Often on the board we talk about confirming your herpes status with other tests.  Here is some info on the herpes blood tests and other sources for more reading :)

The herpes western blot ( WB ).  This blood test is considered the gold standard of herpes blood tests. It's still not perfect but oftentimes it's well worth getting it done to confirm a low positive result.  http://depts.washington.edu/rspvirus/herpes.htm  has all the info your provider needs to order this test for you. Unfortunately it's only done at one lab in the US so it can take up to 2-3 weeks to get your results back. It will report back with a + or a -.  You will not get a numeric result for it.

The herpes biokit hsv2 test.  This is a test that can be done in some clinics and gets you results back in 20 minutes or so.  It's also a good test to use to confirm a low positive hsv2 igg result on other tests.  http://www.biokitusa.com/hsv_introduction.htm  is their website to see if there is a clinic near you that offers it.  I'd have to check but I'm pretty sure it also only reports back with a + or a - and not a numerical result.

The herpeselect is another blood test we frequently talk about. http://www.herpeselect.com/ is their website.  Most times when you get this blood test done  you will get a numeric result - ie hsv1 igg 4. 9 and hsv2 igg 3. 6.  It is a type specific test which means that it can differentiate between hsv1 and hsv2.  Some smaller labs do a version of the test that only reports back with a + or a - and sometimes the lab policy is to only report a + or a - so if your results are in question you might have to have your provider call the lab and do some digging.  They also now have a quick hsv2 igg blood test too that can be done in some doctor's offices that gets you a hsv2 result in around 20 minutes.    

The herpes inhibition assay is a blood test offered by quest/focus labs that can help sort out a false positive hsv2 igg result.  If I understand it properly it will report in a %.  It should be widely available since focus/quest is one of the 2 biggest labs in the country.  

The captia igg blood test.  Captia is also a type specific herpes igg blood test.  They do not have their own website that I"m aware of.  Labcorp is supposed to be switching over to using this as their default herpes igg blood test.  It also will give numeric results - ie hsv 1 igg 5. 6 and hsv2 igg . 23 .  

www.herpesdiagnosis.com is a terrific resource for more reading about herpes blood tests.   As is http://www.ashastd.org/pdfs/blood_test.pdf  for  a quick summary that compares them all.

Also keep in mind - the herpes igm blood test ( what providers often tell you shows a new infection vs an old infection ) is not an accurate blood test for diagnosing herpes with. It should not be used in adults. You can search here on medhelp for zillions of posts by Dr Handsfield, Dr Hook and myself on it.  Also the older non-type specific tests are not worth your time either. If your provider tries to talk you out of herpes blood testing because it won't tell if you have hsv1 or hsv2, ask them to please check with the lab they use to find out about the newer and far more worthwhile tests that their lab is sure to offer :)  

grace

There are soooooooooo many myths and misconceptions out there about herpes and treatments.  If you haven't read the herpes handbook yet at www.westoverheights.com please give it a read. It's a terrific resource to learn more about herpes ( and the website also has info on other std's too ). Also www.ashastd.org  is another valuable resource to learn more at about herpes and other std's.

so the myth I'd like to address in this entry is - suppressive therapy is only for folks who have a lot of ob's.

WRONG! There is no magic number of ob's you have to have before suppressive therapy is appropriate for you.  How you treat your herpes is a personal choice so do your reading and decide for yourself ( and with your partner if you have one ) how you want to treat your herpes.  If you are in a discordant relationship ( one partner has hsv2 and the other partner doesn't ) then suppressive therapy might be the right choice for you even if you can't recall ever having a single genital lesion.  Daily suppressive therapy with valtrex has been shown to reduce the chances of transmitting hsv2 to a partner by 48% ( NEJM jan 1, 2004 ).  It can be a valuable tool for protecting a partner.

Even if you and your partner both have hsv2 - if you are having either frequent ob's or just the ones you do have really inconvenience you you can still go on suppressive therapy.  No reason to suffer thru ob's if you don't want to.  The long term safety of suppressive therapy has been well established so you can stay on suppressive therapy as long as you need to ( JID 186 suppl 1, 2002 ).  It's totally your choice. No risk of kidney or liver damage if you are otherwise healthy. It's definitely worth talking to your provider about if you are interested in.

Do you have to stay on suppressive therapy FOREVER if you chose to treat your herpes that way? No you do not. You might find yourself going on and off suppressive therapy as the situation calls for it in your lifetime of living with genital herpes.  Perhaps you feel more comfortable being on it in a new relationship until you both feel more confident about being together.  Perhaps you find that as you get older you get more ob's so you want to be on it or perhaps even as you get older you decide to stop it because you are just sick of taking medication or you want to see how many ob's you get .  Perhaps you were in a relationship with someone who was hsv2- originally so you chose suppressive therapy but then your partner contracts hsv2 from you or you enter into another relationship with a hsv2+ partner.  You can go on and off it as the situation calls for it. Just remember that if you are going to bother to chose suppressive therapy - you need to be taking your medication as directed reguarly in order for it to work!  

