2: how what is the incidence of that?
Speaker 3: Good question? And then I don't have a number on that.
Speaker 3: I do not know, okay.
Speaker 2: And then the other question is like, could that be
Speaker 2: from an oral HSD one infection just like manifesting like
Speaker 2: the vesicles manifesting in your eyes or what's it?
Speaker 3: It's such a good question, Aaron, So I don't fully know.
Speaker 3: So let me answer that question in roundabout by talking
Speaker 3: about the other serious complications, and that is encephalitis. Okay,
Speaker 3: So herpes encephalitis is very rare. We're talking like between
Speaker 3: two and four cases per one million worldwide each year.
Speaker 2: Very rare.
Speaker 3: Okay, it's very rare. However, it is the most common
Speaker 3: cause of viral encephalitis in the United States and probably
Speaker 3: across the world. But we just have good data for
Speaker 3: the United States.
Speaker 2: Wow.
Speaker 3: Yeah, So herpees simplex virus accounts for fifty to seventy
Speaker 3: five percent of identified cases of viral encephalitis. A lot
Speaker 3: of viral encephalitis. We're just like, we don't know what
Speaker 3: caused this, but when we can figure out what caused it,
Speaker 3: fifty to seventy five percent of the time, it's HSV. Okay.
Speaker 3: And we've talked about encephalitis kind of a lot actually
Speaker 3: on those podcasts.
Speaker 2: We actually have. We just did the tripoli yeah, and
Speaker 2: then we.
Speaker 3: We've done uh yeah. So you know that that's infection
Speaker 3: of your brain itself. In the case of herpes, it
Speaker 3: tends to infect the temporal lobe and and or the
Speaker 3: frontal lobe. But so it causes just kind of the
Speaker 3: same generic encephalitis symptoms. So mental status changes, confusion, behavior changes, headache, seizures,
Speaker 3: you can have neurologic deficits. But the good thing about
Speaker 3: HSV encephalitis is that we have treatment for it. Okay, cool, Yeah,
Speaker 3: but it is super high mortality, like seventy percent mortality
Speaker 3: rate if it's untreated. It's very serious, but again very rare.
Speaker 3: And what's interesting about encephalitis, and this gets to your
Speaker 3: question about how you get the eye infection. You can
Speaker 3: get potentially HSV encephalitis from either a primary or from
Speaker 3: a recurrent infection.
Speaker 2: Okay, okay, so it could just be random.
Speaker 3: Yeah, yeah.
Speaker 2: Is it more common with HSV one than two?
Speaker 3: Yes, great question. It's absolutely the vast majority of cases
Speaker 3: are HSB one.
Speaker 2: Okay, that makes sense. That also makes sense that it's
Speaker 2: the number that. It makes sense that it's the number
Speaker 2: one cause because so many people, as you'll talk about,
Speaker 2: like everyone is infected with HSV. Yeah, exactly, like it's everyone, Yeah, yep.
Speaker 3: And then yeah, the other serious complication is neonatal infection,
Speaker 3: So that's when a baby gets infected. It is possible
Speaker 3: for a fetus to get infected in utero, but it's
Speaker 3: quite rare. Actually, it's more common for a baby to
Speaker 3: get infected if there are active lesions during a vaginal delivery,
Speaker 3: and this is most common if someone gets infected for
Speaker 3: the first time so has their primary HSV infection during
Speaker 3: the last part of their pregnancy. Gotcha, Okay, Herpes is treatable. Yay,
Speaker 3: well kind of. So herpes encephalitis and neonatal herpes infection
Speaker 3: are are very treatable, often without any long term damage
Speaker 3: depending on how severe the infection was. Treatment for oral
Speaker 3: and genital herpes is acyclavier or valet cyclavier or fam cyclavier.
Speaker 3: There's a few others too, but it does not eradicate
Speaker 3: the pathogen period. Okay. So there are a couple of
Speaker 3: different ways that you can go about treating it. Like
Speaker 3: you can use just suppressive therapy and just always be
Speaker 3: taking this drug kind of like we do with HIV
Speaker 3: just keeps your viral load down really low. Or you
Speaker 3: can also use it just if you are about to
Speaker 3: have an outbreak, so you know how you can have
Speaker 3: these prodromal symptoms like tingling or burning, so you can
Speaker 3: have enough a cyclavia on hand to be like, ooh,
Speaker 3: I think I'm about to have an outbreak and start
Speaker 3: taking a cyclivier and that will help squash that. Right, No,
Speaker 3: topical doesn't do anything not recommended. Interested Yep, it exists,
Speaker 3: but it really doesn't help, especially for genital herpes.
Speaker 2: That's what it started as, which is why I asked.
Speaker 3: Yes, yeah, yeah, yeah, it really doesn't work, So oral
Speaker 3: is the way to go. And then if you have
Speaker 3: severe infection, it's ivy Actually, oh wow, okay, yeah, isn't
Speaker 3: that cool? We have ivy? Ooh? I love it.
Speaker 2: Are there side effects from a cyclavier pretty minimal?
Speaker 3: Actually, it's a pretty safe drug as far as they go. Cool. Yeah, yeah,
Speaker 3: so it's pretty good. And it's of course always possible
Speaker 3: that though will be resistance, but at this point it's
Speaker 3: we don't see a lot of resistance to a Cyclivier
Speaker 3: or Valley cyclivier.
Speaker 2: How does it work?
Speaker 3: Oh, okay, it's a nucleoside analog. Okay. So in one
Speaker 3: of our COVID episodes, actually we talked about remdesivir uh huh,
Speaker 3: and it's the same type of drug as that. So
Speaker 3: it's it basically blocks DNA replication of the virus.
Speaker 2: Oh.
Speaker 3: So it can't eliminate it, but it can stop it
Speaker 3: from replicating. So it stops me from having active infection,
Speaker 3: and it drastically reduces the chances of infecting others as well.
Speaker 3: So the infectivity Okay, it doesn't eliminate it, but it
Speaker 3: drastically reduces it.
Speaker 2: Okay. Oh, and then what are some of the things
Speaker 2: that triggers outbreaks?
Speaker 3: Good question. It really can depend on the person. It
Speaker 3: can be stress, It can definitely be like an immune
Speaker 3: compromised state. So whether that's like an actual immuno deficiency
Speaker 3: or just like another cold or another viral infection or
Speaker 3: bacterial infection that kind of gets your immune system out
Speaker 3: of whack. It can be especially for oral herpes, it
Speaker 3: can be like UV light suspending a lot of time
Speaker 3: in the sun can actually trigger a reactivation.
Speaker 2: Interesting.
Speaker 3: Yeah, and then I think for some people they can't
Speaker 3: really pinpoint any triggers. It can really depend on the person.
Speaker 2: Gotcha interesting?
Speaker 3: Cool? Yeah? What else you got any more questions for me?
Speaker 2: Aaron? I think I might have set the record this
Speaker 2: episode with many questions.
Speaker 3: I like it though, Actually I think caffeine, Like that
Speaker 3: whole biology section was actually just you asking questions.
