It’s basically a SELF mantra at this point: Getting tested for sexually transmitted infections is hella important. Is it the most delightful way to spend your time? No. Is it a vital part of looking after your health, sexual and otherwise? Absolutely.
When you go in for routine STI testing, you might realize that your doctor doesn’t test you for herpes. What’s that about? As it turns out, testing for herpes isn’t as straightforward as testing for something like chlamydia or gonorrhea. Here, doctors explain why herpes isn’t usually included on STI panels.
What you need to know about herpes and how it’s transmitted
Two versions of the herpes simplex virus can cause this infection, according to the Centers for Disease Control and Prevention (CDC): herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).
You might be thinking, Oooh, wait, HSV-1 causes oral herpes, and HSV-2 causes genital herpes, right? Technically, yes. But that’s not the full picture. Both viruses can infect either your mouth or your genitals through skin-to-skin contact, the CDC explains.
“HSV-1 has a predilection for the oral mucosa, but cases affecting the genitals are rising,” Susan Bard, M.D., a New York City board-certified dermatologist and adjunct clinical instructor at the Mount Sinai Hospital, tells SELF. This can happen if, say, a person with HSV-1 in their mouth passes the infection to someone’s genitals while performing oral sex. And although HSV-2 is still behind most cases of genital herpes, it can cause oral herpes when someone with this infection on their genitals passes it to another person’s mouth during oral sex.
Whether herpes affects your mouth or genitals, it can cause blisters that may break open, leaving painful sores that can take a week or more to heal, according to the CDC. A lot of people don’t realize that cold sores, also called fever blisters, are actually sores from the herpes virus (typically HSV-1). That first herpes outbreak may also cause flu-like symptoms such as fever, body aches, swollen lymph nodes, and headaches, the CDC says, all of which are a sign that your immune system is putting up a valiant fight against the virus.
You might think these signs would make it really obvious that something is up with your health if you have herpes. But it’s also entirely possible to have herpes without exhibiting any symptoms at all. The virus can lie dormant in the body without ever making itself known. That’s why so many people have herpes without realizing it, the CDC explains.
How common herpes really is
Enough people have herpes to make it a totally commonplace infection, even though we may not treat it as one.
Nearly 48 percent of people aged 14 to 49 in the United States were estimated to have HSV-1 between 2015 and 2016, according to the most recent data from the CDC. This high prevalence makes sense because many people actually get the virus from nonsexual contact as children, the CDC explains. This can happen when a parent greets a child with a kiss on the mouth or while a kid is playing with other little ones, since children aren’t exactly known for their respect of personal space. Remember: HSV-1 often presents as cold sores, but it’s possible that some people with HSV-1 actually have genital herpes.
So, about genital herpes. You may have heard that one in six people has this infection. “That’s a little bit of an outdated figure,” Christine Johnston, M.D., an associate professor and herpes researcher at the University of Washington School of Medicine, tells SELF. That number is related to national survey data released by the CDC in 2010 and based on the years 2005 through 2008. This nationally representative research, published in the CDC’s 2010 National Health and Nutrition Examination Survey (NHANES), tested people’s blood samples for antibodies of HSV-1 and HSV-2, estimating that 16.2 percent of Americans aged 14 to 49 had HSV-2 between the years 2005 and 2008. That’s around one in six.
The most current NHANES data, based on the years 2015 to 2016, puts the number closer to one in eight: 11.9 percent of U.S. people aged 14 to 49 were estimated to have HSV-2 in this time period, according to the CDC. But the real number of genital herpes infections could be higher or lower than that, because we know that HSV-2 can also present orally while HSV-1 can also present genitally. Plus, as we’ll explore in a bit, accurately testing blood samples for herpes can be a tricky task, so these numbers aren’t necessarily definitive.
Overall, it does seem that HSV-2 rates are declining, although there is not a clear reason why. “It is particularly puzzling given that other STIs are going up dramatically, suggesting that the reason for the decline is not changing sexual behavior,” says Dr. Johnston, who is also associate director of UW Medicine’s Virology Research Clinic.
Why doctors don’t automatically test you for herpes
OK, clearly herpes is super common. So why don’t doctors automatically test for it when you ask to get “tested for everything?” To answer that question, it’s important to understand the difference between STI testing and STI screening. Testing is done when you have symptoms, whereas screening is done in the absence of symptoms—just to check to see if you’ve been exposed.
Doctors will screen for STIs such as gonorrhea and chlamydia even in the absence of symptoms. This is key from a public health perspective because catching these infections in time can prevent serious complications such as pelvic inflammatory disease. This happens when an untreated STI like gonorrhea or chlamydia infects reproductive organs, possibly leading to infertility.
Experts don’t screen for herpes for a few reasons.
“The U.S. Preventative [Services] Task Force has recommended against screening asymptomatic adolescents and adults for HSV infections. The rationale is that there is no health benefit that’s been proven and there [are] a couple of risks,” Dr. Johnston says. “One is a false positive test, and the second is a risk of anxiety…[Herpes] is not associated with serious health outcomes, yet it’s still feared.”
Even pregnant people who could theoretically risk passing the virus during childbirth are not screened unless they have a history of herpes outbreaks or a current outbreak, Peter Leone, M.D., of UNC’s Institute of Global Health and Infectious Diseases, tells SELF.
