Let’s Talk About Herpes

Let’s talk about herpes simplex virus. There’re two main types of herpes simplex virus type 1 (HSV 1) and herpes simplex type 2 (HSV2). HSV2 is most often transmitted by genital or anal intercourse. HSV 1 is most commonly transmitted orally and is associated with cold sores. However, both strands of HSV can be transmitted orally or genitally. As a physician, I counsel and treat patients regularly for sexually transmitted infections (STI). That usually involves conversation regarding protection, prevention and treatment. Condom use is the main way of preventing and protecting yourself from transmission of STIs. I advocate for at least yearly testing for STI for my patients. However, I do not routinely test for HSV unless the patient presents with clinical symptoms that warrants testing for HSV. HSV is mainly a clinical diagnosis meaning the diagnosis is made by history and clinical examination. Routine testing for HSV antibody is not recommended without clinical symptoms. Most sexually active individuals have has been exposed to the virus over the course of their lifetime with or without condom use. However, exposure does not automatically assume that you have the disease. Positive antibody simple can mean exposure. Not everyone who has been exposed HSV would have an outbreak. As a result, it is difficult to say when and from whom you contracted HSV. Further, you cannot determine the time duration that an individual have had the antibody. An antibody test can only tell that you were exposed.

I almost always never test for HSV anybody without clinical symptoms. Patients always get very concerned with the positive antibody screen. It can become a very confusing and inflammatory situation with a positive anybody. Another testing that can be done if there is the visible lesion is a HSV culture. However, culture results can also be negative if the sample is not adequate or the lesion has already begun to heal. If there is a visible HSV lesion, the antibody testing may tell if this an old or new infection. Symptoms of HSV range from asymptomatic to tingling and burning without lesions to recurrent genital ulcerations.

There are medications available to treat HSV that shorten the duration and severity of the outbreak. However, there is no known cure for HSV infection.

Author: Sharon Smith, M.D.