Speaker 2: And I still never got the answer that I really
Speaker 2: wanted for why why am I hollow. Those feel so
Speaker 2: hollow when I drink caffeine.
Speaker 3: So yeah, that is the biology of HSV one and
Speaker 3: HSV two. Aaron, Where did this thing come from? How
Speaker 3: did it get here? And why why is it such
Speaker 3: a stigmatizing disease?
Speaker 4: Oh?
Speaker 2: I cannot wait to tell you. Let's take a quick
Speaker 2: break first. As you mentioned, Aaron, herpes viruses are found
Speaker 2: in all of those animal groups that you named. Yes,
Speaker 2: I even have molluscs here again, And there are also
Speaker 2: probably a great deal of herpes viruses that remain undiscovered.
Speaker 2: And one of the major characteristics that herpes viruses share
Speaker 2: in addition to all of the ones that you listed,
Speaker 2: is that they have a super high specificity to their
Speaker 2: host species of preference. Yeah, so like there isn't a
Speaker 2: whole lot of species jumping. And due to this high
Speaker 2: host specificity, viruses that tend to cause lifelong infections can
Speaker 2: actually be very useful in teasing a part when one
Speaker 2: species diverged from another, or studying genetic differences in strains
Speaker 2: can give us a lot of insight into things like
Speaker 2: when and where migrations happened. So, as I alluded to earlier,
Speaker 2: herpes very day is a very very old group like
Speaker 2: millions and millions of years, which makes sense given its
Speaker 2: wide host range and diversity. But the focus of this
Speaker 2: episode is not on herpes vera day. It's not even
Speaker 2: just on human herpes viruses. It's just about HSV one
Speaker 2: and HSV two. So where did these guys come from
Speaker 2: and what can they tell us about our own history?
Speaker 3: Yeah?
Speaker 2: Well, molecular evolution research shows that HSV one probably came
Speaker 2: with humans as they split off from our last common
Speaker 2: ancestor with other primates around six to seven million years ago.
Speaker 2: What yeah, six million.
Speaker 3: Years literally as long as we've been human.
Speaker 2: Oh yeah, even before. And HSV one enjoyed its time
Speaker 2: as an only child for a few million years, but
Speaker 2: then was joined by HSV two between one point four
Speaker 2: and three million years ago in an instance of cross
Speaker 2: species transmission. So, as early humans.
Speaker 3: We had HSV one from the get go, the.
Speaker 2: From the get go, and then we picked up chimpanzee
Speaker 2: herpes virus, but then it sort of evolved into HSV two.
Speaker 3: Fascinating, right, Yes, Okay, so where do we go from here,
Speaker 3: or rather, where.
Speaker 2: Did HSV one and HSV two go from there?
Speaker 5: Yeah?
Speaker 2: Well, wherever humans went of course, yeah, okay, And I
Speaker 2: think this is where it's really interesting to consider how
Speaker 2: the characteristics of different pathogens helps to shape their spread
Speaker 2: historically and like even prehistorically. So in our past episodes
Speaker 2: when we've talked about the evolutionary origins of our particular infection,
Speaker 2: one of the themes that we always hit on is
Speaker 2: how large human settlements facilitated the spread of infectious diseases,
Speaker 2: particularly those transmitted by respiratory droplets or contaminated water. You know,
Speaker 2: your basic crowd diseases. Yeah, for many of those diseases,
Speaker 2: the agricultural revolution was a tipping point, so a settlement
Speaker 2: had to reach a certain population threshold before those pathogens
Speaker 2: could be sustained, Otherwise they would just burn through the
Speaker 2: population and die out. But HSV one and HSV two
Speaker 2: both started their history with humans long before anyone even
Speaker 2: thought about domesticating cows or goats or horses. And the
Speaker 2: reason why the virus didn't just burn out is in
Speaker 2: its biology. Yeah. So it's these long lasting and very
Speaker 2: easily transmittable infections, and so they could be sustained intergenerationally
Speaker 2: very well, like from a mother kissing a baby, from
Speaker 2: grandparents kissing grandchildren, et cetera, like just close contact.
Speaker 3: Plus they don't tend to kill you.
Speaker 2: Well, that's yeah, that's my Number two is that the
Speaker 2: infection is incredibly mild, and so a lot of people
Speaker 2: don't even know that they have it, right like that,
Speaker 2: no one even thought twice about it. So we know
Speaker 2: that humans and herpes have been hand in hand for
Speaker 2: literally millions of years. But when did it first show
Speaker 2: up in writing? So when did people actually take note
Speaker 2: of it? And the answer is that, as per usual,
Speaker 2: we're not really sure. Okay, So the word herpes itself
Speaker 2: was used for hundreds of years to describe any kind
Speaker 2: of blistering, inflammatory skin condition, and the word comes from
Speaker 2: the Greek herpian, which means to creep or move slowly.
Speaker 3: Yeah, I saw that too, and I was waiting for
Speaker 3: you to say it.
Speaker 2: Oh yeah. And so when that word herpes appears in
Speaker 2: ancient or historical writings, we can't know for sure whether
Speaker 2: it was referring to HSV outbreaks or something else like shingles,
Speaker 2: or even like smallpox or something like that.
Speaker 3: Okay, that makes sense, yeah, But.
Speaker 2: As always, where there's uncertainty, there's somebody willing to venture
Speaker 2: a guess. So, for instance, in ancient Rome, emperor Tiberius,
Speaker 2: who ruled from fourteen to thirty seven CE, supposedly banned
Speaker 2: kissing at public ceremonies and rituals during an epidemic of
Speaker 2: oral blisters throughout the empire.
Speaker 3: Okay, so maybe.
Speaker 2: Oral herpes HSV one might have been the first descriptor. However,
Speaker 2: the other complicating factor in determining what was described first
Speaker 2: is that there are other blistering rashes on your genitals
Speaker 2: that could have been confused with herpes, and.
Speaker 3: So definitely we're not really sure.
Speaker 2: Okay, So, regardless of whether the kissing band really happened
Speaker 2: or was really Tiberius's way to try to control herpes,
Speaker 2: HSV one and HSV two do seem to have been
Speaker 2: pretty widely known throughout history, and there are early references
Speaker 2: on how to treat the blisters, such as cauterizing open
Speaker 2: sores using an iron or rubbing gold wedding bands on
Speaker 2: the lesions. What Yeah, gold, Maybe it was partially like symbolic,
Speaker 2: Maybe it was partially just gold is valuable, so it's
Speaker 2: got to have medical properties, ye, properties if.
Speaker 3: It's just gold wedding bands and not like a gold coin.
Speaker 3: I feel like that's pure symbolism, right.
Speaker 2: I know, I know, Well it's better than this other
Speaker 2: the third one I'm about to say, which is that
Speaker 2: people also recommended the use of snail slime to treat lesions.
Speaker 3: No, yes, what kind of snail?
Speaker 2: I don't know it was. It was referred to in Scotland,
Speaker 2: So I don't know what species of snails are in
Speaker 2: Scotland or what is the most common species are?
Speaker 3: How much slime? I have so many questions I know,
Speaker 3: like I mean, would you just like do you just
Speaker 3: put the snails directly on it? Or do you just
Speaker 3: gather the slime?
