Herpes Testing

Genital herpes is transmitted through contact with the following areas of an infected person:

• Blister or sore caused by herpes. The fluids in a herpes blister or sore carry the virus. Contact with those fluids can transmit the infection.
• Saliva or skin around the mouth if your sexual partner has oral herpes
• Genital secretions or skin in the genital area if your sexual partner has genital herpes

Viral shedding of herpes means that the virus is released through skin that appears normal. This has two important consequences. First, somebody infected with genital herpes can spread the infection during sex even if they have normal looking skin. Second, while using a latex condom will reduce the chance of getting herpes, it doesn’t totally eliminate the risk. That’s because the herpes virus can exist in areas that are not covered by a condom.

The two main ways of getting genital herpes are:

• Having sexual intercourse or genital-to-genital contact with somebody who has genital HSV-2
• Receiving oral sex from somebody who has oral HSV-1

During sexual intercourse between a male and female, genital herpes is more easily transmitted from the male to the female (compared to female to male transmission). So genital herpes is more common in females than males.

The following groups are at higher-than-average risk for becoming infected with genital herpes are:

• People who have sex with someone who has genital herpes
• People who have unprotected vaginal, oral, or anal sex
• People with multiple sex partners

Screening means getting tested for a disease before it starts to cause symptoms or serious health problems. The Centers for Disease Control and Prevention and the US Preventive Services Task Force do not currently recommend routine screening for genital herpes in adolescents or adults, including pregnant women, who don’t have symptoms ^(1)(4)(5). There are several reasons why routine screening is not recommended ⁽⁴⁾:

• The serology test for HSV-2 has a high false-positive rate, which means that many people with HSV-2 antibodies don’t actually have herpes
• Confirmatory tests for a positive HSV-2 test are not widely available
• A positive HSV-1 test doesn’t distinguish between oral and genital herpes
• Many people suffer from anxiety and disruption of personal relationships from a test that may not be accurate

However, health care providers may consider screening with herpes serology tests in the following groups ⁽¹⁾:

• Patients with symptoms of genital herpes without a confirmatory laboratory test
• Patients with recurrent genital symptoms or atypical symptoms and negative herpes PCR or culture
• People who have a current or prior sex partner with genital herpes
• People concerned about having a sexully transmitted infection
• Men who have sex with men at increased risk for HIV
• People with HIV

Most people with genital herpes have no symptoms or visible sores or blisters. Or they may have mild skin findings that they believe are pimples or ingrown hairs instead of herpes.

If present, symptoms of genital herpes vary according to whether it is a primary or recurrent episode of the illness ^(1)(3)(6).

A primary episode of genital herpes is when you get the infection for the first time, with no prior antibodies to the HSV-1 or HSV-2. Symptoms include:

• Small blisters or sores on or around the genital, anus, or mouth. The blisters are grouped in small clusters and are filled with clear fluid. The blisters break open and leave painful ulcers. The ulcers dry out and get covered with crust before they finally heal. The episode lasts about 2 to 3 weeks.
• Fever
• Body aches
• Headache
• Swollen and tender lymph nodes in the groin
• Pain with urination or difficulty urinating

A recurrent episode (or outbreak) is when the infection reactivates in your body. The virus travels from the spinal cord back to the skin and genitals. The symptoms are usually milder and don’t last as long as the primary episode. Possible symptoms include:

• Small blisters or sores on or around the genital, anus, or mouth.
• Pain in the genitals in the hours or days before the blisters appear
• Shooting or tingling pains in the legs, hips, or buttocks in the hours or days before the blisters appear

Recurrent episodes occur mostly within the first few years of the primary episode, with decreasing frequency later on.

It is recommended to go to the emergency room or see a health care provider as soon as possible if you have these symptoms during an episode of genital herpes:

• Trouble urinating
• Headache plus fever
• Confusion plus fever
• Trouble breathing
• Changes in your vision
• Abdominal pain, nausea, or vomiting

Genital herpes can cause several complications ^(1)(3)(6)(7).

Herpetic whitlow is the occurrence of painful blisters on your finger accompanied by swelling and tenderness of nearby lymph nodes. Treating with antiviral medications will speed up recovery.

Meningitis is an infection of the lining of the brain, causing fever, headache, neck stiffness, and sensitivity to light.

Encephalitis is an infection of the brain itself causing fever and acute changes in mental status.

Complications in the eye include keratitis and chorioretinitis. Both can cause blindness.

In people with a weak immune system from AIDS, the herpes viruses can also spread to the lungs (pneumonitis), liver (hepatitis), and esophagus (esophagitis).

Neonatal herpes occurs when a pregnant woman with genital herpes passes the infection to her infant in pregnancy, during childbirth, or shortly after birth. Neonatal herpes is one of the most serious complications of herpes. Babies can die from neonatal herpes.

Having genital herpes increases the risk of becoming infected with HIV, the virus that causes AIDS ⁽¹⁾. The sores and ulcers caused by genital herpes makes it easier for the HIV virus to spread.

There are four main ways to make a diagnosis of genital herpes.

CLINICAL DIAGNOSIS

When a sexually active person has the classic herpes sores or blisters, the health care provider sometimes chooses to make the diagnosis of herpes without further testing ⁽⁶⁾. The purpose of this clinical diagnosis is to start treatment immediately in order to relieve severe symptoms. However, several other conditions can cause sores and ulcers in the genital area, such as syphilis, chancroid, granuloma inguinale, lymphogranuloma venereum, fungal infection, Behçet syndrome, and psoriasis (3).