If you have possible herpes symptoms such as sores, your doctor may be able to diagnose you on sight, the CDC notes. Sometimes, though, a doctor in this scenario will decide to perform tests just to be sure. In that case, a doctor can take a swab of the outbreak and test it for the presence of the herpes virus. While it may be possible to determine which type of herpes you have from this kind of test, swab tests aren’t sensitive enough to make it a sure thing every time. “HSV-1 is associated with less frequent occurrences and less [viral] shedding,” Dr. Johnston says, so it may be useful to know which form of the virus you have.
Enter the polymerase chain reaction (PCR) test, in which a doctor takes a sample from the sore to test for HSV DNA and see which type of herpes you have, according to the Mayo Clinic. As the CDC notes, these tests are becoming more popular because they are more sensitive than the usual viral swabs. “That test has excellent specificity, meaning it very rarely has false positives,” Dr. Johnston says.
What if you’re not experiencing symptoms but really want a herpes test anyway, just to know your status? Your doctor could take a blood sample to look for the presence of herpes antibodies. Antibodies are proteins your immune system creates when you’ve been exposed to something harmful, according to the U.S. National Library of Medicine.
But it usually doesn’t make a ton of sense to get tested for herpes antibodies because of that whole dormant-virus thing. Let’s say you test positive but will never have an outbreak in your life. Due to unfair herpes stigma, that might be pointlessly stressful.
“Antibodies mean that you have HSV in your body. It doesn’t mean that you are actively infectious or that you’re going to [have symptoms],” William Miller, M.D., editor-in-chief of the medical journal Sexually Transmitted Diseases and professor and chair at the division of epidemiology at the Ohio State University, tells SELF. “It’s just your body’s way of controlling the virus.”
It’s also possible to get a false positive, Dr. Miller explains, meaning that you don’t have herpes antibodies but the test reports that you do. Or you could get a false negative and actually have herpes antibodies in your system but not know it.
Being proactive about taking care of your sexual health is truly excellent, but trying to get a herpes test when you don’t have symptoms really might be more trouble than it’s worth. The main exception is if you know a current or past partner does have herpes, so even if you might not have symptoms, you have reason to think you may have gotten the infection.
If you do test positive for HSV antibodies, Dr. Johnston says you ask should ask your provider if a confirmatory test is needed. The most commonly used antibody test can have false-positive results. However, more accurate types of antibody tests aren't widely available, Dr. Johnston says, so it makes sense to talk through your options with your doctor. Only after testing positive at that point does she recommend disclosing to sexual partners that you have herpes. “A lot of times people test positive [for antibodies], they tell all of their partners, then they do the confirmatory testing…and it was a false positive,” Dr. Johnston says. “That really is a lot of energy to [expend].”
Otherwise, the main theoretical benefit that could come from herpes antibody testing would be a renewed commitment to having safe sex so you don’t possibly pass herpes—or any other STI—along. (You can shed the virus even when you don’t have symptoms.) But safe sex is also about protecting yourself, so it makes more sense to just start practicing it whether or not you have herpes antibodies floating around your system.
Staying safe while avoiding panic and stigma
It can be tempting to freak out a little bit when you realize that herpes is both super-common and something you aren’t routinely getting tested for. So how do you process that information?
The first step is practicing the same safe sex that you know helps protect you from other STIs. Your best bet here is a barrier method like internal and external condoms for any penetration and physical shields such as dental dams for any oral play. Even though this won’t fully protect you from herpes (since it can pass through skin-to-skin contact with the infected area), it will reduce how much of your skin touches your partner’s.
This is why screening for herpes infection in the absence of any symptoms wouldn’t really do much to cut back on cases—the advice would be the same: Practice safe sex with barrier methods. “I agree right now with the recommendations not to screen people, but I think if we had a better diagnostic strategy, I would be much more in favor of routine screenings,” Dr. Johnston says. “It is important for people to know their status so they can protect themselves and their partners.”
But you also need to remember that the nature of herpes transmission means that you can do everything right and still get herpes—whether it presents as cold sores or genital herpes. If you have sex (even with a condom) you might get herpes. And the fact that it can often present with few or no symptoms means that you might get it from someone who had no idea that they had herpes. The point is that we need to reject the stigma around genital herpes, know the symptoms to watch out for, and get tested if you have symptoms. If it turns out that you test positive, then you can take the next steps to treat an outbreak when it happens and prevent passing it along to future partners.
If you think you have herpes, see a doctor such as your ob/gyn (if you have sores on your genitals) or dermatologist (if you have sores on your mouth), or go to your local health clinic. A medical expert can evaluate your symptoms, take samples for testing, and eventually offer treatment options if you need them.
“You will likely be started on antiviral medications to help you heal faster and make you less contagious,” Dr. Bard says.
Your doctor can also counsel you on how to tell any sexual partners about having herpes while not perpetuating stigma. “The important thing is not to panic,” Dr. Bard says.
The truth is that having herpes simply means you have a viral infection. We know that herpes stigma abounds, and it’s not as simple as just telling you not to care about it. But people with herpes can and do still have sex, fall in love, and have generally excellent romantic experiences (and lives overall). Don’t tell yourself you’re excluded from all that greatness due to one tiny virus.
Correction: This article was corrected to reflect that PCR testing is not used as confirmatory testing after a positive HSV antibody test.
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