Speaker 2: I don't know you'd have to have, like what kind
Speaker 2: of slime gathering equipment would you need?
Speaker 3: Great question?
Speaker 2: I mean, these are fantastic questions. I don't have the
Speaker 2: answer to any of them.
Speaker 3: Wow, snail slime, don't try that.
Speaker 2: Don't try that. No. And then a mention of herpes
Speaker 2: even made its way into Shakespeare's Romeo and Juliet What
Speaker 2: yep in a speech by Mecuccio in Act one, scene four,
Speaker 2: And I don't know how to read in iambic pentameter,
Speaker 2: so apologies and advance over ladies lips who straight on
Speaker 2: kisses dream which off to the angry Mab with blister's
Speaker 2: plagues because their breaths with sweetmeats tainted are So basically,
Speaker 2: Mericuccio is describing the fairy queen Mab who plays pranks
Speaker 2: on sleeping humans, and and he's describing her like one
Speaker 2: of the things that she does is put places blisters
Speaker 2: on young women's lips because she's jealous of them. Oh interesting,
Speaker 2: I think I think that's that's an interpretation. But so
Speaker 2: for any listeners out there that has to read Romeo
Speaker 2: and Juliet for school this semester, you should definitely bring
Speaker 2: that up in discussion. Okay, So, but except for these
Speaker 2: brief mentions of blisters or treatments for blisters, herpes didn't
Speaker 2: really take up that much space in historical medical texts.
Speaker 2: Again not very surprising considering the infection is so relatively benign,
Speaker 2: and only beginning in the seventeen hundreds did physicians start
Speaker 2: to take a closer look at these blisters, and when
Speaker 2: they did that, they primarily concentrated on the genital herpes.
Speaker 2: Interesting in fact, the connection between cold soars and genital
Speaker 2: sores wouldn't really be realized until much later.
Speaker 3: That was gonna be my question when Aaron.
Speaker 2: Well, I mean it was really when microscopy and virology
Speaker 2: had advanced enough to allow people to actually isolate different
Speaker 2: strains and say, okay, this is the same virus. Wow. Yeah,
Speaker 2: I mean that long and there were probably similarities noted
Speaker 2: like oh this is like these these lesions look very similar,
Speaker 2: but you know, okay. So the first recognized description of
Speaker 2: herpes was made in seventeen thirty six by French physician
Speaker 2: John Astrik and his book on what were then called
Speaker 2: venereal diseases from the word venery, which is like, we
Speaker 2: don't use that term anymore for very good reason, because
Speaker 2: it's super judgmental. And this book came on the heels
Speaker 2: of the huge outbreak of syphilis in Europe that had
Speaker 2: begun in the early fifteen hundreds, so see our syphilis
Speaker 2: episode for more on that. And in an attempt to
Speaker 2: try to reduce the incidence of sexually transmitted infections, particularly syphilis,
Speaker 2: the French government ordered mandatory medical surveillance for sex workers,
Speaker 2: which led to a rapid growth of information on like
Speaker 2: all STIs and so in this first description, in addition
Speaker 2: to commenting on the size the shape and the location
Speaker 2: of the blisters, and a bit about like the recurrent
Speaker 2: nature and some sort of the timeline of infection. Astrik
Speaker 2: also suggested a connection between the appearance of the blisters
Speaker 2: and sexual intercourse. Although the link between sex and genital
Speaker 2: herbes seemed to be accepted by most physicians by this time,
Speaker 2: some insisted that it must be due to another reason,
Speaker 2: because oh, I had observed this in this young, recently married,
Speaker 2: very proper woman, and there's simply no way it could
Speaker 2: be sex related, and like, you know it sort of
Speaker 2: you had these preconceived notions of like, oh, well, my wealthy,
Speaker 2: well to do patients have these lesions as well, and
Speaker 2: it couldn't be like, it can't be related to sex.
Speaker 3: Yeah, because wealthy, well to do people don't have that
Speaker 3: I have sex.
Speaker 2: Yeah. And so some of the alternative reasons that were
Speaker 2: suggested ranged from congestion of the genitals, and then they
Speaker 2: also claimed it was just nervous over stimulation or hot weather.
Speaker 2: Which is interesting about the UV radiation actually, yeah, like.
Speaker 3: But how much UV radiation are people getting on their
Speaker 3: labia and their penis probably not a ton, especially in
Speaker 3: the eighteen.
Speaker 2: Hundreds, right, probably not very much.
Speaker 3: Yeah. Yeah, Well, anyways.
Speaker 2: Well the early nineteen hundreds brought some clarity to the
Speaker 2: situation via what was likely medicalized torture, although I don't
Speaker 2: have enough info to say for certain, okay, but basically,
Speaker 2: you know, in an offhanded little comment from where I
Speaker 2: read that material from blisters on the genitals was injected
Speaker 2: into the skin of some people quote human subjects, and
Speaker 2: then they subsequently developed blisters.
Speaker 3: Like nobody volunteered for that experiment.
Speaker 2: No, I mean, even the term volunteer is like problematic
Speaker 2: today in terms of coercion anyway. Okay, So, in nineteen
Speaker 2: thirty four, Albert Sabin, whose name might sound familiar from
Speaker 2: our polio episode Sabe, along with two other colleagues, isolated
Speaker 2: a herpe simplex virus, and then additional strains were detected.
Speaker 2: In later decades and during the first half of the
Speaker 2: twentieth century, herpes in general received a pretty good deal
Speaker 2: of research attention as scientists studied the natural history of
Speaker 2: the virus and discovered its ability to cause these you know,
Speaker 2: quote unquote latent infections just hanging out in the nervous system.
Speaker 2: Because it is a very interesting virus biologically.
Speaker 3: Oh, it's fascinating.
Speaker 2: Yeah, But it wasn't until nineteen sixty seven that researchers
Speaker 2: described the clinical differences between HSV one and HSV two
Speaker 2: nineteen sixty seven and then but it was also around
Speaker 2: the same time that researchers, you know, discovered the tendency
Speaker 2: to cause infections on either the mouth or the genitals,
Speaker 2: you know, respectively, HSV on HSV two.
Speaker 3: Yeah.
Speaker 2: All right, So in the story of herpes, Aaron, we're
Speaker 2: already in the nineteen sixties, and there's one glaring piece
Speaker 2: of the puzzle that's missing, the stigma.
Speaker 3: Yeah. Yeah, everyone's just like, yeah, we all have this
Speaker 3: and it's fine.
Speaker 2: Yeah, because like the stigma, and so the reason that
Speaker 2: I haven't brought it up is because it wasn't there yet.
Speaker 2: It wasn't there. Of course, like the transmission route of
Speaker 2: HSV one and HSV two was well established, and many
Speaker 2: people were happy to point accusatory and judgmental fingers at
Speaker 2: those with other better known STIs such as syphilis, gunnarhea, chamydia,
Speaker 2: et cetera. But herbes didn't receive very much social attention,
Speaker 2: I guess I'll call it. Even in the most popular
Speaker 2: sex or sexual health books of the nineteen seventies, herpes
Speaker 2: barely gets a mention. What why was that? And what
Speaker 2: happened to change this public perception of herpes to what
Speaker 2: it is today?
