[Question #1751] Does my case warrant HSV-2 screening?

43 months ago
Hi! On the CDC website it says that if you have multiple sexual partners this might warrant an HSV-2 screen. I've been really paranoid about whether or not I should get an HSV-2 screening or not, I'm quite paranoid but I just want to list things that I think may or may not qualify me to get screened.

I sort of have had multiple sexual partners before, but never for a long period of time and only had sex with them a few times, and in one or two cases they may have had other sexual partners as well, but again these occurrences were never too consistent or long. Does having multiple sexual partners in the past, but not now, qualify you to get a HSV-2 screening?

I've also had sex with ~ 15 women, and with most of them I had mostly unprotected sex.

I've never had any herpes lesions to my knowledge, but i've been turning past bumps etc over and over again in my head with paranoia.

I am a smoker (not sure if the studies on this are conclusive).

Before I have sex I often shave, and I'm not very good at it which always causes cuts, and sometimes quite deep ones -- one time recently I had a deep cut right before having unprotected sex with a very promiscuous girl.

And I generally have sex for longer durations of time.

I'm not sure if any of this or all of this means I should get a HSV-2 screening, but I'm very paranoid and would prefer not to know; however, I feel that doing so would be a moral lapse and I don't want to be irresponsible. Thank you for taking the time to listen. Oh, and Happy Valentine's Day.


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
The experts on this board are not necessarily in agreement about when herpes testing is appropriate.
My feeling is that if you are doing an STI screen, and you have had multiple partners, as you state, that herpes testing by IgG type specific test is appropriate. 
You are correct - the CDC in it's section on STI screening suggests that herpes testing may be appropriate for males presenting for an STD screen who have had multiple partners.  Fifteen is multiple and since most of those were unprotected, as you describe, that puts you at more risk. 
The fear with herpes testing is false positives.  Most of those false positives occur in people who obtain an index value between 1.1 and 3.5.  About 50% of the people who test in this range turn out to have a false positive.  So if you did get that result, then you would do the second step which is western blot testing.  Just like with HIV, when we get a low positive value, that value should be confirmed.  I order western blots very often now for people who have had low positives.  We know how to confirm a positive on a herpes test, it just isn't as easily available as confirmation for HIV, for example. 
Also the cuts in your genital area from shaving do worry me some as they can be an avenue for entry of viruses - not just herpes.
So if you were my patient, presenting for an STI screen, I would ask you - do you want to be tested for one of the most prevalent STI's or do you just want to be tested for bacterial infections and HIV?  You should probably take into account this question - would you rather find out you have herpes from a lab test or from infecting another person?  If you have herpes, there are things you can do to reduce the risk of transmission.  But if you don't know you are infected, you wouldn't do any of those things, right?
Food for thought.

Terri
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43 months ago
Does the fact that some of the girls I slept with were very promiscuous and never used condoms with other people too make my need for testing increase more?

I was under the impression that 'multiple sexual partners' meant that you have at the same time more than one sexual relationship, as opposed to the number of lifetime sexual partners.  I never had multiple sexual partners in the former sense for very long or very consistently; however, there was some overlap between partners and also on their side as well. What does 'multiple sexual partners' really mean?

To be honest, having an STI like herpes would seriously affect my mental health. It is one of my biggest fears and I'm scared to death to lose that adventurousness and spontaneity from life by always having to shock potential partners. It would put an end to the possibilities of flings and put a hole in my self-confidence.

In light of everything, should I still be tested?


Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
Multiple partners means more than one sex partner in your lifetime. 
I wish I could help you more with this decision.  I'm sure there is conflict in your head - would it be worse to infect another person with herpes or go through the challenge of knowing I have this and disclosing to others?  I think that's the "choice point" for you and only you can weigh that out and live with the decision that you make.  At a minimum, if you decide not to test, you should consider using condoms with every intercourse, both to reduce the chance you might infect someone else if you are infected and also reduce the risk that you would become infected yourself, if you are not already. 

Terri
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43 months ago
It is really a tough choice, but thank you for being so honest.

That being said, is it possible to get a second opinion from this thread from Dr. Hook or Dr. Handsfield? I am more than willing to pay another $25, I just want to get another perspective so that I can make my decision. Let me know what I can do. Thank you so much and Happy Valentine's Day. I really appreciate the work that you do here.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
Dr. Hook answered a very similar question about a week with a person with similar risk factors  - he recommended against testing  I'm sure you can find it if you look within the past week or so.  As I said, we don't necessarily agree on this topic but that's OK - there is room for more than one opinion.

Terri
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