[Question #5748] Should myself and a new partner get HSV iGG testing?

19 months ago
This is a hypothetical question about best practices for preventing getting STDs, genital herpes specifically

I know that 80-90% of people with hsv2 are asymptomatic or unaware they have have symptoms

I also know that screening asymptomatic individuals with iGG testing is not recommended because of false positives 

So what is the best way to avoid getting herpes? Consistent condoms usage?

What about when you are getting into a relationship and you no longer want to use condoms? When you both go to get tested before unprotected sex, she HSV1/2 iGG Be included?

I don’t want to get hsv2 but I also don’t want myself or my new partner (both asymptomatic) to get a false positive

So best way to not get herpes:
Option 1: test every new partner before unprotected sex and risk false positives 
Option 2: use condoms until you’re in a serious relationship and “hope” you’re partner doesn’t have asymptomatic hsv2?
19 months ago
To summarize a more clear question: 
Should two asymptomatic people entering a new relationship get HSV tested before unprotected sex? Even while risking false positives ?

If the answer is no testing, how can one prevent hsv ?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
19 months ago
The best way to avoid getting herpes is to use condoms consistently yes. 
Experts vary in their response to should you get tested.  We kept track of false positives in our practice for seven years.  Most occur in people who get an index value of 1.1 to 3.5 on their IgG test.  But only 6% of people tested positive in that range and half were false positives - that is, they did not confirm as positive when they did a herpes western blot.  To me, that doesn't seem like a high rate of false positive.  If you did the test and one of you came back with an index value between 1.1 and 3.5, you could obtain the western blot for clarity.  When my clinic was open we included a herpes IgG test in every STD screen unless someone knew they were already infected OR they didn't want to risk the possibility of a false positive.  But we had easy access to the western blot and most people who needed to confirm, did so.  That's my view on this.  Others feel differently.  Let me say that when I was single, I never had sex with anyone without a full battery of STD tests, including herpes.  At times, it was highly illuminating.

Terri
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19 months ago
Thank you for the response

To clarify:

1. Are you saying you personally, when single, did ask every partner to get tested for herpes or did NOT ask them to get tested for herpes? Not sure if you had a typo

2. Here is a quote from an interview you did:

“I think the other way clinicians can deal with the low positive HSV serology results is to make confirmatory testing reflexive; if you order an ELISA and the result is a 1.1 to 3.5 you reflex it to a Western Blot. I think it should be reflexed to a Western Blot, but having said that I will add the answer isn’t always clear. We might get a 2.8 on an ELISA and then get an indeterminate Western Blot, for example, which isn’t really rare. There isn’t a perfect solution but reflexive testing is a reasonable approach. Sometimes we don’t get a clear answer for people. They can have an indeterminate Western Blot for years and a low positive ELISA with no symptoms, so we really don’t always know if people have herpes or not and that drives them nuts…and I don’t blame them.” 


Based on the above quote, is the Western Blot reliable enough to do confirmation ? What percentage of low positives result in indeterminate? Wouldn’t the same protein that tripped the ELISA also trip the Western Blot a majority of the time ?

19 months ago
Typo correction: what percentage of low positives result in indeterminate Western Blot*
19 months ago
I guess that’s my main concern
I would feel horrible in the situation you described
A low positive ELISA and indeterminate Western Blot forever (even if UW does consider that negative I would still worry that I might have herpes)

It’s very difficult to decide if screening myself and partners is the right choice or to just leave it be if asymptomatic 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
19 months ago
You're right that was a typo.  I had everyone test for everything including HSV
In my experience, about 8% of low positives are indeterminate.  But now UW says if you get two indeterminates, 3 months apart, you should consider yourself negative.  OR if you have not had sex in a year, you can consider an indeterminate negatiave.
I think the decision to screen/test or not is so individual.  Some people are totally comfortable not screening - I was not.  It's not that I rejected someone who was positive for herpes - I actually had a four year relationship with someone who had herpes and I never got infected.  I just would want to know up front what everyone's status was so I could enter into a sexual relationship knowing what needed to happen - condoms and/or suppression.  That's all.

Terri
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