Speaker 3: Yeah?
Speaker 2: Okay, so the first question why herpes didn't garner that
Speaker 2: much attention. That could have been due to a number
Speaker 2: of different reasons. One could be that the other more
Speaker 2: common STIs, with their potential to cause much more serious
Speaker 2: health issues, had long overshadowed the mild infections caused by HSV.
Speaker 2: Another reason could be that since at the time there
Speaker 2: was no treatment for HSV, its short descriptions primarily focused
Speaker 2: on the natural history of the viruses, and there wasn't
Speaker 2: much more to say about it.
Speaker 3: Okay.
Speaker 2: Some healthcare professionals were even hesitant to label HSV two
Speaker 2: as a sexually transmitted virus since it could also be
Speaker 2: spread non sexually. So that takes me to the next question,
Speaker 2: what happened to flip the switch on herpes?
Speaker 3: Yeah?
Speaker 2: Before I start to answer that, I want to say
Speaker 2: that for this part of the story, I'm focusing on
Speaker 2: how the stigma of herpes grew in the US in
Speaker 2: the last few decades. I don't really know how herpes
Speaker 2: is perceived in other parts of the world. But I
Speaker 2: would love to know more. So if you have any
Speaker 2: info or articles or personal experiences like, please send them
Speaker 2: our way. I would I would love to know more
Speaker 2: about that. Okay. So, for hundreds of years and into today,
Speaker 2: sexually transmitted infections have been used by some people to
Speaker 2: drive a particular narrative. As Alan Brandt pointed out in
Speaker 2: a book I read called No Magic Bullet, which is
Speaker 2: about the social history of STIs in the US, these
Speaker 2: narratives fall into three basic themes. One is that sexually
Speaker 2: transmitted infections are considered punishments for immoral behavior. Another is
Speaker 2: that people use STIs to argue for a more conservative
Speaker 2: or restricted sexuality. And the third is that an STI
Speaker 2: is not simply an STI. It's a symptom of a
Speaker 2: much larger systemic issue and indicative of the decay of
Speaker 2: society as we know it.
Speaker 3: Oh geez.
Speaker 2: So those are like the three primary narratives that it
Speaker 2: had been used to in terms of like to make
Speaker 2: some sort of moral argument.
Speaker 3: Yeah.
Speaker 2: For a long long time, more prominent sti is like
Speaker 2: syphilis and gonorrhea were used as the cases in point,
Speaker 2: but then came antibiotics and these painful, deadly diseases that
Speaker 2: were delivered as divine punishment cleared up with a quick
Speaker 2: course of penicillin.
Speaker 3: Oh, this is fascinating here.
Speaker 2: And then the sexual Revolution of the nineteen sixties really
Speaker 2: changed the landscape in terms of normalizing sex, having all
Speaker 2: different kinds of it, talking about it, and most importantly,
Speaker 2: enjoying it. And the sexual Revolution deserves a much more
Speaker 2: nuanced history retelling than I can give it, or that
Speaker 2: I'm going to give it right now, But I'll recommend
Speaker 2: a book that covers some great ground. But casting off
Speaker 2: the puritanical attitudes about sex that had prevailed for hundreds
Speaker 2: of years provided a little glimpse into what it might
Speaker 2: be like to live in a progressive, non judgmental society.
Speaker 2: This social movement gained momentum with policy changes such as
Speaker 2: the legalization of birth control pills and abortion. Make Love
Speaker 2: not War was the motto and also the name of
Speaker 2: the book on the Sexual Revolution that I was going
Speaker 2: to recommend. But you know, of course, the Sexual Revolution
Speaker 2: wasn't the utopia that it is often described to be.
Speaker 2: Some of the more prominent figures held racist, or sexist
Speaker 2: or homophobic views, and there were still clear boundaries on
Speaker 2: like what was or wasn't acceptable, and you know, and
Speaker 2: so on. But that glimpse looked great to some people.
Speaker 2: To others it looked dangerous. The youth of America was
Speaker 2: destroying the natural order of things quote unquote. And it's
Speaker 2: not like the stigma or shame surrounding sex or sti's
Speaker 2: disappeared during this time. It was just drowned out by
Speaker 2: louder voices for a little while. And when the sexual
Speaker 2: revolution started to wane a bit in the late nineteen
Speaker 2: seventies for a number of reasons, including economic downturn, commercialization
Speaker 2: of sex, sort of disillusionment overall. With this movement, there
Speaker 2: were plenty of people ready and willing to take back
Speaker 2: up that mantle of sex is bad and you deserve
Speaker 2: to be punished for having it. But they needed a
Speaker 2: new villain to fill the roles previously held by syphilis, gonorrhea,
Speaker 2: and chlamydia.
Speaker 3: Because those are treatable now, uh huh.
Speaker 2: Enter herpes. What Herpes, despite being for the most part,
Speaker 2: as you described, a very benign infection that does not
Speaker 2: require sexual contact to transmit, herpes suddenly became the symbol
Speaker 2: of the consequences of sexual liberation. Wow, it became the
Speaker 2: evidence that opponents of the sexual revolution had long been
Speaker 2: looking for that any kind of sex outside of the
Speaker 2: narrowly defined one man, one woman only after marriage was
Speaker 2: going against Mother Nature. The evangelist Billy Graham said quote,
Speaker 2: we have the pill, we have conquered VD with penicillin,
Speaker 2: but along comes herpes simplex too. Nature itself lashes back
Speaker 2: when we go against God. Of course, HIV was also
Speaker 2: used to drive these same repressive narratives. Check out our
Speaker 2: HIV episode from way back on our first season for more.
Speaker 2: But in response to this moralistic interpretation of herpes, a
Speaker 2: commentator from nineteen eighty two said quote, if herpes did
Speaker 2: not exist, the moral majority would have had to invent it.
Speaker 3: Whoa.
Speaker 2: And then popular media fed into this too, So early
Speaker 2: nineteen eighties news articles in like Time magazine were titled
Speaker 2: quote today's scarlet letter herpes or herpies, the new sexual leprosy.
Speaker 3: The newest sexual leprosy. See our leprosy episode if you'd
Speaker 3: like to know all about that.
Speaker 2: Oh my, uh huh uh huh uh huh. And so
Speaker 2: these types of headlines and these types of like fear mongering,
Speaker 2: they just all they did was increase the hysteria and
Speaker 2: stigmatization around the virus by telling the story of how
Speaker 2: Jim or Nancy or whoever, and how their chance at
Speaker 2: love and happiness was forever ruined by their positive diagnosis.
Speaker 2: Like they weren't informative pieces of journalism, right, they.
Speaker 3: Were like scarre life is ruined because now you have herpes.
