Herpes Testing: When to Get Tested & Understanding Results

Genital herpes is a common sexually transmitted infection (STI) caused by two types of viruses: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2). Even as often associated with oral herpes (cold sores), HSV-1 can also cause genital herpes, and increasingly, it’s being recognized as a significant contributor to anogenital infections, particularly among women and men who have sex with men.

Understanding the Viruses

HSV-1 is typically associated with oral herpes, causing cold sores or fever blisters around the mouth. However, it can be transmitted to the genital area through oral sex. HSV-2 is more commonly associated with genital herpes and is usually spread through sexual contact. According to the Centers for Disease Control and Prevention (CDC), in 2018, there were an estimated 572,000 novel genital herpes infections in the United States among people aged 14 to 49.

It’s important to understand that many people with genital herpes have no symptoms, or remarkably mild symptoms that are easily mistaken for other skin conditions like pimples or ingrown hairs. In other words a significant number of people are unaware they have the infection and may unknowingly transmit it to others.

When to Consider Testing

The CDC does not generally recommend routine herpes testing for people without symptoms. This represents as blood tests for herpes have limitations, and a positive result doesn’t necessarily change sexual behavior. Individuals are no more likely to use condoms or abstain from sex after a positive test than they were before. However, testing is recommended in specific situations:

• If you have genital symptoms that could be related to herpes.
• If you have a current or past sexual partner with genital herpes.
• If you are seeking a comprehensive STI screening, especially if you have multiple sexual partners.

If you are sexually active, open and honest communication with your healthcare provider about your sexual health is crucial. They can help determine if testing is appropriate for you.

Types of Herpes Tests

If testing is recommended, your doctor can order several types of HSV tests. These include:

1. Viral Culture: A sample of fluid or tissue from a herpes sore is grown in a laboratory to identify the virus.
2. DNA Test (NAAT): This test detects the presence of the herpes virus’s genetic material in a sample from a sore. It’s generally more accurate than a viral culture and can detect more infections.
3. Antibody Blood Test: This test looks for antibodies to HSV-1 and HSV-2 in your blood. Antibodies are proteins your body makes to fight off an infection.

Experts, like Handsfield, suggest requesting a DNA test if you are being tested for herpes, as it’s generally more accurate. It’s also important to ask your doctor to determine the specific virus type (HSV-1 or HSV-2), as the course of the disease and treatment options differ.

HSV-1 vs. HSV-2: What’s the Difference?

While both HSV-1 and HSV-2 can cause genital herpes, there are key differences. HSV-1 is more likely to cause recurrent outbreaks that are less frequent and less severe. Approximately 40% of people with HSV-1 experience no recurrent outbreaks in the year or two following infection, and many never have another outbreak after that.

In contrast, HSV-2 infections that produce symptoms often lead to more frequent outbreaks – around four to five times per year. Although a person with HSV-2 is less contagious during symptom-free periods, they remain contagious during outbreaks. This makes HSV-2 more likely to be transmitted through sexual contact.

Because of the higher frequency of outbreaks with HSV-2, ongoing antiviral therapy may be more beneficial for individuals infected with this virus.

Limitations of Testing and Important Considerations

It’s crucial to remember that a herpes blood test can only determine if you have been exposed to the virus; it cannot tell you who gave you the infection. False-positive test results can occur, meaning the test indicates you have herpes when you actually don’t.

The CDC notes that type-specific serologic tests can be used to aid in the diagnosis of HSV infection when genital lesions are absent. However, IgM testing for HSV is not recommended.

What Happens Next: Ongoing Research and Guidance

The CDC continually reviews and updates its guidance on herpes testing and treatment based on new research and data. Ongoing surveillance efforts help track the prevalence of herpes infections and identify trends in transmission. Further research is needed to develop more accurate and reliable diagnostic tests, as well as more effective prevention and treatment strategies.

If you are concerned about genital herpes, the most important step is to have an open and honest conversation with your healthcare provider. They can assess your individual risk factors, recommend appropriate testing, and provide guidance on managing the infection and preventing its spread.