In a perfect world, testing for STIs would be as simple as taking an online quiz. You’d plug in your answers, hit submit, and boom: Seconds later, you’d have your outcome. More importantly, the results would be accurate. Unfortunately, in the case of certain sexually transmitted infections — herpes included — securing your status isn’t straightforward. Without a herpes outbreak present (such as a cold sore) it’s extremely difficult to know whether or not you’re HSV-positive, and herpes testing is so flawed and misunderstood that doctors say it leads to unnecessary stress.
Picture this: You’ve started seeing a new partner and you two feel ready to have sex. You tell them you should both go get tested first, and they happily agree. (Cheers to open communication.) From there, the two of you go get blood tests and ask to be screened for STIs, including both types of herpes: herpes simplex virus type 1 (HSV-1), which most commonly causes oral herpes, and herpes simplex virus type 2 (HSV-2), which most commonly leads to genital herpes.
Neither of you has ever experienced symptoms, and so when the test comes back and reveals that you’re herpes-positive, you’re stunned. You’re instantly hit with a minefield of emotions, including shame — no surprise, given the decades of stigma surrounding herpes and other STIs. But wait: Did you know that most people are positive for HSV-1, and that most are asymptomatic, meaning they have no symptoms?
1. If you have zero symptoms, getting tested won’t help you
The problem is that blood tests for herpes when no lesions or symptoms are present are often bullshit. I realize that’s a pretty strong word, but after speaking with the very doctors who have administered these tests, it’s become more and more apparent to me how misunderstood — and in some cases, just plain wrong — the results they give are.
Part of the reason they’re flawed has to do with the fact that most people have been exposed to HSV-1 or oral herpes. “For HSV-1, close to 100 percent of people in the U.S. are antibody-positive because they have been exposed at some point in their lives, though only a percentage of these individuals will actually get cold sores,” says Adam Friedman, the residency program director at The George Washington University School of Medicine & Health Sciences in Washington, D.C. He adds that blood tests can be misleading because they usually don’t detect the herpes virus itself and instead look at the level of antibodies against the virus, which is merely a sign of immune response to it.
2. There are two common blood tests used to identify herpes — and they’re often misleading
“I had a patient once who underwent this test, which was positive, and was told she has herpes, which to her was devastating and life-altering,” Friedman says. “She burst into tears when I explained the significance or lack thereof with this test, which is very misleading.” There are two common blood tests used to identify herpes: IgG and IgM. The IgM test is still used by some doctors even though it has been denounced by the Centers for Disease Control and Prevention (CDC): According to the American Sexual Health Association (ASHA), IgM tests can lead to deceptive results, as well as false assumptions about how and when a person acquired HSV.
And that’s not all: IgM tests fail to accurately distinguish between HSV-1 and HSV-2 antibodies, leading them to provide false positive results for HSV-2. In other words, if you’ve been exposed to oral herpes (which most people have), results of the IgM test could lead you to believe you’re positive for genital herpes when in fact you simply have antibodies fighting against HSV-1.
IgG tests, on the other hand, are more accurate but aren’t without their own issues. For instance, ASHA says that while an IgG test can distinguish between HSV-1 and HSV-2, the problem is that the time it takes for IgG antibodies to reach a detectable level varies on a person to person basis. This means that even with accurate results, someone could get a false negative if they have the test administered too soon after contracting the virus (physicians recommend waiting 12 to 16 weeks).
Aside from the two aforementioned blood tests, there are other FDA-approved gG-based blood tests that can offer accurate results, which the ASHA has broken down in this handy chart. However, the association also points out that these tests can’t determine whether the site of infection is oral or genital, which poses a problem for those who want to know their HSV-1- or HSV-2-specific status.
All of this tells us that sure, there are some currently available blood tests for herpes that can tell you your status — or give you some idea of it — but they’re still far from perfect. And when we’re dealing with a disease that’s highly and widely stigmatized the way herpes has become, most people are looking for airtight answers. This is precisely why so many doctors, as well as the CDC, do not recommend getting tested unless you have the common symptoms associated with herpes, such as itching, burning, or a blister.