Speaker 2: Uh huh. And I think it's really important that like
Speaker 2: people's stories are told and that like, you know, if
Speaker 2: someone if someone feels like their life is ruined, let's
Speaker 2: tell that story. But let's talk about why they feel
Speaker 2: that way and why we as a society have made
Speaker 2: them feel that way, so not just be like yep,
Speaker 2: you're right, yep, yeah, look at you now. And then
Speaker 2: there was a new word that was introduced into the
Speaker 2: conversation that further othered people who were HSD positive, herpetic
Speaker 2: herpetic herpetic words and we've kind of talked about this
Speaker 2: a bit before on the podcast, but words that reduce
Speaker 2: a person's identity to one thing, herpetic syphilitic lepers. These
Speaker 2: do an enormous amount of damage and are incredibly dehumanizing.
Speaker 2: But in a way that was kind of the goal
Speaker 2: of the people using them, and so herbies rose to
Speaker 2: a position of notoriety in the late nineteen seventies and
Speaker 2: into the early nineteen eighties, helped along by these many
Speaker 2: many news reports on the topic. Who knew how to
Speaker 2: get that readership up? And the effectiveness of this new
Speaker 2: narrative around genital herbies can be reflected in some stats
Speaker 2: from this time. Between nineteen seventy and nineteen eighty five,
Speaker 2: the prevalence of HSV two in the US rose from
Speaker 2: thirteen point six percent to fifteen point seven percent. But
Speaker 2: between those same years, roughly doctor's visits for genital herpes
Speaker 2: increased ten times over.
Speaker 3: Okay, yeah, yeah.
Speaker 2: And that's not necessarily a bad thing, because if you
Speaker 2: believe that you have an STI, you should go to
Speaker 2: a clinic or talk to your primary care physician. Yeah,
Speaker 2: but that lopsided increase is indicative of how awareness had
Speaker 2: crossed over into fear, because it wasn't just that the
Speaker 2: number of doctor visits was increasing, but it was also
Speaker 2: the response to a positive diagnosis, shame, depression, self exile,
Speaker 2: loss of self worth. These were all very real and
Speaker 2: common responses to being diagnosed with herpes, and this was
Speaker 2: also reported in those news articles, but again not in
Speaker 2: that hey, let's talk about why this is happening, rather like, well,
Speaker 2: this is what you get, so don't have sex.
Speaker 3: This is the consequences.
Speaker 2: But who'st to gain from all of the stigma around herpes. Well,
Speaker 2: certainly the opponents of progress, those who wanted to impose
Speaker 2: their moralistic beliefs over everyone else and control people's bodies,
Speaker 2: and also news outlets who were generating these must read articles.
Speaker 2: But there's a third group who had been waiting for
Speaker 2: their time to shine, pharmaceutical companies. In nineteen eighty two,
Speaker 2: around the same time as the peak of herpie's panic,
Speaker 2: the FDA approved a cyclavire, the very first treatment for
Speaker 2: HSV one and two, produced by the pharmaceutical company Burrow's Welcome.
Speaker 2: A cyclavi was first introduced as a topical cream, and
Speaker 2: sales were disappointingly low, probably because, as we talked about,
Speaker 2: it doesn't really.
Speaker 3: Work, doesn't really work.
Speaker 2: The development of oral a cyclavier so like the oral
Speaker 2: pill form, that improved sales quite a bit, as did
Speaker 2: the magazine ad campaign that Burrow's Welcome launched in Cosmo,
Speaker 2: Rolling Stone, People, Playboy, and other popular magazines, and this
Speaker 2: may be where you go, Hey, I think I smell
Speaker 2: a conspiracy or hey, I think I've heard this conspiracy
Speaker 2: theory before. So there's a conspiracy theory. Also, I'm going
Speaker 2: to start a petition to call these conspiracy hypotheses because
Speaker 2: this is the theories.
Speaker 3: Yeah, I know, it's part of the problem when people
Speaker 3: don't understand the word theory. It's because of things.
Speaker 2: Like that exactly. So, there's a conspiracy hypothesis that's all
Speaker 2: over the Internet that claims that Burrow's Welcome created the
Speaker 2: herpee stigma to sell a cyclovia because of the early
Speaker 2: low sales.
Speaker 1: WHOA.
Speaker 2: Let me just say that from what I've read, there
Speaker 2: doesn't seem to be a whole lot of truth or
Speaker 2: at the very least evidence in this conspiracy hypothesis. Did
Speaker 2: Burrow's Welcome play into the stigma and fear mongering?
Speaker 1: Sure?
Speaker 2: Did they profit from it, absolutely, But did they create it?
Speaker 2: Not likely.
Speaker 3: Yeah.
Speaker 2: If you look at the timing of when their promotional
Speaker 2: campaigns began, the stigma around herpes was well established by
Speaker 2: the time the first ads were out, and even then,
Speaker 2: the ads themselves didn't really buy that much into the
Speaker 2: herpes panic. They often represented someone who felt comfortable in
Speaker 2: their dating life or secure after talking to their doctor
Speaker 2: and getting treatment. So it was like they were, for
Speaker 2: the most part, from what I saw positive ads interesting.
Speaker 2: So and also burrows Welcome didn't need to create any
Speaker 2: STI stigma, Like, if you look at the history of STIs,
Speaker 2: there's always stigma, always, always, always.
Speaker 3: Always hard to have. Yeah, right around STIs.
Speaker 2: Yeah, And when directly asked about it, not by me,
Speaker 2: but in an article that I read, a representative denied
Speaker 2: any involvement in promoting the stigma, which, like, I know,
Speaker 2: what else would you expect them to say? But whatever,
Speaker 2: they go, oh.
Speaker 3: Yeah, sure, yeah, we totally did. That was great marketing.
Speaker 2: And I don't want to sound like I'm offending big
Speaker 2: Pharma because I'm definitely not. Like I'm just saying that
Speaker 2: in this particular instance, Burrow's Welcome may be innocent of
Speaker 2: what they've been accused of. We got it.
Speaker 3: We gotta say the facts, you know what I mean?
Speaker 2: I like truth. I mean that's where that's what I
Speaker 2: just like it created by Burrows Welcome or not, The
Speaker 2: stigma around herpes never abated. When I earlier referred to
Speaker 2: the peak of the panic. I meant in terms of
Speaker 2: the number of news articles or made for TV movies
Speaker 2: about herpes. Since then, the stigma has barely budged. To
Speaker 2: this day, it remains perhaps the most stigmatized of all
Speaker 2: the STIs. There's the Cards Against Humanity card about it.
Speaker 2: It's referenced in countless TV shows and movies as a joke,
Speaker 2: and all of that serves to further present silence and
Speaker 2: shame as the appropriate response to a positive diagnosis. Somehow
Speaker 2: it is socially acceptable to make fun of this and
Speaker 2: to other or ostracize people who are HSV positive. And
Speaker 2: I think that there's a lot of you know, undoing
Speaker 2: that remains in terms of breaking down the stigma or
Speaker 2: examining it at the very least. And I really really
Speaker 2: like the way that Courtney talked about navigating the stigma,
Speaker 2: because it is so big that like it is a
Speaker 2: bit maybe unrealistic to say, you know what, in my lifetime,
Speaker 2: there will be like, let's end the stigma against herpes.
