0:01 Intro: Hi there, welcome to Well Dukes, brought to you by The Well. Each week, you'll hear conversations from a variety of JMU staff and students that we hope challenge what you know, think, or do in regards to your own health and helps you be Well Dukes. 

[Musical interlude]

0:22 Mikayla: Hey Dukes. I’m Mikayla.

0:24 Jordan: And I’m Jordan.

0:25 Mikayla: And this episode is on herpes.

0:29 Jordan: Mikayla and I get asked about herpes a lot, so we decided this would be a great way to answer some common questions!

0:36 Mikayla: Yeah! So on this episode, we have Bryson Via, who is one of our Well Peers and is a sophomore Pre-PA health sciences major. Bryson interviews Katy MacDonald, who is one of our women’s health nurse practitioners here at the JMU women’s health clinic.

0:51 Jordan: Yeah, Katy is a gem! She talked about the different types of herpes, how transmission happens, how common herpes are and even some um… interesting remedies she’s seen over the years. So, enjoy!

[Musical Interlude]

1:11 Bryson: Hi, Katy. My name is Bryson. And I was just going to ask you about some of the different types of herpes viruses today.

1:19 Katy: Great! Nice to meet you, Bryson.

1:23 Bryson: So, um, Katie, I always hear people talk about herpes. Like it's, you know, the worst thing in the world. Can we talk about it and clear some rumors up?

1:31 Katy: Absolutely. Herpes is the most painful STI, and not always prevented by condom use. So it is very frustrating. And when people get it, they are devastated. So there's two types of herpes: type one and type two. The difference is type two is more virulent, meaning it's more likely to reoccur, it's more likely to have bigger and worse blisters, things like that. You can have type one or type two on your mouth, or your genitals. You know, when you see somebody with their mouth is covered in cold sores, that is type two herpes virus on their lips.

2:21 Bryson: Got it. So, which of the two types of the herpes virus would you say is more prevalent in college students?

2:29 Katy: Type one, thankfully, is more prevalent everywhere. I did talk with my other NP in Women's Health, just to verify. At JMU, we see definitely a lot of type one. Herpes is also very seasonal. You see more outbreaks in the summer. We don't know why, but sun exposure, for some reason, can cause outbreaks. You know, I should have started - the main thing I want to tell people is 50% of the people who get herpes never get it again. And I can't stress that enough. And for women, the person who really ever needs to know, I mean, you should tell sexual partners, but that's a whole other issue. But your obstetrician when you are pregnant is the person who has to know that you have herpes, because if you have an outbreak during labor, that can affect your child.

3:34 Bryson: Got it. So, we talked about how you said herpes is prevalent on - it can be prevalent on the, you know, oral cavity, you know, and then on the genitals. So, do the herpes that are found on your oral region, can that come from oral sex?

3:55 Katy: Yes. So, you pass herpes on to a partner by having a lesion. So, if you have lesions on your mouth and you have oral sex, you will give it to that person on their genitals. Also, anal sex is - you can get herpes around the anal orifice also. So, if you have - so men can have a very tiny lesion in their scrotum, and with scrotel hair and everything like that they wouldn't know that they have it. And when they have vaginal, penis in vagina, intercourse with a partner, they will give that partner herpes on their vulva. So, that's how it gets spread. So, same thing with women who have lesions on their mouth and then have oral sex, we'll give it to their partner's penis.

4:52 Bryson: So, would it be the same sort of concept for anal sex with like the tearing and lesions in the rectum sort of idea?

5:01 Katy: No, it's um, herpes likes mucous membranes. So, your mouth, your vagina and your anus are all mucous membranes. So, that's why it affects those areas. So, no tearing has to be involved. It is a skin-to-skin contact and it doesn't take much. The other thing I want to tell people is the incubation period of herpes is very varied. You know, the CDC says it's about 6 to 26 days, but we've seen it as early as 2 days. I've seen it years after somebody. So, you don't always get herpes automatically, depending on your immune system. When you get infected by somebody, it may come out years later.

