Herpes - new partner testing - should it be done?

I know that Dr. HHH only advocates HSV testing in those who are symptomatic or have had exposure to persons known to be infected.  And given the HSV-2 IgG test's low positive predictive value in low risk populations, I can see why (i.e., lots of false positives in low risk populations).  And maybe his stance will change when more accurate tests are developed, but that's probably a long way off, so we're stuck with the IgG tests at the moment.

I recently tested negative for both HSV-1 and HSV-2.  I would like future partners to be tested prior to engaging in sexual acts.  Is that unreasonable given some experts' (like Dr. HHH) stance?

My argument is that 90% of those with genital herpes are unaware they have it.  So while my partner may be truthful in saying that she hasn't experienced any outbreaks (we know that in many cases, people simply don't know how to identify the less obvious outbreaks until they learn more about herpes), the fact is that if she had it, she probably wouldn't know she had it.  Same for all her prior partners.

As for HSV-1, many people don't know they have it because they fall into the camp that doesn't get recurring cold sores.

So how can I effectively protect myself if I nor my partner is aware of her HSV status?  Of course, I can use condoms, but these aren't foolproof, and how can we avoid sex during outbreaks if she doesn't recognize mild outbreaks?  As for oral, yes, dental dams and condoms can be used, but this seems so impractical.  I have never met anyone who has used a latex barrier of any sort for oral - seems to me it's not even worth having oral if latex is required.

This has turned into a bit of a rant, but I guess I'm just frustrated at the state of the art when it comes to herpes testing.  I'd like my future partners to get tested, but at the same time, I don't want to put anyone through the stress of having a false positive, which I experienced.

Comments from Grace or anyone else?

[bjune0266]

Dude, I can understand testing potential partners for HSV 2 prior to sex. I know quite a few single ladies that require potential mates to show proof of negative HSV 2 results. But HSV 1??? No way. If you're going to require testing prior to kissing you're going to spend the rest of your life masturbating alone. You can catch HSV 1 obviously from just kissing. Just have a potential partner get tested for EVERYTHING with you. That way you can be safe for everything (except HSV 1).

[tom52]

Thats great...require all future partners to test for HSV 1 & 2.

I tested twice, I had never had any sysmptoms, not very sexualy active in the past 9 years.  Both my igg test for HSV2 came back negative.

Two months after my last negative test, I had an initial OB...WTF???  I went to the doc, he swabed and tested postive for HSV2.  Current partner test negative with no symptoms or OB.

Nothing is 100%.  You take a chance.

[jonasK]

Your situation certainly serves as a reminder that antibody tests can have false negatives.  My understanding is that the false negative rate is considerably higher for the HSV-1 IgG test than for HSV-2 IgG test, but as your case demonstrates, rare does not equal zero.

Yeah, I guess all I can do is ask future partners to get tested (goodbye one night stands!), and hope that they are not getting false negatives.  And if they get a low positive like I did, then they'll have to sweat it out until a confirmatory test is done, and by the time that's done, they'll probably hate me anyway for putting them through that.  Arrrgh, the whole thing is so frustrating.

[gracefromHHP]

You are preaching to the choir here with me!  

Yes, the incidence of false positives can make it a pain in the butt with confirmatory testing but it sure beats having to deal with herpes showing up later on in a relationship and all the hassle that can be ( suspecting infidelity, thinking the infected partner was aware of infection and lied etc ).  And yes, there are false negatives too - some folks just won't test + on the current tests we are using and sometimes partners are tested too early ( or with the wrong test ).  If you wait at least 4 months though for testing from the last partner, the incidence of false negatives is 2% for hsv2. You really can never be 100% accurate and you do the best you can. I think none of us would ever, ever fault someone if they had did the appropriate testing and then found out later on that they really did have herpes.  

I think it's attractive when someone is sexually responsible myself.  I actually often get pissed off that men I date don't ask about std's and testing and such and condom use before they have me half undressed.  I know they aren't getting tested. I know they aren't using condoms.  Folks just assume so much erroneously :(

grace

[jonasK]

Sounds like you advocate HSV testing for new partners, even if that person is asymptomatic and has no known genital herpes positive prior sex partners?

[gracefromHHP]

Sure do - we advocate hiv testing even though only 1% of the population in the US has it. Why we don't advocate hsv testing when 56% have hsv1 and 24% have hsv2 is beyond me.

grace

[jonasK]

Ha, that made me laugh out loud.  And it's a great point.  You need to convince Drs. HHH and EWH!

[Ophelia23]

Yes, I got a false negative on the HSV-1 portion of the test. Then a culture confirmed I had HSV-1 genital (I had been with the same sex partner for about a year at the time of these tests).

We probably don't advocate HSV testing because honestly, for most people, there are not the huge health ramifications that are associated with HIV. Also, serious cultural predjudices exist againt herpes of any kind. Encouraging testing may actually make large numbers of people hysterical rather than eliminating the stigma of herpes. We can already see in popular culture that cold sores are beginning to partake of the stigma against genital herpes, as more and more people realize these virus are actually pretty much the same thing.

Sorry, my sociology major is showing ^__^;;

[gracefromHHP]

There are valid arguments for testing everyone routinely and valid arguments for not testing everyone routinely.  I can agree with both but obviously favor routine testing because 1 - had to deal with it myself - both having it and also having had transmitted it unknowingly to a partner in the past and 2 - work in healthcare and see what can happen when a newborn has contracted herpes either during delivery or from an oral infection on someone post delivery.  Currently the push is on to at least inform folks if they aren't being tested for herpes so that if they want it they can seek it out elsewhere and also a push to test more expectant mothers.  I think we have a long way to go in our counseling of folks about herpes in general - both how common it is and how to reduce transmission to others of both oral and genital herpes.

grace

[waringblender]

I also favor testing of both partners at the start of a sexual relationship.

I wonder if the OP plans on dumping women who test positively though - is this a way to "weed out" people who have HSV?

It is more likely that you won't contract herpes in a relationship with a positive person than that you will. Every man I've ever been with has been HSV negative and nobody ever contracted it from me that I know about. Some of those were without condoms and I always use the medication.

Condoms are really effective against herpes. Not sure what you read, but they really have a large protective effect, and you probably have already had sex with a person with genital herpes anyway. That's how common it is.

[Ophelia23]

That is very true about neonatal herpes. I hadn't thought about that before. I assume it happens more often among mothers who do not know they have herpes?

Also, all very true, waringblender. People who KNOW they have herpes can take steps to prevent passing it on (condoms, meds, recognizing OBs). Someone who buries their head in the sand is much more likely to spread HSV. But I think condoms are only about 50% effective...

[waringblender]

Nope. According to the Handsfield guy, they are 90% effective.

[Curiousitykilledthecat1225]

Just bumping this up because I think it's important for those who do not get to a doctor in time for a culture (within 2 days of symptoms) to then get the blood test after the appropriate amount of time has passed to ensure its accuracy.