Speaker 2: So Aaron, it's your turn. It's kind of an abrupt
Speaker 2: end to the history. But that's all that I've got
Speaker 2: because you know, since I mean, there's I could talk
Speaker 2: about an unethical vaccine trial that happened a little while back.
Speaker 2: But I mean really, I just kind of wanted to
Speaker 2: end by saying, hey, we really the stigma is where
Speaker 2: it was in the early eighties more or less. So
Speaker 2: hit me with some prevalent stats, some social science stats,
Speaker 2: some psychological status. Tell me what's going on with herpes today?
Speaker 3: Would love to right after this break. You wanted stats,
Speaker 3: Let me give you some stats here Erin worldwide, an
Speaker 3: estimated three point seven billion with A B humans underage
Speaker 3: fifty have HSV one. That's sixty seven percent of the
Speaker 3: global population.
Speaker 2: Do you say under fifty? Yeah?
Speaker 3: Okay. Here's a weird thing about all of the stats
Speaker 3: associated with HSV one and HSV two. They end at
Speaker 3: age fifty, as if after age fifty you don't exist.
Speaker 2: That's the Hollywood. Although if it were the Hollywood of
Speaker 2: whatever STI is, then it would be like males and
Speaker 2: females under fifty and males over fifty.
Speaker 3: Right, exactly.
Speaker 1: Yeah.
Speaker 3: The World Health Organization also estimates that of those three
Speaker 3: point seven billion with a B people with HSV one,
Speaker 3: somewhere between one hundred and twenty and one hundred and
Speaker 3: ninety million of those people have genital HSV one rather
Speaker 3: than oral HSV one, and an estimated four hundred and
Speaker 3: ninety one million people ages fifteen to forty nine, which
Speaker 3: is thirteen percent of the global population, have HSV two.
Speaker 2: I mean, it's extraordinarily common.
Speaker 3: It is, it's so so common, and it really does
Speaker 3: bug me that you can't git numbers for like you
Speaker 3: still have it at fifty two.
Speaker 2: Okay, maybe there's maybe there's a legitimate reason for it.
Speaker 3: Well, okay, let's talk about some legitimate reasons for things.
Speaker 3: Because I don't have a lot of them. I haven't
Speaker 3: found a lot of them. Okay, listen.
Speaker 2: Wonderful.
Speaker 3: So, unlike other STIs, herpes is not a notifiable disease,
Speaker 3: which means we don't have great state by state data
Speaker 3: and we don't have super great numbers on the incidence
Speaker 3: of infection. It's also not universally screened for. If you
Speaker 3: go into a clinic because you are symptomatic in any way,
Speaker 3: or you have a partner who has tested positive, or
Speaker 3: you have any type of concern and want to be tested,
Speaker 3: then absolutely any doctor would test you for herpes. But
Speaker 3: universal screening for herpes is not recommended the way it
Speaker 3: is recommended for some other sties, and the CDC, as
Speaker 3: well as the USPSTF, which is the US Preventative Service
Speaker 3: Task Force, and a bunch of other task force guideline
Speaker 3: generating organizations all agree on this idea to not recommend
Speaker 3: universal screening. So let's explore why, Yeah, I want to
Speaker 3: hear this. In my opinion, there's one good, legitimate reason
Speaker 3: and then some others that they kind of throw in
Speaker 3: that I don't know how I feel about. Okay, okay.
Speaker 3: So largely our screening tests for HSV are super kruddy, which.
Speaker 2: Is not that surprising considering sort of the history of
Speaker 2: a lack of funding or maybe not a big incentive
Speaker 2: for Yeah.
Speaker 3: I think we're lacking incentive. So at this point, the
Speaker 3: false positive rate can be as high as fifty percent
Speaker 3: depending on which test is you and confirmatory testing, so
Speaker 3: not the screening test, but like confirmatory better testing is
Speaker 3: only done at a few labs in the country, so
Speaker 3: it's not widely available. I think it's also worth mentioning
Speaker 3: that even during pregnancy, which we know could potentially be
Speaker 3: high risk because of the risk of neonatal transmission, we
Speaker 3: still don't recommend universal screening, which is something that we
Speaker 3: do do during pregnancy for a lot of other STIs,
Speaker 3: even though we know that people with vaginas are more
Speaker 3: likely to get herpes overall.
Speaker 2: And again, is this because the high rate of false
Speaker 2: positives and sometimes false negatives?
Speaker 3: Yes, absolutely, okay, And so I do want to point out, however,
Speaker 3: that the CDC on its FAQ section, which I think
Speaker 3: is the supposed to be accessible section of their website,
Speaker 3: they list a lot of reasons besides the false positive
Speaker 3: and false negative rate that they don't recommend universal screening.
Speaker 3: They say, in part because the stigma associated with HSV
Speaker 3: is so great. Then that kind of goes along with
Speaker 3: we don't want to give someone a false positive because
Speaker 3: there's so much stigma. It's also, they say, because we
Speaker 3: don't have treatment that can eliminate the infection, but we.
Speaker 2: Do have treatment that can greatly reduce your viral load.
Speaker 3: Okay, I do, and it can also reduce the rate
Speaker 3: of transmission. Okay. They also say on the CDC website
Speaker 3: that because the long term complications are essentially minimal to
Speaker 3: non existent with HSV compared to other STIs that we
Speaker 3: do screen for, like chlamydia and gonorrhea and syphilis. They
Speaker 3: also really highlight in their FAQ section that part of
Speaker 3: their reasoning, part of their rationale, is that telling people
Speaker 3: their HSV status does nothing to change their sexual practices,
Speaker 3: or at least we don't have evidence that it will
Speaker 3: change their sexual pract This is okay. I really don't
Speaker 3: like that.
Speaker 2: There are lots of problems with this.
Speaker 3: I feel there are, and I think that the biggest,
Speaker 3: the most legitimate reason, and the one that USPSTF sites
Speaker 3: in their guidelines is just because our screening tests are
Speaker 3: so cruddy. What's the point of a screening test that
Speaker 3: has a fifty percent false positive rate?
Speaker 2: That's right, I mean, and I think the fact that
Speaker 2: the CDC brings up the aspect of stigma associated with
Speaker 2: this is good because it's like, Okay, we're acknowledging that
Speaker 2: there's a huge problem with stigma, but at the same time,
Speaker 2: it's saying, there's this problem, but yeah, we can't do
Speaker 2: anything about it, so it's not actually changing the conversation
Speaker 2: about why the stigma exists. And also the fact that
Speaker 2: this is still a public health issue that can be
Speaker 2: affected or impacted in some way by screening. I don't
Speaker 2: like it. I don't think.
Speaker 3: Either I think. But so I guess that leads us
Speaker 3: to the question of is there any hope in terms
Speaker 3: of vaccines, etc. Yeah, I want to talk about that.
Speaker 2: Yeah, I do want to know that, because so there's
Speaker 2: a chicken pox vaccine, there is, and that can hide
Speaker 2: out on your nerves. It does, So why don't we
Speaker 2: have a herpes vaccine?
