How Does Genital Herpes Affect A Pregnant Woman And Her Baby
Neonatal herpes is one of the most serious complications of genital herpes.5,16 Healthcare providers should ask all pregnant women if they have a history of genital herpes.11 Herpes infection can be passed from mother to child during pregnancy or childbirth, or babies may be infected shortly after birth, resulting in a potentially fatal neonatal herpes infection. 17 Infants born to women who acquire genital herpes close to the time of delivery and are shedding virus at delivery are at a much higher risk for developing neonatal herpes, compared with women who have recurrent genital herpes . 16,18-20 Thus, it is important that women avoid contracting herpes during pregnancy. Women should be counseled to abstain from intercourse during the third trimester with partners known to have or suspected of having genital herpes. 5,11
Taking A Genital Or Oral Herpes Test
Testing for genital and oral herpes may be performed with a blood sample or a sample of fluid swabbed or scraped from a sore. Both types of samples are collected by a health professional when conducted at a doctors offices, clinic, or community organization.
If a patient is experiencing an outbreak, a doctor can collect a sample for testing by swabbing or scraping a sore. Material from the sore can be used for a herpes viral culture, PCR testing,
A Tzanck smear or an antibody test.
If a patient is not currently experiencing an outbreak, a blood test may be used to identify HSV antibodies. If a doctor suspects a brain infection with HSV, a lumbar puncture may be performed to obtain a sample of cerebrospinal fluid for analysis.
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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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.
Why Is Testing Recommended Only In These Areas
When a herpes âoutbreakâ occurs, the blistering and rawness that appears around the genitals, rectum, or mouth can be very painful. The sores which appear when an outbreak occurs can take weeks to heal properly. The herpes blood test can provide your medical provider with information about what can be expected in the future. This would include what medications would be necessary to control symptoms and how you could lower the risks of spreading the infection to a partner.
If you know that you have or had a sexual partner with genital herpes, this testing can tell if you also have the virus. For women who are pregnant, this blood test is very important because the fetus can become infected with HSV-1 or HSV-2 if the mother is infected. This can place the pregnancy at risk and in babies, a herpes infection can even be fatal.
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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
Medically reviewed by Michele Emery, DNP
Are you worried you might have been exposed to the herpes virus?
First: dont panic. The HSV viruses are a lot more common than you may think, and are very manageable in most cases.
Second: if you think youve been exposed to the herpes virus, testing is going to be your first plan of action.
Take a couple deep breaths and when youre ready, read on.
When Should I Get A Genital Or Oral Herpes Test
Testing for the viruses that cause genital and oral herpes may be ordered when a patient develops signs and symptoms of a herpes infection. Although many people who contract HSV never notice symptoms, signs of an initial infection appear 2 to 20 days after infection and depend on the type of HSV causing the infection.
When signs and symptoms of an initial infection occur, they may include:
- Small sores on the skin
- Tingling, itching, or burning on the skin
- Fever, headache, or body aches
- Swollen lymph nodes
After the initial infection, HSV remains dormant inside of the body. HSV can reactivate throughout a patients life, causing symptoms of genital or oral herpes to reappear. While the trigger for an HSV outbreak is often unknown, potential triggers include a fever, stress, physical trauma, and a suppressed immune system.
Generally, expert organizations do not recommend herpes testing for patients without symptoms. An exception may be made for certain patients, including:
- Patients who have a partner with genital herpes
- Patients seeking a more complete STD test panel, including people with multiple sexual partners
- Babies born to a mother who has HSV
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What Is The Herpes Simplex Virus
The herpes simplex virus is a type of virus that causes infections in humans. Approximately 3.7 billion people under the age of fifty â or 67% â have been infected with HSV-1 in their lifetimes. There are about 491 million cases of HSV-2 worldwide â or 13% of the global population between the ages of 15 and 49.
HSV is spread through direct contact with the virus. This can happen during sex or while giving birth.
The virus leads to an increased risk of infection with human immunodeficiency virus . It can also cause you to develop more severe conditions if you have a compromised immune system.
HSV can have particularly problematic results if youâre infected with the virus when youâre born. The chance of passing it on while pregnant is low but â if it happens â it can lead to disabilities and death.
Thereâs also a social stigma associated with this virus that can be damaging to your mental health if you ever become infected.
How Accurate Are Blood Tests For Herpes
According to the University of Maryland Medical Center, nearly every person in the United States about 85% of the population will be infected with herpes by the time they reach their sixties. If youve ever had one of those annoying cold sores on your tongue, youve already experienced an HSV outbreak. For most people, the herpes simplex virus will never present any lasting or major symptoms but for people who become infected with genital herpes, a common STI which causes painful sores and flu-like symptoms, the virus is a serious medical issue which needs to be managed with antiviral medication. Of course, in order for herpes to be managed effectively, it needs to be diagnosed first but just how accurate are our current testing methods? In this article, our Baltimore clinical malpractice attorneys will explain how herpes is diagnosed, which tests are most accurate, and what to do if you or your partner was the victim of a herpes misdiagnosis.
