I haven’t had any symptoms but recently I have been a bit paranoid about me getting cold sores now or being at risk of spreading them to others. The information about testing for HSV1 seems very confusing, especially since it appears between 50-90% of adults are already infected. Should I get tested for HSV1 or is this not a realistic concern? I know I am an anxious person regarding health matters so just looking to qualm my fears.

well, I think it depends upon how badly you want to know if you have HSV 1 - do you think about it a lot, is it worrying you, nagging at you?  You could certainly test, but if you do, you should know that the IgG test misses 30% of HSV 1 infection compared to the gold standard western blot and if positive, will not tell you if you have this orally or genitally.  If you have never received oral sex and are positive, then it is almost certain that you would have this orally.  What do you think?

Terri

1. My gut feeling is that this is not a realistic concern given how common HSV1 is,  and I should only be concerned if I become symptomatic. Is this a reasonable stance? Do you see any harm in this thought process, especially given the testing is somewhat ambiguous? Would it be wrong not to get tested?

1. My gut feeling is that this is not a realistic concern given how common HSV1 is,  and I should only be concerned if I become symptomatic. Is this a reasonable stance? Do you see any harm in this thought process, especially given the testing is somewhat ambiguous? Would it be wrong not to get tested?

I don't think it would be wrong not to get tested, no.  There is just no requirement for that, especially HSV 1.

2. I read the CDC doesn’t recommend screening for HSV2 unless the person is symptomatic, which leads me to believe that I don’t need to be screened for HSV1 if I’m not symptomatic?

What the CDC says about HSV 2 testing is that HSV 2 antibody testing should be considered when a patient requests an STD screen.  This is not your situation

3. My main concern is potentially spreading the virus to others through kissing or oral sex. I know several people who get cold sores and it doesn’t seem to interrupt theirs lives, all of them are married in fact. I can’t ever remember hearing about a situation in which I heard a person telling someone not to kiss them because they had a history of cold sores. I couldn’t find anything to suggest people should never kiss anyone again if they’ve ever had a cold sore.  Do I need to tell every person I kiss I may have been exposed to HSV1? What about oral sex? These thoughts seem more like a rabbit hole than a realistic concern.

NO!  You don't need to say that at all, so please don't.  If you were actually testing positive for HSV 1, you would need to decide about disclosure and not everyone agrees about when and how to do this.

4. What is the difference between the western blot and IgG? Does the western blot require an active infection?

The western blot looks for all of the proteins associated with HSV 1 and 2 antibody while the IgG looks for a single protein.

Terri

I have a few questions going forward:

1. What tests do you usually order for a patient such as myself(30s male, heterosexual, no IV drug using/sex worker partners, no known exposures) for an STD screening? I am quite concerned about my PCP ordering the HSV1/HSV2 antibody testing after learning that there are high false negatives for HSV1 and even more concerning, high false positives for HSV2? I love my PCP and he seems sharp, but I’m sure he doesn’t have the expertise of you in this regard.

2. I really wish getting screened for STDs wasn’t so anxiety provoking for me. The fear of the social stigma associated with STDs far outweighs the actual fear of the disease itself for me. Do you have any tips for framing the process to make it seem less scary? 

1. What tests do you usually order for a patient such as myself(30s male, heterosexual, no IV drug using/sex worker partners, no known exposures) for an STD screening? I am quite concerned about my PCP ordering the HSV1/HSV2 antibody testing after learning that there are high false negatives for HSV1 and even more concerning, high false positives for HSV2? I love my PCP and he seems sharp, but I’m sure he doesn’t have the expertise of you in this regard.

Unless a patient declined I always included HSV testing in my STD screens.  Always.  And if I got back low positives (where the false positives happen) I ordered the western blot for confirmation.  the CDC clearly states that HSV antibody testing should be considered in those seeking STD screening.  There are NOT high false positives for HSV 1 - the issue with HSV 1 is the lack of sensitivity for HSV 1 - it misses 30% of HSV 1 infections.  And it is not high for HSV 2 either - about 3% of people who use this IgG test will get a false positive on their HSV 2 test.  I have zero issues with how your PCP handled this situation - zero.

2. I really wish getting screened for STDs wasn’t so anxiety provoking for me. The fear of the social stigma associated with STDs far outweighs the actual fear of the disease itself for me. Do you have any tips for framing the process to make it seem less scary?

Hmmmm, not really, except to ask you - would you rather know what's going on with your body so you can do something about it or would you rather not know what's going on and find out by infecting another person?  That's how I would think about that.

I didn't underline the NO.  Not sure why are you seeing that.

Terri