Speaker 3: Yeah? I cood question one paper that I read that
Speaker 3: I really it was pretty dense, but I really enjoyed
Speaker 3: their last closing line. It was huh and I quote,
Speaker 3: HSV is assuredly wilier than we are clever. Okay, Yeah,
Speaker 3: we still don't have a vaccine. There have been a
Speaker 3: few that have made it all the way through phase
Speaker 3: three trials, but then in those phase three trials have
Speaker 3: been found to just really not be effective. We just
Speaker 3: still don't have a good handle on the immune response
Speaker 3: to HSV and how exactly to best make a vaccine.
Speaker 3: So there are certainly a lot of groups working on it.
Speaker 3: You know, there is still a lot of interest in
Speaker 3: both prophylactic so preventative vaccines, but also therapeutic vaccines, especially
Speaker 3: not just in the US, but in low and middle
Speaker 3: income countries because there is a lot of association between
Speaker 3: HSV infection and increasing the risk of HIV transmission. So
Speaker 3: in a lot of places where HIV is a very
Speaker 3: very high burden, people are like, well, if we target HSV,
Speaker 3: could we then also reduce HIV. So there's definitely a
Speaker 3: lot of groups working on it, but we're not there yet.
Speaker 2: Okay.
Speaker 3: So with that in mind, we've talked a lot about
Speaker 3: stigma in general. In this episode, we wanted to talk
Speaker 3: with someone who is a bit of an expert, not
Speaker 3: just on herpes and the stigma associated with herpes, but
Speaker 3: on sexually transmitted infections in general, who wrote an entire
Speaker 3: book about these bugs, their science, their history, and their stigma.
Speaker 3: This was a really exciting interview for us, you guys, no.
Speaker 2: It was. It was such a great interview. We had
Speaker 2: such a good time we did.
Speaker 3: We were honored and thrilled to get to speak with
Speaker 3: this next guest. We had such a fun conversation. We
Speaker 3: can't wait for you all to hear her thoughts about herpes,
Speaker 3: about other sdis how to have the talk with kids,
Speaker 3: why it's so important. Now we talk about sex, the
Speaker 3: role of doctors and providers in you know, creating a
Speaker 3: sex positive environment, it's really fun. So, without further ado,
Speaker 3: may we present doctor Aina park.
Speaker 6: I'm doctor Aina park I am an associate professor at
Speaker 6: the University of California, San Francisco School of Medicine, a
Speaker 6: medical consultant to the Centers for Did's Control and Prevention
Speaker 6: in the Division of SDD Prevention, and the.
Speaker 5: Medical director of the California Prevention Training Center.
Speaker 3: Amazing, So we wanted to start off by asking you
Speaker 3: about your upcoming book, Strange Bedfellows, which is due to
Speaker 3: be released next February. First of all, we absolutely both
Speaker 3: loved the book, like so much, we're just laughing out loud.
Speaker 3: It's phenomenal.
Speaker 2: Oh my gosh, we laughed so hard we spit out
Speaker 2: our quarantinees. Sure did.
Speaker 3: It's so accessible and hilarious, but it's also so informative.
Speaker 3: So can you tell our listeners what Strange Bedfellows is
Speaker 3: about and what inspired you to write it?
Speaker 5: Sure?
Speaker 6: So, Strange Bedfellows really is a love letter to my field,
Speaker 6: which is such a transmitted infection and HIV prevention research.
Speaker 5: And it takes stories and history and you know.
Speaker 6: In depth interviews with scientists and humor and sort of
Speaker 6: weaves them all together and each chapter tackles, you know,
Speaker 6: a different concept or a different infection and traces you know,
Speaker 6: some of the history that's relevant to it, as well
Speaker 6: as some of the you know, cutting edge research and
Speaker 6: the current thinking. But throughout I think it wears its
Speaker 6: theory really lightly, and you know, humor. I feel like
Speaker 6: I try to infuse throughout and real stories that I
Speaker 6: think people can connect with.
Speaker 2: Well, you did such a great job with it. It
Speaker 2: was I kept reading it going, oh my gosh, I
Speaker 2: need to tell every person I know about this book.
Speaker 5: So well, feel free, Aaron.
Speaker 2: And we're starting here.
Speaker 3: Yeah. So, I think we've both had friends tell us
Speaker 3: about their STI diagnoses and how their doctor kind of
Speaker 3: just handed them a prescription and then shoot them out
Speaker 3: the door, leaving not a lot of time for discussion
Speaker 3: or questions. So how much do you think that provider's
Speaker 3: attitudes about sex and sexually transmitted infections contributes to the
Speaker 3: stigma that we see in the general population.
Speaker 5: I think it can strongly contribute.
Speaker 6: And I think part of the issue that we talked
Speaker 6: about is there are larger sort of societal dis comfort
Speaker 6: that translates to providers. You know, unless you're practicing that
Speaker 6: skill of talking about sex. If you're not used to
Speaker 6: talking about it, you know, you feel awkward, and then
Speaker 6: the patient senses that you feel awkward, so then they
Speaker 6: feel awkward. And so I do think that it can contribute,
Speaker 6: and so I have an editorial actually coming out in
Speaker 6: a couple of days where my colleague and I talk
Speaker 6: about how providers really if they if they don't feel
Speaker 6: comfortable doing it, they need to figure out some other
Speaker 6: way to assess sort of sexual behavior and what's going on,
Speaker 6: you know, either through some sort of like computer or
Speaker 6: tablet based sort of assessment or paper based assessment, because
Speaker 6: if they don't feel comfortable asking those questions, then they're
Speaker 6: not going to be able to counsel effectively. And so
Speaker 6: I absolutely think it contributes. But that being said, I
Speaker 6: know that some physicians and other you know, healthcare providers
Speaker 6: are never going to to get there, you know, I
Speaker 6: acknowledge that they're just never going to get there. And
Speaker 6: so that's why I feel like if people are able
Speaker 6: to put systems in place to make sure that that
Speaker 6: information is you know, collected somehow, especially like people's gender
Speaker 6: identity and as well as you know, their sexual sort
Speaker 6: of preferences and their sexual behavior. I think that will
Speaker 6: help at least set up to have enough information to
Speaker 6: counsel effectively.
Speaker 2: Yeah, and so you know, from your experience as a
Speaker 2: primary care provider, how do you walk that super fine
Speaker 2: line between talking with the people that you treat about
Speaker 2: the risks of these infections or the risks of certain
Speaker 2: sexual behaviors while also encouraging the sex positive or healthy
Speaker 2: sexual attitudes. Basically, how do you strike that balance between
Speaker 2: you know, where knowledge becomes empowering without causing fear or shame.
Speaker 6: Right, So, I do think it's a very fine line,
Speaker 6: and you know, you toe the line and sometimes you
Speaker 6: swing back and forth from one side to the other.
