Getting Tested for Herpes

By Terri Warren, R.N.

If you were asked to estimate what percentage of the American population is infected with the genital herpes virus, what would you say? One in 20? One in 10?

Try 1 in 5 over the age of 12. In addition, many people have a less typical form of genital herpes caused by the kind of herpes that normally causes cold sores around the mouth. This type usually is transmitted through oral sex with someone infected with the cold sore virus.

Why is it that most people with genital herpes don't know it? There are several reasons. A major one is the common belief that everyone infected with genital herpes has significant symptoms. The truth is that most people have minor symptoms, mild enough or transient enough to pass without concern. Or perhaps the symptoms that are present are confused with something else--a friction burn from unlubricated sex, a yeast infection, skin caught in a zipper, a reaction to a new detergent. If symptoms go away and are not severe, a person may never visit a health-care provider to determine what is going on. And "genital" herpes can occur anywhere in the area normally covered by boxer shorts. Many people don't realize that the genitals may not be the location of outbreaks.

So why don't health-care providers routinely test for the genital herpes virus? The most common reason cited in a study we did of 865 health-care providers was the belief that there is no accurate blood test to distinguish between the two types of herpes: HSV-1 (the usual cold sore virus) and HSV-2 (the usual genital herpes virus). A second reason often cited was that since there is no effective treatment for genital herpes, it makes little sense to take the time to diagnose it. It simply upsets people for no good reason. A third reason given was that the high cost of treating genital herpes is prohibitive for many patients.

There are now four tests, three of which are FDA-approved, that accurately make the distinction between HSV-1 and HSV-2, but access to them is not always simple. Some laboratories run new blood tests called type-specific serologies (TSS), while others still use older tests that do not accurately make the distinction between the two types of virus. It may be difficult for health-care providers to identify what tests their labs use.

About 90 percent of those infected with HSV-2 are unaware of their infection, and we know that people can (and frequently do) transmit virus without apparent symptoms. Given those numbers, if you had genital herpes and didn't know it, would you rather find out by transmitting virus to someone else or by a blood test? I think that the answer for most of us is quite clear, and that it effectively counters the notion that knowing you're infected is not useful.

Treatments for genital herpes are available. The cost of antivirals can be an issue for some people, but a less expensive, generic antiviral is available. And, both GlaxoSmithKline and Novartis, two manufacturers of brand-name herpes medications, offer low-cost programs for people who cannot afford to buy their medications (see "For More Information").

Finding out that you have genital herpes is not easy. Because this is a lifelong sexually transmitted infection, people may often feel angry, depressed and frustrated. But adjustments can be made to one's sexuality. Counseling with a health-care provider is a first step. There also are local groups in which people infected with genital herpes seek support and share information. Many excellent books are now available on herpes, and there are some very good Web sites for gathering information anonymously. There is even a Web site where people with herpes can meet others with herpes for discussion and friendship.

I strongly encourage anyone with symptoms that concern them, or anyone being screened for sexually transmitted diseases, to seek accurate testing for herpes simplex virus. Now that precise testing is available, people can avoid discovering that they have genital herpes by infecting someone else.

Terri Warren, R.N., is owner of the Westover Heights Clinic in Portland, Ore., specializing in the treatment of sexually transmitted diseases.

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