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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.
Tingling Or Pain Before Blisters Form
If you know you’ve been exposed to herpes, you may want to watch for prodromal symptoms. “About 50% of people will have symptoms such as itching, tingling, or pain on genital skin before blisters or sores appear,” said Dr. Shim. Usually you’ll experience an outbreak later, but it’s possible to have this tingling or itching and have no sores emerge.
Suppressive Therapy For Recurrences
To suppress outbreaks, treatment requires taking pills daily on a long-term basis. Acyclovir and famciclovir are taken twice a day for suppression. Valacyclovir is taken once a day. The doses for these antiviral drugs are reduced in people with impaired renal function.
Suppressive treatment can reduce the frequency of outbreak recurrences by 70% to 80%. It is generally recommended for people who have frequent recurrences . Because herpes recurrences often diminish over time, you should discuss annually with your provider whether you should stay with drug therapy or discontinue it.
There is some evidence that valacyclovir may help prevent herpes transmission, particularly in situations where one heterosexual partner has HSV-2 and the other partner does not. However, this drug does not completely prevent transmission. While taking any suppressive therapy for genital herpes, it is still important to regularly use latex condoms and to avoid any sexual activity during recurrences.
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Shattering The Genital Herpes Myth
March 22, 2000 Many people who have tested positive for the virus that causes genital herpes, but say they have no symptoms of the disease, may in fact have the virus in their genital tracts, according to a study in this weeks issue of The New England Journal of Medicine. This is important, researchers say, because it means that contrary to popular belief asymptomatic people are potentially infectious, and they could be unknowingly fueling the herpes epidemic.
Previous studies have found that almost 25% of adults over age 12 in the United States are infected with herpes simplex virus type 2 , but only 10% to 25% of people who have the infection report having lesions.
Most genital infections are caused by herpes simplex virus type 2, and numerous studies have shown that most people with infection dont give a history of genital herpes, study author Anna Wald, MD, MPH, tells WebMD. There has always been a question of whether those people are shedding the virus meaning whether they have the virus present in their genital area or whether they are truly asymptomatic. Wald is an assistant professor in the department of medicine and epidemiology at the University of Washington in Seattle.
The other major finding, she says, was that 83% of this group were potentially infectious.
This group was then compared to 90 subjects who were aware that they had genital herpes.
How Is It Spread
The herpes virus is spread by skin-to-skin contact with a person who has the herpes virus:
- Most often, from herpes sores or blisters
- Less often, from normal looking skin where the virusfirst entered the body
- The herpes virus enters the body through the:
- Lining of the mouth
- Regular skin that has small cracks or cuts
People with a weak immune system can get a herpesinfection more easily. A weak immune system is causedby some diseases and by somemedicines used to treat serious diseases.
People who don’t know they have herpes can still spread the virus to others.
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How To Prevent The Spread Of Herpes
Although herpes is a lifelong virus that cant be cured, it goes through periods of dormancy between outbreaks. This means that while the virus is still present, its not actively replicating.
During this time, you may not experience any signs or symptoms of having the disease even if youve had a previous outbreak before.
However, you can still spread the herpes virus to your sexual partners at any time, even if no sores are present. In addition, although rare, its possible to spread oral herpes to the genital region and vice versa.
For this reason, its extremely important to be mindful of the following preventive measures:
- Tell your partners that you have genital or oral herpes. This allows them to make informed decisions about their own sexual health, and its the responsible thing to do.
- If youre experiencing the signs and symptoms of an upcoming outbreak, avoid all sexual contact. Youre most likely to spread the virus to others during an outbreak.
- Its possible to spread the herpes virus even without an outbreak. If youre worried about spreading the disease to a partner, research shows that antivirals are effective at reducing this possibility.
Having oral or genital herpes doesnt mean that you can no longer have sex. However, its your responsibility to prevent the spread of herpes to your sexual partner.
If you have herpes, you can still take care of your sexual health through open communication and safer sex.
Herpes Tests & Diagnosis
Depending on where you are in the stage of exposure or infection, your medical provider may perform an examination or run tests to provide an accurate diagnosis.
- Physical examination: If you have active sores, your doctor may examine them to determine if they appear like HSV-1 or HSV-2 sores.
- Fluid sample: If you have active sores, your medical provider may swab a sore and send the fluid to the laboratory for testing, which can confirm that it is caused by either HSV-1 or HSV-2.
- Blood tests: If you do not have any active sores or other specific physical signs of herpes simplex, your doctor can order blood tests to identify viral antibodies to confirm a diagnosis.
If you are diagnosed with HSV-1 or HSV-2, your doctor may be able to prescribe antiviral medication to shorten an active outbreak or help alleviate symptoms.
They may also recommend over-the-counter antiviral creams or other products to provide pain relief.
Some medications, when taken orally or applied topically, can prevent outbreaks if used at the first sign of a sore, such as the initial feelings of tingling that precede the formation of a sore.
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Risk For Genital Herpes
According to the US Centers for Disease Control and Prevention , about 1 in 6 Americans ages 14 to 49 years have genital herpes. While HSV-2 remains the main cause of genital herpes, HSV-1 has significantly increased as a cause, most likely because of oral-genital sex. Except for people in monogamous relationships with uninfected partners, everyone who is sexually active is at risk for genital herpes.
Risk factors for genital herpes include:
- History of an STD
- First sexual intercourse at an early age
- High number of sexual partners
- Low socioeconomic status
Women are more susceptible to HSV-2 infection because herpes is more easily transmitted from men to women than from women to men. About 1 in 5 women, compared to 1 in 9 men, have genital herpes. African-American women are at particularly high risk.