Speaker 6: I think my sort of take on it is that
Speaker 6: I generally am very sex positive in terms of the
Speaker 6: fact that I normalize having sex, that you should have sex,
Speaker 6: if you want to have sex with multiple partners, you know,
Speaker 6: it's fine. What I try to do is take a
Speaker 6: harm reduction approach and say, listen, STIs are going to
Speaker 6: happen to everybody, so normalize and then also an acceptance
Speaker 6: piece of it that STIs are sort of the cost
Speaker 6: of doing business in the sexual marketplace, even if you
Speaker 6: use condoms one hundred percent of the time. For penetrative
Speaker 6: sex you can still catch, you know, particularly the viral STIs,
Speaker 6: you can still catch those. And so I think so
Speaker 6: the normalizing acceptance, and then if people sort of ask questions,
Speaker 6: I am truthful, you know about what the consequences can
Speaker 6: be of having multiple partners in a short period of time,
Speaker 6: for example, which certainly could increase the risk of STIs
Speaker 6: in each IV.
Speaker 5: But I don't.
Speaker 6: I don't discourage people from expressing themselves sexually however they
Speaker 6: want to.
Speaker 5: I don't think it's effective because people are.
Speaker 6: Going to have the drive and the urge to have sex,
Speaker 6: and making them feel guilty and ashamed about it just
Speaker 6: prevents them from actually coming in and.
Speaker 5: Seeking the services they need. Some people might disagree with me.
Speaker 6: They might say we should take a little bit more
Speaker 6: of a truthful and factual and not scare tactics, But
Speaker 6: you know what I mean, a little bit more of
Speaker 6: a hardline on it, and I just don't feel that way.
Speaker 3: Yeah, yeah, So what are some of the ways that
Speaker 3: we as individuals can work towards reducing the shame and
Speaker 3: stigma surrounding STIs. What's your advice for us?
Speaker 6: So two things I think those folks that are parents,
Speaker 6: I think should probably begin having discussions with kids early,
Speaker 6: as soon as they start bringing up the topic and
Speaker 6: normalizing sex and normalizing the fact that STIs are a consequence.
Speaker 5: Of sex that are going to happen to everybody. So
Speaker 5: that's a.
Speaker 6: Piece to for with young people. The other thing is
Speaker 6: is I think being open with friends and colleagues about
Speaker 6: getting STI tested, or if you know you actually have
Speaker 6: an STI telling a friend, and I think the more
Speaker 6: people that know other people who've been dealing with an STI,
Speaker 6: I think, you know, the more other people realize that
Speaker 6: this is a consequence of having sex.
Speaker 5: It's not something that only happens to other people, do
Speaker 5: you know what I mean.
Speaker 6: I also think that we should change our language around
Speaker 6: how we discuss STIs because I'll tell you I was
Speaker 6: at a hotel at a conference and I was in
Speaker 6: line and someone asks me what I do for a living,
Speaker 6: and then of course, like it always ends up becoming
Speaker 6: a longer conversation.
Speaker 5: As soon as I tell home.
Speaker 6: But she was telling me, this woman in the line
Speaker 6: was telling me like, oh, yeah, I just started dating
Speaker 6: again because I broke up and I got my STI
Speaker 6: test and I was clean, And a lot of patients
Speaker 6: use this terminology of I'm clean, and that would be
Speaker 6: that would imply that if you had an STI, that
Speaker 6: you would be dirty, right if that's the opposite of clean.
Speaker 6: So changing our language around how we talk about STIs
Speaker 6: I think would definitely help. And then I also think
Speaker 6: with herpes in particular, I would like to change our
Speaker 6: language and call it something like HSB positive instead of
Speaker 6: having herpes, because most of the time people who have
Speaker 6: HSB do not have actual clinical herpes.
Speaker 5: And yet, you know, if you talk.
Speaker 6: About yourself as saying I have herpes, you know, really
Speaker 6: you don't.
Speaker 5: You know, you have a virus, you may or.
Speaker 6: May not actually express it, and you may not have
Speaker 6: symptoms at all.
Speaker 5: Most people don't write recognizable symptoms.
Speaker 6: So I think framing it as calling it, you know,
Speaker 6: HSB positive, just the way we say HIV positive instead
Speaker 6: of you know, having AIDS, because most people with HIV
Speaker 6: don't have AIDS.
Speaker 5: I think changing our language would certainly help.
Speaker 6: I think with the advent of social media, I think
Speaker 6: there always were sex positive people out there.
Speaker 5: But now I I feel like young people.
Speaker 6: Can actually more easily find examples of people who are
Speaker 6: sex positive out there, and that is something that just
Speaker 6: I didn't have growing up. So I actually think that
Speaker 6: and I also think that there is there is a
Speaker 6: lot more visibility for you know, sex positivity. So I
Speaker 6: think that, you know, we haven't we haven't.
Speaker 5: I don't think gone backwards, but we still have a
Speaker 5: long way to go.
Speaker 4: Let's put it that way.
Speaker 2: Thank you so much, doctor Park. That was so wonderful.
Speaker 2: We really appreciate you taking the time out of your
Speaker 2: day to chat with us.
Speaker 3: It was such a fun conversation.
Speaker 2: Oh I love it, And you guys should go and
Speaker 2: pre order Strange Bedfellows by Inina Park as soon as possible.
Speaker 2: And let me just tell you will not be disappointed.
Speaker 3: Oh it's so good.
Speaker 2: Okay. So sources, yes, okay, a few of the books
Speaker 2: I already mentioned make Love Not War by David Allen,
Speaker 2: and then there's No Magic Bullet, a social history of
Speaker 2: an aerial disease in the US that's by Alan Brandt.
Speaker 2: And then also of course I used Strange Bedfellows by
Speaker 2: doctor Park wonderful. And then I want to shout out
Speaker 2: a couple of articles that were super helpful. So one
Speaker 2: is by Hutfeld from nineteen sixty six called history of
Speaker 2: Herpe's genitalis and then another one is worth I'm at
Speaker 2: all twenty fourteen Evolutionary origins of human Herpes simplex viruses
Speaker 2: one and two. And then another great article that I
Speaker 2: found was actually on slate dot com by lv Anderson
Speaker 2: titled how Herpes Became a sexual Boogeyman, and that is
Speaker 2: an incredible read and has like all of the you
Speaker 2: know sources linked, So that was that was very helpful.
Speaker 3: We will post all of our sources for this episode
Speaker 3: and every single episode on our website, this podcast will
Speaker 3: Kill You dot com. You can learn lots more about
Speaker 3: the biology, the specifics on vaccine development, encephalitis, new natal infections.
Speaker 3: There's a lot there. Yeah.
Speaker 2: Great. Thanks again so much to our wonderful guests, Courtney
Speaker 2: Brahm and Ana Park. We really appreciate you taking the
Speaker 2: time to chat with us and we just had the
Speaker 2: best time talking with you. We wish the conversations would
Speaker 2: never end.
Speaker 3: I know, it was so fun. Thank you again so much,
Speaker 3: and thank you to Bloodmobile for providing the music for
Speaker 3: this episode and all of our episodes.
Speaker 2: And thank you to you listeners for listening. We love you,
Speaker 2: we appreciate you, and we hope that you enjoyed this episode.
Speaker 3: We hope.
Speaker 2: So all right, Well with that, wash your hands you
Speaker 2: feelthy animals.
Speaker 6: Bonbu bonba bum bu
Speaker 4: Bum bum bu