Should The Clinician Order Herpes Serology
Serology is not appropriate in this case. This occurrence is suspicious for a primary outbreak in someone previously uninfected, and if so, antibodies are not going to be present. It takes 3 weeks to several months after exposure to the herpes virus for antibodies to be detectable in the blood.7
It is important, however, to remember that first clinical presentations can occur long after the primary infection.8 The clinician should not assume that what appears to be a primary outbreak indicates the patient has been recently infected or counsel the patient that they must have been infected by their current partner. There is no way to determine when the patient was initially exposed.
Clinicians may be tempted to test for herpes immunoglobulin M in an effort to determine if this is a new infection. In the case of HSV, however, IgM is not exclusively produced with initial infections. It can reappear with recurrences years after initial infection. The presence of herpes IgM cannot help differentiate between initial and established infections.7
The Bottom Line: Tests For Herpes Are More Worry Than They’re Worth
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.
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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 illness 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.
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In The Absence Of Answers
Herpes tests arent the only ones with a risk of false positive results. False positives can occur for any test that diagnoses viral infection based on antibodies, i.e., your bodys immune reaction, rather than direct detection of the virus. For similar diagnostics like HIV and hepatitis C testing, protocols automatically call for a second test that directly detects the virus whenever an antibody test comes back positive, said Paul Swenson, laboratory director in the department of public health of King County, Washington. Herpes, however, is a particularly challenging infection to directly test for, because the virus spends most of its time hiding in nerves. Swab tests can sometimes detect the virus during outbreaks, but this isnt an option for people without symptoms. Thus even the Western blot relies on antibodies, and may give indeterminate results to a small number of people.
But two steps of antibody testing are still more reliable than one step todays diagnostics for Lyme disease and syphilis are a two-step antibody testing approach, said Dr. Edward Hook, a medical epidemiologist specializing in STI screening and prevention at the University of Alabama, Birmingham, who questioned why such a standardized two-step approach hasnt taken firm hold for herpes.
Type Of Tests Used To Diagnose Herpes
There are four main types of diagnostic tests that can be used to diagnose herpes. Your doctor will determine which type of test to use based on whether an outbreak is present or not.
If youre experiencing what you believe to be a herpes outbreak, your doctor can use a viral culture test or virus antigen detection test. If youre not experiencing symptoms, you can have an antibody test.
- Viral culture test.This test is used to determine if a sore contains the herpes virus. This test can sometimes produce a false-negative, meaning that it may not detect the virus even though its present.
- Virus antigen detection test. This test is used to determine if antigens to the herpes virus are present in a sore or lesion.
- Antibody test. If youre not experiencing an outbreak yet but still believe you may have been exposed, you can opt to have an antibody test performed. This test will only show a positive result if the antibodies to the virus have been developed. Therefore, this test isnt necessarily recommended for recent exposure.
- Polymerase chain reaction test. With this test, a healthcare provider can screen a sample of your blood or tissue from a sore. They can use this to determine if HSV is present and which type you have.
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Testing With No Symptoms
Blood tests can be used when a person has no visible symptoms but has concerns about having herpes. Blood tests do not actually detect the virus instead, they look for antibodies in the blood.
IgM vs. IgG
When an individual contracts herpes, the immune system responds by developing antibodies to fight the virus: IgG and IgM. Blood tests can look for and detect these antibodiesnot the virus itself. IgG appears soon after infection and stays in the blood for life. IgM is actually the first antibody that appears after infection, but it may disappear thereafter.
IgM tests are not recommended because of three serious problems:
The accurate herpes blood tests detect IgG antibodies. Unlike IgM, IgG antibodies can be accurately broken down to either HSV-1 or HSV-2. The challenge here is that the time it takes for IgG antibodies to reach detectable levels can vary from person to person. For one person, it could take just a few weeks, while it could take a few months for another. So even with the accurate tests, a person could receive a false negative if the test is taken too soon after contracting the virus.