Feel free to talk about your experiences with suppressive therapy or ask any questions you might have about it either here on the journal or on the herpes community forum :)

grace

So you think you might have herpes - what do you do? Well the best thing to do is go be seen by your provider within 24-48 hours of the start of symptoms.  Why? Well nothing replaces a good exam and basic testing for starters. Also viral lesion cultures are frequently false negative - in fact on average 70% of them are! Getting the culture done within a day or two of the start of symptoms increases your chances of having an accurate culture done. If you can get a pcr culture done of the lesion(s) for herpes even better!  It's more likely to pick up on herpes than a regular viral lesion culture is.  Once you get back from your appointment - THEN come to the board and ask questions and get support while waiting for your results to come back :)  You'll find we frequently suggest on the boards testing for yeast and bacterial infections too. Both can trigger herpes infections and both can mimick herpes symptoms so ruling them out no matter what your gender is a good idea.  Studies have shown that about 2/3's of females have something besides just herpes going on with their first herpes ob so you might as well get seen and tested and take care of it all at the same time.

Another thing to consider is to ask for a baseline herpes igg blood test at your appointment - especially if your provider suspects herpes is the cause of your symptoms.  Most folks assume that if it's the first time they've noticed symptoms that it has to be a newly acquired infection for them but the research backs that about 1/2 of all presumed new infections really are just the first recognized recurrence. Getting a blood test as well as a lesion culture and typing might help you and your partner figure out who had it first so it's well worth doing.  

grace

This is a question that is frequently asked on the herpes forum - folks want to know which treatment is best for them. So how do you figure it out?  If you aren't sure if you have hsv1 or hsv2 you need to find that out so that you can better make decisions about treatment.  You also need to know what your partner's status is if you have a regular partner.  Then you need to do some reading.  Both the herpes handbook at www.westoverheights.com and the herpes info at www.ashastd.org have terrific info on herpes and treatments to learn more at.  Be prepared when you talk to your doctor so that the two of you can make decisions together about how to treat your herpes. Genital herpes treatments are patient driven - the patient gets to make most of the choices about it.  

So what are your treatment choices?  Well first off - you can chose to do absolutely nothing if you want. You don't HAVE to treat your herpes at all if you don't want to.  All recurrences will run their course in about 7-10 days on average ( the first ob usually lasts longer ).  You aren't harming your body by not taking the herpes antivirals.  some folks get fairly mild ob's and don't mind waiting them out.  You can also use topicals for pain relief/comfort too  as well as oral pain medications like tylenol or ibuprofen or even aspirin.  

Episodic therapy is also a choice. This is when you just treat each ob as it happens. You can use acyclovir, valtrex or famvir for this.  Just keep in mind that the antivirals work best when taken at the very first sign of a potential ob so if you start feeling that tell tale tingle/itch or whatever your prodrome is ( if you have one ) start the meds then. No need to wait until you have a full blown ob - the sooner you can start the meds the faster they work.  Some folks can even head off a full blown ob if they start medication early enough.  On average episodic therapy helps to heal lesions about 2 days faster than doing nothing at all. It also helps to reduce pain faster and reduces shedding faster.  If you have questions about doses - see the resources I listed previously or just ask on the board and someone will gladly help you :)

suppressive therapy is when you take herpes medications every single day to help reduce the number of recurrences you are having and to help make the ob's you do have milder/heal faster.  Suppressive therapy also helps to reduce the chances of transmitting the virus to your partner too if you are in a discordant relationship ( one partner has hsv2 and the other one doesn't ).  On average suppressive therapy reduces ob's by 70%.  suppressive therapy is an option no matter how many ob's you are having. there isn't some magic number that you have to wait and see how many ob's you are having before you can start it.  for some folks just 1 ob a year is too much for them to deal with. for others it might be never having an ob that they are aware of and just wanting to reduce shedding to help reduce the chances of infecting their partner. It's your choice!

which medication to chose for suppressive therapy? valtrex is the most convenient - most folks only have to take it once a day when they don't have an ob.  Famvir is usually the most expensive option though it recently has been released in a generic form so depending on your insurance it might be cheaper than valtrex. You need to take it twice a day.  Acyclovir is the old tried but true but it's also the medication that all other herpes meds compare themselves to.  It's been available in a generic version for a long time now and is usually the most affordable option.  You have to take acyclovir twice a day suppressively.

How to make treating your herpes more affordable? Well if you have insurance look into your options. If you have a copay - many insurances have a mail order pharmacy program that if you utilize it you can save money on your copays ( and it also beats going to the local pharmacy each month too ).  Oftentimes if you order your medications in a 3 month at a time supply you also save money.  valtrex's website offers $10 off coupons for every single time you refill your prescription for suppressive therapy. It's not much but if you have a $10 or more copay it'll help.  It is $120 a year savings even though $10 a time doesn't seem like much if you don't have insurance.  If you don't have insurance - shop around!  Some stores offer different medications at different prices and make it worth refilling your prescription at one vs another.  If you are treating your herpes episodically - walmart and other places offer their $4 prescriptions. For walmart it's 200mg tablets , 30 at a time ( I know -the amount makes no sense at all - do you hear me walmart??? ).  Since taking 200mg 5x/day for 5 days is a hassle - talk to your doctor about writing the prescription so you can get the cheaper price but how you can take more than 1 pill at a time and only have to take pills 3x/day for either 2 days or 5 days.  Also check out the herpes homepage's deal with drugplace.com.  They offer 6 weeks of suppressive therapy with acyclovir ( 100 400mg tablets ) for around $25 if you mention HHP. You still need a prescription from your provider but it might be your cheapest option. ( all things I just mentioned only apply to people in the US )

grace