3. Doctors don’t advise getting a blood test for herpes without any symptoms
Hilda Hutcherson, assistant professor of obstetrics and gynecology at Columbia University Medical Center in New York, is one of those doctors. “I usually don’t do tests for herpes [unless] someone has a lesion or a sore, something I can see, [then] I will do a swab and take it to a culture or check the DNA on the materials I removed,” she says. “If there’s nothing there and I do a blood test and the blood test comes back positive, let’s say it’s positive for type 1, what does that really mean? Most people are positive for type 1.” She adds that someone could be HSV-1-positive and either have or not have genital herpes. The result “doesn’t mean much, and it makes people go crazy.”
Hutcherson’s motto is pretty simple: Why stress yourself over something if you haven’t seen anything — especially when it’s something as common as herpes? “Let’s say they have a blood test come in positive but they’ve never had a lesion. Now what? You may never get a lesion,” she says. It’s for this reason that she recommends people do not get tested for herpes unless they have a visible lesion that can be cultured and taken to a lab. Now let’s say you get tested anyway and it comes back positive, despite you having no symptoms. What do you do from there?
4. Useful methods include testing an actual lesion
Keep in mind that there’s no such thing as “safe” sex, only safer sex, which means using protection and being open and honest with your partner. “It can definitely happen,” Friedman says of the chances of transmitting the virus to a partner without a visible outbreak. “It’s called asymptotic shedding [and] there are studies showing that the rates of transmission of HSV-2 are the same for symptomatic and asymptomatic.” He adds that this is why using protection during sexual contact is so important, regardless of what blood tests say. Unfortunately, you can never ensure your risk of transmission will be zero, whether or not you know you have herpes, but using a condom or dental dam will get you closer to it.
Like Hutcherson, Friedman also doesn’t recommend blood tests for herpes in the absence of symptoms. “The tests that are useful involve sampling the actual blister or cold sore,” he says, which can involve smearing scrapes of skin cells from the sore onto a slide, targeting the infected cells. As with some of the blood tests, though, this sampling test still won’t tell you what type of herpes virus is present. A viral culture, on the other hand, will tell you which virus you have, though it takes some time to come back. “Direct fluorescent antibody is by far the best,” Friedman says, “as you can get a result in a matter of hours which can be as useful as a culture.” Not all hospitals have access to this method, however.
5. If you get a positive result, don’t panic — it really doesn’t mean much
All of this is to say that unless you have symptoms consistent with the herpes virus, why put yourself through the emotional turmoil of getting a blood test that may or may not give you legit results? As Hutcherson notes, if you do get a blood test and it comes back positive but you’re asymptomatic, what does that mean for you if you have nothing to treat? For many, due to the high rate of stigma still surrounding herpes, it can mean feelings of self-contempt, humiliation, and distress, all of which could be avoided if you aren’t experiencing any symptoms.
To recap, while there are some tests for herpes that can prove correct, none are 100 percent perfect, and blood tests are particularly problematic since they can produce false positives and negatives. We also know that the majority of the population has some form of herpes, so IMO, it’s a mystery why we’re still making a big deal out of it. No one likes blisters or sores, but neither does anyone love having acne, a widespread condition (85 percent of young adults battle it) without the same levels of attached shame.
6. The bottom line: Tests for herpes are more worry than they are worth it
If you do have symptoms, don’t fret: If you know your status, you’re at an advantage in that you can talk with your doctor and find an antiviral drug that works for you. Medication can curtail the severity of your symptoms, as well as the number of outbreaks you get. Additionally,
taking an antiviral daily will greatly reduce your chances of transmitting the virus to someone else. In case you missed it, there’s also a very promising new drug for herpes on the horizon, which researchers say could be the most effective one yet.
Take it straight from the pros and don’t put yourself through the stress of a herpes blood test if you don’t need to. And, whether you have symptoms or not, know that you’re not alone if you are herpes-positive.
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