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Diagnosing Genital Herpes

Herpes can be detected by a viral culture of a lesion, if one is present, or a blood test. Ashley recommends both methods.

With a viral culture, a doctor swabs a lesion to pick up cells, puts the swab in a special solution, and sends it to a lab for growing and analyzing.

Although a doctor may recognize a herpes lesion by examining it, a viral culture will confirm the presence and type of HSV, says Ashley. Once they know whether they have HSV-1 or HSV-2, people have a better idea of how often they will have recurrences.

But viral cultures do have their drawbacks. If the lesion has started to heal (usually 48 hours after its appearance), the swab may not pick up enough virus and the culture result will be a "false negative." (False positives in cultures are rare.)

A blood (serology) test can be used to confirm a negative culture. It can also be used to diagnose herpes in a person who has no symptoms, who has genital irritation but isn't sure it's herpes, or who has a sexual partner with herpes and wants to find out if he or she has already become infected.

"Diagnosing whether someone has herpes or not is quickly done by a serology test because once you've become infected, an immune-competent [healthy] individual will develop antibodies to the herpes that is infecting them," says Thomas Simms, a biologist in the FDA's Center for Devices and Radiological Health.

Herpes antibodies will usually show up in the blood several weeks after a person first becomes infected. Some blood tests can determine the type of herpes infection, but cannot indicate whether the herpes is oral or genital. So people without symptoms may not know for certain if their herpes is oral or genital.

There are currently two FDA-cleared blood tests that accurately determine if a person is infected with HSV-1 or HSV-2, the HerpeSelect ELISA Kits and the HerpeSelect Immunoblot Kit made by Focus Technologies of Herndon, Va. (For more information, see "Herpes Blood Tests".)

Another blood test is the Western Blot. Although not 100 percent accurate, the Western Blot is considered the "gold standard" of blood tests and is used to determine the accuracy of other herpes blood tests that are developed. The University of Washington is the premier institution for performing and interpreting the test. (See "For More Information" to find out how you can have your blood tested with a Western Blot.)

Many older FDA-cleared blood tests for herpes are still on the market, and many labs use these tests because they are widely available and inexpensive. Although they may be labeled type-specific (can determine whether the infection is HSV-1 or HSV-2), they are not reliable, says Simms.

But it's difficult for people to make sure they are getting one of the newer, accurate tests, says Wald. Doctors and even lab workers may not know what test they're using. "The patient needs to ask, but it's a very tall order. It will take a significant amount of work on their part and phone calls to the lab themselves."

This is where a herpes support group can help, says Adams, who facilitates a group called HELP of Washington. "We keep a list of doctors who are up to speed, knowledgeable, and know what the right tests are."

The Emotional Impact

For many people, the social and emotional distress of having herpes is far worse than the physical symptoms of the disease, especially upon first discovering they have been infected.

Adams knows this well. After some marital difficulties and a separation, Adams and her husband reunited. But their tenuous relationship was further strained when he brought genital herpes back to the marriage. "It hurt our chances of getting back together," says Adams. The relationship ended in divorce.

The doctor who diagnosed Adams wasn't very understanding, she says. "I really felt betrayed on all counts." Adams found understanding and information from the herpes support group that she now helps facilitate. "It always hurts to see someone feel so worthless and angry at the world," she says. "We see people who say 'I haven't told anyone. I haven't dated in five years.' This virus has taken over their whole life. We let them see that we're OK. We all lead normal, happy lives."

Adams, who used to have painful outbreaks every month, now has them rarely. She keeps an antiviral drug in her medicine chest just in case, but hardly ever has to use it. "I'm a firm believer that attitude is all-important. If you're upset about it and you think about it all the time, you're going to have outbreaks. Once you realize this isn't going to kill you, at that point you feel stronger and your whole immune system gets stronger."

"The hardest thing about having genital herpes is having to tell someone," says Adams. Like many people with herpes, Adams believes it's important to tell a new partner about the disease before having sexual relations.

"People should have a right to make an informed decision," says STD clinic owner Warren. "The consequences of not telling are not only possibly infecting a person with a disease that they don't want, but the question of trust comes up. What else haven't you told them about yourself? Our experience indicates that far more people accept sexual partners with herpes than reject them."

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.