5:56 Bryson: Wow, years - that's definitely a big margin probably, you know, an outlier in some of the data. So, how would I… go ahead, go ahead.

6:09 Katy: I just want to interrupt on that. So, what we didn't talk about is 80% of the human population of the universe has herpes. It is in the family of the chickenpox virus, it is very, very, very common. So, you know, so 20% chance, you know, you're dating somebody who doesn’t have it, but that's how common it is. And that's why I go back to 50% of the people who get outbreaks never get it again. For the people who do get outbreaks, you know, sometimes with women, it's once a month with their menstrual cycle. Outbreaks, as you have more, get less and less severe. So, if you had five blisters your first outbreak, the blisters tend to come back in the same place, but sometimes not as many and sometimes not as big. So that's actually a good thing too. But there is suppressive therapy, taking an antiviral medication once a day. You know, some people do it for years, it's there - have very few side effects. But that helps prevent them from having other outbreaks all the time.

7:30 Bryson: So, let's say someone contracted a version of the herpes virus in their youth. And then, let's say 20 years later, they've had a certain number of outbreaks spread over a period of time, and you said that they become less and less. Is it possible that once they reach a certain age, they will no longer have any visible symptoms of herpes anymore?

7:54 Katy: I don't know that that's the case. I don't know if that's ever been studied. So just going back to, let's talk about grandparents with cold sores, who kiss their little grandchildren. That's how probably most of us got type one herpes. So...

8:10 Bryson: That's really interesting to think about. I actually had talked about that with a friend the other day, who's a pre-nursing student, and we were just kind of joking around a little bit. And she brought the question up, and I had actually never thought about that before, like how we could have gotten herpes, unintentionally of course, from family members that have you know, like, given you a kiss on the cheek, whatever. That's definitely an interesting thing. Because I don't think a lot of people think about that when people think about herpes, they think about just, you know, some form of sex and not, [Katy: That is correct] not really, you know, fluid transmission, but you know, whether that's right, a kiss or, you know, sharing a drink, I would say that, that sort of thing.

8:53 Katy: So, it's really hard to get herpes from, like an inanimate object. Like, you didn't get your herpes from the toilet seat. I'm sorry.

9:07 Bryson: I've heard that as well.

9:08 Katy: Yeah. So it's, it's got to be a kiss to the mucous membrane. It's mucous membrane to mucous membrane. That's how it gets spread.

9:16 Bryson: Awesome. Okay. What are the most common ways herpes are transmitted?

9:24 Katy: So, it's hard to believe the herpes lesions are very painful. So I described it as when you burn your finger and you get that blister on your finger and you know how long that hurts. That's what herpes feels like on your penis or your vagina or your mouth. So, you have to have - they do talk about this, asymptomatic shedding. I've been in practice for 30 years, and I truly can say, I don't think I've ever seen a case like that. But when people's lesions get so small, and they have intercourse with somebody, they can spread it. So, but most people who have a herpes genital outbreak are not thinking about having sex, they are in pain.

10:12 Bryson: Right. Yeah. What are some misconceptions and stigma about herpes that you think people should really know the truth about?

10:23 Katy: Well, I feel bad for any people who get herpes, they feel so dirty. And it's just, you know, all the STIs are out there. You know, I like - sex is a great thing, you should not be punished for having sex. So I think that they think they're a bad person for this. I mean, they need to all get over that. I do think people adjust well, once they've been diagnosed with herpes. And once they find out that, you know, I seem like I'm a 50 percenter, you know? I think the hardest thing for college people is, you know, the way, you know, drunk sex, whatever - you're not saying to the partner, “So, have you ever had chlamydia, gonorrhea, syphilis, herpes?”. You know? Where’s the pre, like, you know.. condoms? Well, condoms only protects you from really gonorrhea and chlamydia, syphilis, shankers. And herpes lesions and genital warts, you know, are on scrotums and vulvas. Condoms don’t, you know, you got to do some saran wrap birth control, if you want to get - not have those? I don't know.

