Doctor Rich:
Welcome back to the Doctor Rich channel. Long overdue…we have Darcie Camacho back in the studio!.
Darcie:
Thank you for having me again!
Doctor Rich:
It was probably two years ago — one of our very first Doctor Rich videos was recorded here!
Darcie:
Yes, two years later!
Doctor Rich:
So here we are. So today, we’ve scoured the internet for your questions most commonly asked about genital herpes. And make sure you stick around to the end to find out how this is often misdiagnosed.
Don’t have time to read this post? Watch the video here instead!
Doctor Rich:
Hi, I’m Doctor Rich — board-certified urogynecologist and passionate women’s healthcare advocate.
Darcie:
Okay, Doctor Rich! So first question: Can herpes kill you?
Doctor Rich:
I would’ve said no…but there is a very rare condition called herpes viremia — where it’s a systemic infection. Herpes is actually a double strand of DNA. It’s a sexually transmitted infection — you only get it through sexual encounters. It’s an invasive little virus because it comes out and presents as painful ulcers. And it’s fairly unpredictable how often you’re going to have episodes. But for the most part it’s a nuisance, and something that can be painful and can be an uncomfortable conversation that you have to have. But in general terms, this is not lethal.
But in very rare circumstances, the herpes virus can spread into the blood — and it can actually be fatal about 30% of the time when that happens. Fortunately, it is super rare, and risk factors are mainly patients who are otherwise immunocompromised; they don’t have a healthy immune system. Examples of this would be conditions such as HIV or any number of autoimmune diseases.
Darcie:
Number two: Can herpes cause infertility?
Doctor Rich:
So herpes (as we talked about) is a sexually transmitted infection. It causes painful ulcers. It doesn’t really have any impact on fertility.
Darcie:
Number three: Can herpes be transmitted through childbirth?
Doctor Rich:
So this is actually one of the worst possible outcomes with the herpes disease. So for pregnant mothers that have an active outbreak, they should not be able to labor and have a vaginal delivery. This is because that can be transmitted to the baby, and it could actually affect the nervous system. And there’s actually a very high mortality rate or death rate among babies that are infected in that way during delivery. So women who do have an active lesion during labor should have a C-section at the time of their delivery.
And on to myth-busting! Let me see…here’s one for you, Darcie! Can you get herpes from a toilet seat?
Darcie:
No, you cannot.
Doctor Rich:
Absolutely correct. You cannot get herpes from a toilet seat. You can’t get gonorrhea, chlamydia, syphilis…these are all sexually transmitted diseases that require intimate sexual contact.
Darcie:
I know one thing people think is that if they wear a condom, they don’t get exposed to herpes. Is that correct?.
Doctor Rich:
A lot of patients feel that they’re having safe sex if they’re wearing a condom — and absolutely, you should wear a condom. But just understand that because the virus can present not just on the actual head (or shaft) of the penis itself — it can be on the scrotum — transmission can occur even if you’re practicing safe sex.
Darcie:
Correct.
Okay, next question: If my blood test is positive, do I have herpes?
Doctor Rich:
So there’s actually a very common misconception — maybe the most important thing you’ll hear today! So zero positivity (or zero prevalence) for HSV or herpes (HSV 1 or 2) is between 75 and 90%. 75 to 90% of people have a positive test — but not all of those people have genital herpes. The WHO estimates somewhere around 13% of adults between 14 and 59 have genital herpes. The simple presence of having a positive blood test essentially means that you had a cold sore at some point in your life. Classically, HSV 1 meant cold sore and HSV 2 was the virus type that caused genital herpes. But there’s a lot of mixing and matching — and now you can have HSV 2 here, HSV 1 there…
Darcie:
If you want to know for sure, I think the best way is to get a vaginal culture, right?
Doctor Rich:
That’s right.
So you have to go in to see your provider when you have an active lesion, and they can swab that lesion. And that DNA test is very, very accurate.
Darcie:
Is there a cure for herpes?
Doctor Rich:
No, there’s no cure for herpes. So unfortunately, once you have it, you have it. The virus — if not causing active lesion — is in your nervous system. But you can get to the point where it’s suppressed and you don’t have another outbreak.
Darcie:
So what if I have a cold sore and I give oral sex to my partner?
Doctor Rich:
That’s actually a fantastic question because we’ve had a number of patients where that was the means of transmission! They were in a monogamous relationship. They had no other prior relationships before that relationship — and yet the patient ended up with genital herpes.
Now, the partner had known cold sores (known oral herpes). And unfortunately that virus type became general herpes and the partner. So this is a great example of something that you wouldn’t think about — but that’s something you definitely need to be careful about. It can’t kill you for all practical purposes, only rare circumstances. And as Darcie brought up — it IS possible to have oral to genital transmission.
[Darcie begins looking at her phone.]
Darcie, aren’t you paying attention?
Darcie:
I’m so sorry — I was subscribing to your channel, Doctor Rich!
