Is herpes select test needed?

[chrislarson310]

Hi Doc

I am 28 year old male. I have been dating this girl for 3 months now. We have decided to start having sex. Since I am paranoid about stds we went and both got tested. The clinic only offered HIV and syphilis testing. We're both negative. My concern is that my current girlfriend has not had any herpes select test done ever.  I had gotten a herpes select test done myself a few months ago which was negative. The problem is a lot of clinics do not offer the test and a lot of doctors are against testing for HSV-2 if there arent any visible outbreaks. I am aware that only 20% of people with genital herpes (HSV-2) get outbreaks while the other 80% do not know that they have it. My current girlfriend has never had a genital herpes outbreak. However, I fear that she still could have the HSV-2 virus since 1 in 5 americans have the virus (very scary). I am also aware that there are several false positive tests with the herpes select test from the 0.9-3.0 range.

1. Since I am very concerned with getting HSV-2, Do you feel that it would be necessary for her to get a herpes select test done even though she has never had an outbreak and has had only 3 sexual partners in the past? Or are her odds for having HSV-2 low enough (because she never has had an outbreak) not to worry? I am just confused as to how necessary the herpes select test is for couples, with no visible outbreaks, who are planning on having sex. Would you recommend it for couples with no visible outbreaks as a precaution?

2. We had unprotected vaginal sex yesterday for a very short time (1 minute max), what are my odds of getting genital herpes (HSV-2) from this incident considering her background and current scientific statistics?  I am very worried about this. I didnt sleep because of it last night.

3. She claimed to have shown HPV in an earlier papsmear but recently had a papsmear done where it no longer showed up. Does this mean she no longer has HPV?

thanks

[Edward W Hook, MD]

All of the above.  Odds are she doesn't have HSV-2, the duration was short and most exposures to infected persons do not result in infection.  EWH

[chrislarson310]

Thank you for the response. I am just wondering why you say that the exposure with my GF yesterday is of no concern. Is it because the chances are very low considering her relatively low sexual background (3 partners), the fact she has never had an outbreak, or because of the short duration of exposure? Or all the above?

[Edward W Hook, MD]

I'll provide you with a few comments regarding the HSV tests i just a moment but first let me tell you that all things being equal, you have no reason for concern related to the exposure to your GF yesterday.  No concern at all so don't worry.

As far as the issue of testing is concerned, it is a fine idea to get tested as long as both members of the couple are OK with the idea.  If you choose to do so, you need to be sure to have a good test.  There are several good, reliable type-specific IgG tests available for HSV.  The Herpes Elect is one, the Biokit assay is another which tests only for HSV-2 (you can be relatively sure she has HSV-1 given her history of cold sores) or the UW Western blot.  These tests can be ordered from just about any doctor's office.  With the Biokit or HerpeSelect you will get the results back sooner than with the Western Blot which can take a month to 6 weeks to get back.  


Whatever you do, PLEASE do not get an IgM test.  They do nothing but cause trouble and have no value but yield many false positive test results.

Finally regarding HPV, your question is rather vague but to cut to the chase, I would tell you not to worry about HPV or HPV testing. Just about everyone has it and tests do nothing but cause undue concern. At the present time the  important things are first and foremost to that your GF should get the HPV vaccine (approved for women, not men) and as every women should, she should have regular PAP smears, not to detect HPV but to detect the rare but the important consequence of HPV, HPV-related precancerous changes.  for men there is no meaningful benefit to testing or treatment, except if genital warts are present.

For additional information on both HSV and HPV, I would suggest the excellent American Social Health (ASHA) web sites (disclosure- both Dr. Handsfield and I are on the ASHA Board of Directors)

Hope this helps.  EWH

[chrislarson310]

also since she has HSV-1 (oral herpes) I thought about her getting the Western Blot (university of Washington) herpes test to ensure that the test will less likely be false positive result. I know its costly but peace of mind for me is priceless. Would you reccomend the western blot as a first test or should she take the herpes select first?

[chrislarson310]

I forgot to add if you do reccommend that she get tested for HSV-2 which is the best test for her to take to ensure the least possibility of a false positive? She gets cold sores on her lips and I know certain tests will show false positive for HSV-2 if HSV-1 is present. I have heard there are a few Herpes Select tests, Igg, Igm...I would like to know what test she should ask for.

thanks