For the most accurate test result, it is recommended to wait 12 16 weeks from the last possible date of exposure before getting an accurate, type-specific blood test in order to allow enough time for antibodies to reach detectable levels.
Developing The Risk Scores
We include detailed results for study 1 in order to illustrate how the algorithm was constructed results for other studies are available from the authors on request. Sex, age, genital blisters, lifetime number of partners, history of non-specific urethritis , gonococcus, warts, lice, Trichomonas vaginalis , and thrush are all significantly associated with HSV-2. Country of birth, ethnicity, marital status, oral blisters/sores, cold sores, mouth ulcers, sexuality, age at first sex are not. Table 2 indicates the factors identified in the model selection process. The interactions between sex and the other three terms were each tested, and none found to significantly add to the model. The score to be added for each factor is specified in the final column of table 2. For example, if the patient is a 23 year old man with three lifetime partners and no history of genital blisters his score is 2, whereas if the patient is a 34 year old woman with seven lifetime partners who has never had genital blisters her score is 6.
The variation in HSV-2 prevalence by risk group, across the four studies
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How Do The Tests Work
HSV tests detect IgG and immunoglobulin M antibodies. IgG antibodies are present soon after infection with HSV and remain in the blood for life. A test result showing IGg antibodies will tell a person that they have experienced an infection in the past and that they have antibodies against the virus.
IgM antibodies appear before IgG antibodies but may disappear when the infection is inactive. Testing for IgM antibodies is not a useful way to distinguish between primary and recurrent episodes of HSV infection. Therefore, doctors do not recommend IgM testing.
A positive herpes antibody test cannot tell people where they have HSV infection or when they contracted the infection. It cannot tell if a person was capable of passing on the infection at the time of the test, nor can it tell if specific symptoms are due to herpes.
Once a sample comes back from laboratory analysis, a person will receive one of the following results:
Doctors Dont 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 dont do tests for herpes someone has a lesion or a sore, something I can see, I will do a swab and take it to a culture or check the DNA on the materials I removed, she says. If theres nothing there and I do a blood test and the blood test comes back positive, lets say its 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 doesnt mean much, and it makes people go crazy.
Hutchersons motto is pretty simple: Why stress yourself over something if you havent seen anything especially when its something as common as herpes? Lets say they have a blood test come in positive but theyve never had a lesion. Now what? You may never get a lesion, she says. Its for this reason that she recommends people do not get tested for herpes unless they have a visible lesion that can be cultured and sent to a lab. Lets say you get tested anyway and it comes back positive, despite the fact that you have no symptoms. What do you do?
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Herpes Blood Test Results Explained
A herpes blood test is not considered to be a general screening test because false positive results are a possibility. Genital herpes is a fairly common sexually transmitted disease, so if youre concerned about an infection of the HSV-1 or HSV2 virus, it is important to discuss your sexual history with your doctor to determine if this blood test is right for you.
There are a lot of questions about the herpes blood test, so this guide is intended to help everyone understand why the recommendations for testing are designed as they are today.
I Tested Positive For Herpes What Should I Do Now
For most people, having herpes does not affect their health or quality of life. To prevent passing on cold sores and genital herpes to others, a person can:
- avoid kissing others when the virus is active
- use condoms when having sex
- avoid skin-to-skin contact during an active outbreak
- avoid sharing towels, toothbrushes, and lipstick when they have sores around the mouth
- wash their hands well after touching a sore
Having multiple sexual partners can increase the risk of
transmitting STIs such as herpes. People can decrease this risk by openly discussing STI status and prevention with any partners and practicing safe sex.
It is
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How Is The Test Used
Herpes testing may be used a few different ways:
The U.S. Centers for Disease Control and Prevention does not recommend screening for herpes in the general population, but it may be helpful in some cases, such as:
- If you have signs and symptoms, such as genital sores that may be related to herpes
- If you have or had a sex partner with genital herpes
- If you would like to have a complete exam for sexually transmitted diseases , especially if you have multiple sex partners if this is the case, you should discuss STD testing with your healthcare practitioner.