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What Causes Herpes Simplex
HSV is a contagious virus that can be transmitted through direct contact with sores.
That said, since the virus also sheds on a small percentage of days, its possible to transmit or contract HSV even when symptoms arent present. In fact, many people contract HSV from people who dont know they have the virus.
Are There Any Risks To The Test
There is no known risk to having a swab test.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
If you had a lumbar puncture, you may have pain or tenderness in your back where the needle was inserted. You may also get a headache after the procedure.
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When To Talk With A Doctor
Talk with a doctor if you notice any sores on or around your genitals. Other STIs, like syphilis, can look like herpes but need different treatment. Treatment is needed to prevent complications and transmission.
Your doctor will let you know whether you should test for herpes or another STI, and they can help you get treatment if needed.
How Can Herpes Be Prevented
Correct and consistent use of latex condoms can reduce, but not eliminate, the risk of transmitting or acquiring genital herpes because herpes virus shedding can occur in areas that are not covered by a condom.25,26
The surest way to avoid transmission of STDs, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested for STDs and is known to be uninfected.
Persons with herpes should abstain from sexual activity with partners when herpes lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms, he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected and they should use condoms to reduce the risk. Sex partners can seek testing to determine if they are infected with HSV.
Daily treatment with valacyclovir decreases the rate of HSV-2 transmission in discordant, heterosexual couples in which the source partner has a history of genital HSV-2 infection. 27 Such couples should be encouraged to consider suppressive antiviral therapy as part of a strategy to prevent transmission, in addition to consistent condom use and avoidance of sexual activity during recurrences.
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Can Herpes Simplex Virus Cause Serious Infections
Yes. The most serious, or life-threatening, HSV infections can occur in newborns who are infected during birth and in individuals with weakened immune systems , such as organ transplant recipients and people with HIV/AIDS. Neonatal herpes is a serious condition, but also very rare. While 25-30% of pregnant women have genital herpes, less than 0.1% of babies born in the U.S. each year get neonatal herpes. This means that most women with genital herpes give birth to healthy babies.
HSV lesions tend to be more extensive and persist longer in newborns and immunocompromised people than in individuals who have healthy immune systems.
Polymerase Chain Reaction Test
As with the viral culture, your doctor swabs or scrapes a sample from one of your sores. A lab gets the sample and looks for genes from the herpes virus. PCR test results usually come back to you within 24 hours.
Youre more likely to get this test if you have symptoms but its been longer than 48 hours since they showed up. In this case, you can rely on the results from this test more than the viral culture.
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Why Doesnt Everyone Receive A Herpes Blood Test
Both HSV-1 and HSV-2 may be common infections today, but a majority of people who actually have this infection will not experience any symptoms. Disease control agencies, such as the CDC do not recommend herpes testing for anyone without symptoms. There is evidence that diagnosing someone without symptoms does not change their sexual behavior.
When discussing your sexual habits with your doctor, it is more effective to determine if you should be tested for any or all STDs instead. This would include a herpes blood test at this point.
If there are bothersome signs and symptoms of a herpes outbreak, then the herpes blood test may be able to provide useful information. Youll want to consider requesting this blood test if any one of these three sexual health issues would describe your current situation.
- You are currently experiencing genital symptoms that you believe could be related to herpes.
- You are currently having sex or have had a sexual partner in the past who you know had genital herpes.
- You have had multiple sexual partners in the recent past and you want to have a complete STD exam.
Is There A Link Between Genital Herpes And Hiv
It is easier for a person with genital herpes to get or transmit HIV infection.
If a person with a herpes infection is genitally exposed to HIV, their risk of acquiring HIV is than someone without genital herpes. This is because genital herpes can cause breaks in the skin and make a person more vulnerable to HIV infection.
A person with HIV and genital herpes is more likely to transmit HIV to sex partners.
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When Should You Get Tested
The best time to get tested for herpes varies, depending on what’s happening.
If you’re exhibiting symptoms of an initial outbreak which include pain, itching and redness of the affected location fatigue, fever and chills and, ultimately, painful sores or ulcers it’s best to see a healthcare professional about getting tested.
However, if you think you’ve been exposed to the virus and aren’t yet exhibiting symptoms, HSV may take some time before being able to show results on a test. While the exact time frame is unknown and varies from person to person, two weeks is usually enough time to yield accurate test results.
Most people become concerned about being infected with the herpes virus after contact with a potentially infected person. Often, simple things like kissing someone with a visible cold sore or facial acne around the lips can cause concern about HSV-1.
For genital herpes, most people become concerned about potentially being infected after sexual contact with a person that shows symptoms of herpes. This can include oral sex with someone that has cold sores, which can potentially spread to the genitals.
Since herpes is asymptomatic in many people, you could be infected with the virus even if you dont have any symptoms.
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.
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