People with compromised immune systems, such as those who have HIV, are at very high risk for genital herpes. These people are also at risk for more severe complications from herpes. Drugs that suppress the immune system, and organ transplantation, can also weaken the immune system and increase the risk for contracting genital herpes.
Treatment Of An Initial Outbreak
The first outbreak of genital herpes is usually much worse than recurrent outbreaks. Symptoms tend to be more severe and to last longer. Your provider will prescribe one of the three antiviral medications, which you will take for 7 to 10 days. If your symptoms persist, treatment may be extended. An acyclovir ointment may also be prescribed for topical treatment of initial genital herpes.
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Genital Herpes Treatment In Pregnancy
You may be offered antiviral treatment:
- to treat outbreaks in pregnancy
- from 36 weeks to reduce the chance of an outbreak during birth
- from diagnosis until the birth if you first get herpes after 28 weeks of pregnancy
Many women with genital herpes have a vaginal delivery. You may be offered a caesarean, depending on your circumstances.
Is Herpes Simplex Related To Herpes Zoster
Herpes simplex and the varicella-zoster virus are related, but they arent the same. VZV causes chickenpox and shingles.
Like HSV-1 and HSV-2, shingles can cause a painful, blistering rash. The shingles rash usually shows up on the back, side, abdomen , neck and face. It is often only on half of your body, following the pattern of your nerves. See your healthcare provider if you have a new rash and suspect you may have shingles.
A note from Cleveland Clinic
Herpes simplex is a virus. Once you have herpes, its a lifelong condition. A herpes infection can lead to outbreaks , but youll also have times when you have no symptoms. The main sign of herpes is sores that appear on the infected skin. Some people choose not to treat herpes, especially if symptoms are mild. Others take antiviral medications to reduce the severity and frequency of outbreaks.
Last reviewed by a Cleveland Clinic medical professional on 05/17/2022.
References
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How Do I Get Tested For Herpes
If you have symptoms, your doctor can take a swab from the area and send it for testing. A positive swab result confirms that you have herpes.
A negative test may mean that you dont have the infection, or it may mean that the virus was not present on the skin when the swab was collected.
Although there is a blood test available, this will only tell you whether you have ever been exposed to a herpes virus. This could be oral or genital herpes and you may never have had or may never get any signs of the infection. It is not recommended to screen people who dont have any symptoms of herpes. If you want more information, please discuss this with a doctor.
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 . According to the American Sexual Health Association , 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 , results of the IgM test could lead you to believe you’re positive for genital herpes, when in fact you simply have antibodies 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 from person to person. 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 .
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Exposed Individuals Without Evidence Of Immunity Should Be Offered Post
- Healthy individuals age 12 months and older should be given varicella vaccine within 5 days of exposure.
- The following individuals should receive VariZIG within 10 days of exposure:
- Immunocompromised individuals.
- Pregnant woman.
- Hospitalized preterm infants whose mother lacks evidence of immunity against varicella.
- Hospitalized preterm infants less than 28 weeks of gestation or birthweight of 1000g or less, regardless of maternal immunity.
- It is not indicated for newborn infants whose mother had onset of zoster around delivery to receive VariZIG. This differs from the varicella recommendations.
How Do You Know If You Have Genital Herpes
The only way to know if you have genital herpes is by amedical exam. Your health care provider can examineyou and test for it. Lab samples are taken from a sore,blister, or blood. Your health care provider may ask totest you for other infections at the same time.
Tell current and most recent sex partners of your herpes infection.
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How Is Herpes Spread
Remember if your partner has cold sores on the mouth you can get genital herpes through oral sex.
The use of condoms and dental dams decreases the risk of passing on herpes.Its strongly recommended that you use these to protect you and your partner from all sexually transmitted infections.
It is possible to have been exposed to herpes many years before having symptoms, the first episode doesnt mean it was passed on from a current partner.
Is It Possible To Have Herpes And Not Know It
Category:
Is it possible to have herpes and not know it because you have never had any sores?
Yes. Millions of people have genital herpes and dont even know it, because they never had symptoms or their symptoms were minor. Because the sores of an outbreak go away and do not always recur, and because they can be mistaken for minor problems like razor burn, many people never see a health care provider to get a proper diagnosis.
When someone does have symptoms, they can include
- pain and discomfort in the genital area
- itching and burning sensations during urination
Sores can last up to several weeks and then go away. Sores can return up to six times a year or more, or they may not return for years, if ever.
If you think youve been exposed to herpes or have symptoms that sound like those described above, see your health care provider. She or he can take swabs of the sores or perform a blood test to see if you have herpes. Although there is no cure for herpes, there are prescription drugs available to treat the symptoms and to reduce the number of recurrences.
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Myth #: People Cannot Spread Herpes To Others Unless They Have Sores Or Blisters
Fact: People can spread herpes to others at any time, including when they do not have any symptoms.
People with herpes may experience outbreaks and remissions. During an outbreak, a person has active sores or blisters, but in remission, they may have no symptoms at all.
The virus is usually more contagious when a person has an outbreak, but it can also spread when it is in remission.
Reactivation And Recurrent Outbreaks
- Extreme temperatures
- Menstrual periods
The virus then travels to the skin and can cause another, often milder, outbreak. However, reactivation may not cause any symptoms.
Before an outbreak, some people experience prodrome. This is characterized by tingling, itching, or pain in the affected areas before the lesions appear.
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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.
How Will My Healthcare Provider Know If I Have Genital Herpes
Your healthcare provider may diagnose genital herpes by simply looking at any sores that are present. Providers can also take a sample from the sore and test it. If sores are not present, a blood test may be used to look for HSV antibodies.
Have an honest and open talk with your healthcare provider about herpes testing and other STDs.
Please note: A herpes blood test can help determine if you have herpes infection. It cannot tell you who gave you the infection or when you got the infection.
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