What Happens During A Herpes Antibody Test
There are different tests for HSV. Doctors will choose a test based on a persons health history and symptoms. Options include the following:
- Swab test: A healthcare professional uses a swab to take a sample of fluid and cells from a herpes sore. They then order a PCR test or viral culture to determine whether HSV is present. This is the most reliable way to test for HSV. Doctors normally do this as standard procedure before ordering any other sort of test.
- Blood test: A healthcare professional uses a needle to take a small amount of blood from a vein in a persons arm.
- Lumbar puncture: Doctors may use this method if they suspect a person has an infection in the brain or spinal cord. It involves numbing the skin of the lower spine and inserting a thin, hollow needle between two vertebrae to collect cerebrospinal fluid.
A doctor will send samples to a laboratory for testing and a person should get their results within a few days.
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Getting Help With Confirmatory Testing
I’ve found that an important part of mental health for patients with herpes is to feel a sense of understanding and agency around their diagnosis and test results and to learn information that can help them make a decision about whether they want to pursue confirmatory testing or not. I often refer patients with low positive results to consult with a medical expert if they have additional questions. The healthcare provider I trust the most with these types of questions is Terri Warren, NP, who has been an excellent resource for many of my patients. There may be other healthcare providers who can navigate appropriate confirmatory testing, but many providers have not learned how to do this. If you are questioning your diagnosis and want to learn more about confirmatory testing, you can do so here. If you need help coping with the diagnosis or with awaiting results, therapy or a support group can often help.
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 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.
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What Happens During An Hsv Test
HSV testing is usually done as a swab test, blood test, or lumbar puncture. The type of test you get will depend on your symptoms and health history.
- For a swab test, a health care provider will use a swab to collect fluid and cells from a herpes sore.
- For a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
- A lumbar puncture, also called a spinal tap, is only done if your provider thinks you may have an infection of the brain or spinal cord. During a spinal tap:
- You will lie on your side or sit on an exam table.
- A health care provider will clean your back and inject an anesthetic into your skin, so you won’t feel pain during the procedure. Your provider may put a numbing cream on your back before this injection.
- Once the area on your back is completely numb, your provider will insert a thin, hollow needle between two vertebrae in your lower spine. Vertebrae are the small backbones that make up your spine.
- Your provider will withdraw a small amount of cerebrospinal fluid for testing. This will take about five minutes.
- Your provider may ask you to lie on your back for an hour or two after the procedure. This may prevent you from getting a headache afterward.
Study Questions Reliability Of Diagnostic Tests For Herpes
Up to half of those screened for genital herpes may be incorrectly told they are infected
Tests commonly used to diagnose oral and genital herpes are often unreliable, missing some cases of infection and, in others, identifying an infection that does not exist, say researchers at the University of Washington School of Medicine.
In nearly half of patients with commercial test results indicating that they were infected with the most common cause of recurrent genital herpes, herpes simplex virus 2 , a subsequent test showed that the initial diagnosis was incorrect, the researchers report in a paper published today in the journal Sexually Transmitted Diseases.
The high rate of false-positive HSV-2 tests was particularly troubling, said Dr. Anna Wald, who led the research.
These tests arent as good as they ought to be, given that they are used to diagnose someone with a chronic, lifelong sexually transmitted disease. Wald directs UWs Virology Research Clinic and is a professor of medicine, epidemiology, and laboratory medicine.
The investigators examined results from FDA-approved tests used to diagnose HSV-2 and herpes simplex virus type 1 , the most common cause of cold sores.
These tests, called enzyme-linked immunoassays, detect the presence of antibodies to the herpes simplex viruses in a persons blood. When the antibodies are detected, the test is positive, meaning that the person is infected by the virus. No detected antibodies indicates no infection.
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