Therefore, it is recommended to test for genital herpes with laboratory tests ^(1)(3)(6)(8).

Genetic Material Of The Virus

The blisters are scraped to obtain fluid. The fluid is analyzed for genetic material (DNA) of the virus with a test called polymerase chain reaction (PCR).

GROW THE VIRUS

The blisters are scraped to obtain fluid. The fluid is placed in a container of nutrients to allow it to grow and multiply. Growth of the virus confirms the diagnosis of herpes.

DIRECT FLUORESCENT ANTIBODY

This test uses fluorescent antibodies to allow direct visualization of the herpes virus in fluid samples.

ANTIBODIES TO THE VIRUS

Serology is a blood test that looks for antibodies that your body makes in response to infection with the HSV-1 or HSV-2 virus. The recommended serology test (IgG) cannot tell whether the herpes simplex infection is currently active or has been active in the past. Because it takes time for your body to make antibodies, the test result may be negative in the early stage of the infection.

For people with herpes symptoms, a combination of tests are useful for determining if the episode is primary or recurrent. In a primary episode, there would be a positive PCR or culture but no IgG antibodies. In a recurrent episode, there would be a positive PCR or culture as well as IgG antibodies.

Before starting treatment for genital herpes, your health care provider may ask about the following:

• Symptoms
• Sexual partners
• Safe sex practices
• History of exually transmitted infection in the past
• Other medical conditions
• Allergies to medications

Genital herpes cannot be definitively cured. The goals of treating with antiviral medications depend on the individual patient situation and may include the following:

• Relieve symptoms
• Shorten the duration of episodes
• Lower the frequency of episodes
• Lower the risk of transmitting the infection to sexual partners

For treating a person’s first known episode of genital herpes, it is recommended to start a course of oral antiviral medication within 72 hours. Treatment options for include ⁽⁹⁾:

• Acyclovir 200 mg five times a day for 7–10 days
• Acyclovir 400 mg three times a day for 7–10 days
• Famciclovir 250 mg three times a day for 7–10 days
• Valacyclovir 1000 mg two times a day for 7–10 days

For people who have recurrent episodes of genital herpes, it is recommended to start a course of oral antiviral medication at the earliest sign of recurrence, such as tingling or burning, even before the blisters appear. Treatment options include ⁽⁹⁾:

• Acyclovir 400 mg three times a day for 5 days
• Acyclovir 800 mg two times a day for 5 days
• Acyclovir 800 mg three times a day for 2 days
• Famciclovir 125 mg two times a day for 5 days
• Famciclovir 500 mg once, followed by 250 mg two times a day for 2 days
• Famciclovir 1000 mg two times a day for 1 day (e.g. a total of two doses)
• Valacyclovir 500 mg two times a day for 3 days
• Valacyclovir 1000 mg once a day for 5 days

Daily suppressive therapy is available for people who have frequent recurrent episodes of genital herpes (e.g. 6 or more episodes per year) or who wish to lower the risk of transmitting the infection to their sexual partners. Options include ^(9)(10):

• Acyclovir 400 mg two times a day, every day
• Famciclovir 250 mg two times a day, every day
• Valacyclovir 500 mg once a day, every day
• Valacyclovir 1000 mg once a day, every day

The American College of Obstetricians and Gynecologists recommends the following strategies to lower the risk of a pregnant woman transmitting genital herpes to her infant ⁽⁵⁾:

• Pregnant women with active recurrent genital herpes should be offered daily suppressive antiviral medications at or beyond 36 weeks of pregnancy
• Pregnant women with genital herpes blisters or symptoms during labor should be offered a Cesarean delivery (C section)

Topical treatment with creams or ointments is not effective for reducing symptoms of genital herpes.

The most reliable way to avoid genital herpes or other sexually transmitted infections is to avoid vaginal, anal, and oral sex.

If you are sexually, active, consider these measures to lower your risk of getting or transmitting genital herpes ⁽¹⁾:

• Stay in a mutually monogamous relationship with a partner who doesn’t have genital herpes or other STDs. Mutually monogamous means that you and your partner have sex only with each other and not with other people
• Use a latex condom at all times
• Avoid sex when you or your partner have an episode of genital herpes. While using a condom will reduce the chance of getting herpes, it doesn’t totally eliminate the risk. That’s because the herpes virus can exist in areas that are not covered by a condom.
• Advise your sex partners that herpes can be transmitted an an infected person to a noninfected even in the absence of symptoms (due to viral shedding)

Taking valacyclovir 500 mg once daily lowers the risk of transmitting genital HSV-2 herpes infection to a sexual partner. This was demonstrated in a large clinical trial involving 1,484 heterosexual, monogamous couples with healthy immune systems where one partner had HSV-2 and the other partner did not ⁽¹⁰⁾.

There is no vaccine available to prevent getting or transmitting herpes.

Genital herpes in a pregnant woman may or may not increase the risk of miscarriage. The research is inconclusive ⁽¹¹⁾.

IMPORTANT:

Question: What is a cold sore?

Answer: A cold sore, or fever blister, is caused by the HSV-1 virus. Many people become infected with HSV-1 from non-sexual contact, such a kiss. The HSV-1 virus can also cause genital herpes. This happens when HSV-1 is spread from the mouth to the genitals during oral sex. But most cases of genital herpes are caused by HSV-2.