The Herpes Simplex Virus (HSV) is a common viral infection causing sores on the mouth or genitals. Despite its prevalence, HSV is not routinely included in standard sexually transmitted infection (STI) screening panels. This often leaves individuals unaware of their HSV status, raising questions about why this common infection is excluded from typical STI screenings.
Understanding HSV Testing Challenges
The decision not to routinely test for HSV in asymptomatic individuals stems from a perceived lack of public health benefit. Unlike other STIs where early detection prevents serious complications and curbs transmission, routine HSV screening has not significantly reduced transmission rates or altered the epidemic’s course.
Limitations of available tests also play a significant role. Blood tests detect HSV antibodies, indicating past exposure rather than current infection or its location. These tests can yield false positives or negatives, especially for HSV-1 antibodies, and cannot differentiate between oral and genital herpes without clinical context.
Many people with HSV experience no or very mild symptoms, making routine testing less clinically relevant for them. The potential for psychological distress, stigma, and impact on relationships associated with an unexpected diagnosis is also a consideration.
Current Approaches to HSV Diagnosis
When HSV testing is necessary, it relies on specific diagnostic methods. The most accurate way to diagnose HSV is by testing samples from active sores or blisters. Viral culture and polymerase chain reaction (PCR) testing are used, with PCR offering higher sensitivity for detecting viral genetic material.
Blood tests, which detect IgG and IgM antibodies, are used when no active lesions are present but exposure is suspected, or for partners of infected individuals. These type-specific antibody tests distinguish between HSV-1 and HSV-2, but cannot pinpoint the exact infection location or acquisition time.
Healthcare providers recommend HSV testing in specific situations:
Presence of suspicious genital or oral lesions.
For partners of individuals diagnosed with HSV.
In certain cases during pregnancy to prevent neonatal herpes.
For patients with recurrent genital symptoms lacking a clear diagnosis.
Living with Undiagnosed HSV
The policy of non-routine HSV testing has practical implications for individuals unknowingly carrying the virus. A significant concern is the potential for unintentional transmission, as unaware individuals can transmit the virus to partners, particularly through asymptomatic viral shedding. This lack of awareness also hinders open discussions about sexual health and preventive measures.
For pregnant individuals, undiagnosed HSV carries specific risks. If a mother has active lesions during vaginal delivery, there is a risk of transmitting the virus to the newborn, potentially leading to neonatal herpes, a serious condition. This risk is managed through careful monitoring and, in some cases, antiviral medication during late pregnancy.