11:33 Bryson: Right. Is there any sort of symptoms besides just sores? Or is there anything people should look for? If they're, they have herpes?

11:45 Katy: Excellent question. That is an excellent question. Everybody's first herpes outbreak, almost always you feel kind of fluish, a little bit of fever a little, you know, joint aching. I mean, you feel like you're coming down with something. And then let's like boom, a day or two later, the blisters start coming. And the blisters can keep coming for a few days. So that's why it's really important. If you have you know, if your penis or vagina is hurting, you need to go to the doctor. Because the antiviral medications when you start those right away, and they also give numbing creams to use. And, you know, we tell women to sit in the bathtub and, you know, pour water over their vulva when they pee and drink a lot of water. Because when you pee and your urine hits those blisters, that's truly painful also. So, see your healthcare provider right away. Get on the medications, they work great. I tell people to carry a refill of those medications with them, especially if they're going on vacation to a warm, sunny climate. You know, like I said, it's not just tanning, that's fine. It's getting sunburned or a lot of sun exposure, for whatever reason causes outbreaks. We do not know why, but Phyllis and I stay very busy in August with many, many herpes outbreaks.

13:16 Bryson: So Katie, I feel like we've covered so much already about herpes. Another question I wanted to ask you is, can you get any sort of illnesses or infections by having herpes?

13:32 Katy: You know what Bryson, that's an excellent question. I should have gone into that. So, it is very important when you get a herpes, herpes lesions to keep them clean and dry. Because you can get secondary bacterial infections in those lesions and get very, very sick. So wherever your herpes lesions are, just keep them clean and dry. Get on your medications, so they, you know, start to resolve.

14:03 Bryson: And what is something that people should not do when they suspect that they have herpes? Like, is there something that they should avoid putting on their blisters or outbreaks that I think should help is there, you know, certain things they should avoid?

14:26 Katy: Also, very good question. Yes. People - I've have over the years come to the office and they said, I got this sore and I put olive oil on it. I put butter on it, because think about what people do for burns. It kind of looks like a burn it feels like a burn. So I've had people put crazy I can't think of the craziest things - yeast creams, all those A. they make, you know, the lesions more painful and that - using anything like that is more likely to cause secondary infection.

15:04 Bryson: Got it. Well, that’s…. wow. I can't even imagine people putting olive oil on... And actually, that's something I didn't even know that people put on burns either. I've never even heard of that.

15:18 Katy: Um, you know, you think burns cooking, what do you use for cooking?

15:26 Bryson: I guess. Wow, that's crazy. So, Katy, what do you think are the key takeaways that people listening should know about herpes.

15:39 Katy: So the main thing is, it affects everybody, it doesn't care, you know, who you are, or how many people you slept with, or, or what you do for a living. So, go to a health care provider right away, do not self-treat. If you're going to Google something, look at the CDC website for herpes. They have a very good fact sheet. To know that, you know, you're gonna have a good life, you're gonna get married, if you want to get married, you're gonna have babies, if you want to have babies. Herpes will not diminish your life in any way. There are good medications out there, talk to your health care provider if you keep having recurrent outbreaks. Remember that, you know, you may not ever have this again, it may be a once in a lifetime thing. And for women, make sure you tell your obstetrician, if you do want a pregnancy, that you have had a history of herpes.

16:45 Bryson: Awesome. I think that is all great information for everyone to know. Okay, Katy, so just to, you know, let the audience know a little bit about both of us just on a more personal and fun level. What sort of music do you like to listen to when you are, you know, stressed and just want to relax and just really enjoy your day and your time with yourself?

17:12 Katy: Anything! I love all music, jazz, classical, rock and roll anything but country or Metallica. Country makes me very, very sad. And sometimes angry.

17:33 Bryson: I do agree that country makes me sad. Although I do like country, I know that. I know that there are some songs that make me just very, like want to sit in my room and just, you know, pout. I'm more of a - I do like some like alternative rock. You know, there are some artists out there that I do really enjoy. I'm more of an alternative, you know, I know some of the viewers might have - or listeners I should say probably heard of, you know, like Rex Orange County or I'm just trying to think of some other ones like Clairo… Katy’s shaking her head.

