can i be tested for herpes without an outbreak

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

blood and

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