can i be tested for herpes without an outbreak
when thinking about herpes testing it's
important to make a distinction in two
types of testing really one is testing a
person who presents in a clinic or with
a doctor that actually has lesions
genital lesions and so we can test those
lesions with very specific testing to
see if that lesion is caused by herpes
herpes culture is sort of the the old
standby many clinics including ours is
still doing culture the problem with
culture is that it's not it's very
specific meaning that if it's positive
we actually know that herpes is present
but it's not necessarily very sensitive
especially in some of older lesions a
person comes in typically not
immediately after he break he or she
breaks out with with herpes usually
there's a couple of days that go by
during that day shedding of the virus it
decreases and so that the sensitivity of
these cultures is decreasing so we
really need to have much more sensitive
tests and we now have DNA testing as we
do for a lot of other things and so we
can do DNA testing and some laboratories
are actually doing that and it appears
that more and more clinics and doctors
are offering this much more sensitive
test that tests can also make a
distinction between the different types
of herpes herpes simplex virus type 1
which typically occurs around the the
mouth of cold sores is basically what we
call that and the genital lesions are
typically type 2 even though the
proportion of lesions that are caused by
type 1 in the genital area is increasing
so it's important to to know what's
what's causing these lesions and having
a much more sensitive test would be of
great use for us in the clinic's then
secondly there are so called serological
tests that are testing 22 antibodies
meaning you know our immune system
develops resistance against these
viruses or making antibodies and you can
detect those antibodies in the in the
we have very good sensitive as well as
specific to us to detect antibodies
against type 1 or type 2 to summarize
the two types of tests the ones the
direct test for the virus can tell you
immediately whether it her peas is
causing that particular lesion rod then
there's the antibody tests of body's
immune reaction and it takes several
weeks sometimes up to three months to
develop as a body so there's a delay
between on seven fection and when the
tests can be composite and then beyond
that the tests the antibody tests are
not perfect if someone has lesions
clearly the preferred test is a direct
testament virus ideally a DNA test if
it's available because it'll pick up
more infections than culture so we
absolutely agree on that I want to take
a slight tangent and re-emphasize what
you looted to in the importance of
knowing virus type there are some
physicians out there who assume say oh
it's just herpes you don't need no virus
type because herpes is herpes no matter
what and in fact there's a big
difference if you're unlucky enough to
get genital herpes but lucky enough that
it's hsv-1 typically quite by oral sex
because HSV one more commonly causes
oral herpes that's actually a good news
scenario because the clinical course a
need for treatment are very different
from the two diseases genital HSV one
recurs much less frequently in fact
probably forty percent of people never
have a second outbreak and the others
are typically have an outbreak once
every year or two as opposed to an
average of 345 up to 10 times a year
with genital HSV to the need for
treatment therefore is different the
potential risk for transmission to
partners is different and it is critical
for everybody the genital herpes to know
and for their physicians to know that
they have to know virus type and you can
determine that either by culture DNA
testing which can determine the virus
type or by the antibody tests which are
also the proper kinds of tests there are
some older tests out there that don't
accurately distinguish type one from
type 2 in terms of blood tests so those
people who are getting tested and
physicians and clinics who are ordering
those tests need to be sure they are
requesting a type specific test the
other thing I want to say about antibody
testing by the way is that many labs
automatically offer what's called IgM
testing immuno goblin type M as opposed
to in a new club um type G or igg
testing in theory becomes positive
sooner than igg and so an IgM test for
some infections can help detect early as
suppose the late infection the problem
is that often doesn't work that well
with herpes the IgM testing often
doesn't proceed IgG IgM antibody but the
test also has a lot of false positive
results the labs offer these tests
because quite frankly they are very
cheap to do they have a high profit
margin and there is just an assumption
that it's a good thing to do and Doc's
not knowing the difference just order
what the lab shows on its panel and they
check off the box my advice to and this
is going to be in the upcoming revision
of the CDC's STD management guidelines
that are going to be released in early
2015 that I GM testing for HSV has no
role whatsoever doctors ordering tests
please do not request the IgM test
patients who are perhaps going to an
online site and arranging your own ages
we testing ignore the IgM don't do it
it'll get you in more trouble than it