18:12 Katy: So, I'll just tell you this. My music thing goes along with my techo thing. My horse and buggy out back. So I was probably alive when Mozart was, you know?

18:31 Bryson: Oh, goodness. So it's definitely...

18:34 Katy: So, all of those things I've never heard of, but I will tell you, my husband who's a little bit older than I and my son who's a lot younger than I, are both into very alternative so they would know what you were talking about.

18:47 Bryson: Oh, awesome! Okay, you can then maybe you can go home and ask and be like, “Hey, you know…”

18:52 Katy: I will. I'm gonna text my son.

18:56 Bryson: Well, it was very nice talking to you, Katy.

18:58 Katy: Same here, Bryson. Good luck with your career. You're in a wonderful field and it will give you a lot of job satisfaction.

19:06 Bryson: Oh, thank you so much. 

19:08 Katy: You're welcome!

[Musical Interlude]

19:11 Jordan: Katy is great. I adore her so much. 

19:15 Mikayla: She -  I just - I love the fact she is never afraid to answer a question. Every event that we’ve ever had with her she will full-on tell her opinion and I love it. She brings a sense of realness to sexual health education and she tells it like it is and she’s funny. She’s fun. So I am so happy that she was able to be on this episode. And Bryson did a great job as well. We love having student involvement and speaking of student involvement, we asked folks on our social media page to submit questions about herpes for this upcoming podcast episode. And so I actually just want to take a minute so we can answer one of those questions we received. So Jordan, a student asked “If you get cold sores, does that mean you’re always contagious for herpes even when the sore goes away?”

20:07 Jordan: That’s a great question. Cold sores, which are herpes blisters that are on or around the mouth. Are herpes simplex virus 1 or type 1 as we heard Katy mention. A person is most contagious when they have an outbreak or right before an outbreak, like right at the first signs and experiencing symptoms. For cold sores, that might feel like some tingling around the lip or maybe some like heat or inflammation and irritation. It is possible to spread Herpes Simplex Virus 1 when someone doesn’t have a cold sore present, but it is very uncommon. So typically that spreading happens or transmission happens when someone actually has the sore present. I don’t want to say that because I don’t want people to be afraid to ever kiss someone ever again. That is okay. As Katy said, it is very common and that is oftentimes how someone may have gotten it. If someone does have herpes and gets cold sores, they should avoid kissing or sharing utensils/cups until their sore is completely gone and then they also may want to take a little more precaution if they tend to get cracked or chapped lips because that tear in the skin or any sort of openings or any other blisters can cause the viral transmission. Again, when they are either kissing or sharing anything with someone else.

21:36 Mikayla: We also want to address something that we get asked a lot but it didn’t come up in this interview. So, while JMU does offer STI testing, or Sexually Transmitted Infection testing, to students, herpes testing is not a part of that. As Katy said, herpes is very, very common, so a lot of people would show up as positive for one of the two strains even if they don’t have any outbreaks. If someone suspects they have herpes because they notice sores or lesions on their mouth, genitals, or anus they should see a provider and they should be able to do an exam and prescribe medication, if needed. We’ll have a link to JMU’s testing information in our description.

22:17 Jordan: Yeah. We know it can feel painful and uncomfortable, and not to mention the obvious visually unappealing when someone has a herpes outbreak, but don’t be afraid to see a doctor and get that medication and remember it is not going to be like that for the rest of your life.

22:33 Mikayla: So, be sure to follow us on Instagram @JMUWellDukes so you can submit your questions or you can email us anytime at welldukes@jmu.edu.

22:45 Jordan: Next week, our episode will be in honor of National Eating Disorders Awareness Week and we’re going to have a special guest from the Counseling Center to talk about the different types and resources available to JMU students.

22:57 Mikayla: If you’re listening to this episode for HTH 100 credit, your passcode is “HSV”. Those letters again are H. S. V – which stands for herpes simplex virus!  That’s all for this episode. Remember, be well Dukes!