[Question #6597] HSV Testing And recent Chlamydia diagnosis

15 months ago
Hello All,

I know you get a lot of similar questions and are more than capable of filling in the blanks. So, I’m going to be brief. Besides, I find I get a lot out of your answers without really even reading the questions. 

I was recently diagnosed and treated for chlamydia. My first question is, what is the deal with HSV1/HSV2 testing? Or rather, lack there of? When I was tested for chlamydia (and other things) the clinician actively talked me out of herpes testing. This was at a Planned Parenthood; I feel like they’re reliable.  Furthermore, can herpes tests distinguish between types 1 & 2? Can a person be tested for only one type or the other, not for both?

Finally, I know you get a lot of towel questions.  However, with chlamydia specifically, since that’s what I was carrying around, do I need to worry about my ejaculate on a towel? I masturbate frequently, usually into a towel. I know my family members get into my hamper to do the laundry. Do I need to be concerned about anyone having come into contact with my ejaculate while I was positive for chlamydia? Should my family members be tested?

Thank You!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
15 months ago
I'm going to take your question about herpes testing as I answer the herpes question on this forum.  I ran a private STI clinic for 35 years in Portland, OR and included a herpes antibody test in every STI screen unless someone refused it or already knew that they had it.  However, you are correct that it is often not included in an STI screen.  There are probably several reasons for that.  Cost is one issue, especially in public health settings.  There is no cure for herpes (though there are effect treatments).  Unlike some of the bacterial infections like gonorrhea and chlamydia which can cause issues like inability to become pregnant, herpes does not cause these sorts of issues.  Some clinicians are reluctant to tell someone who is antibody positive but has no symptoms that they have a highly stigmatized infection.  Some clinicians don't know what to tell those patients about how to handle their infection, medically.  The routinely available antibody tests are not perfect - they miss 30% of HSV 1 infections and 8% of HSV 2 infections, compared to the gold standard herpes western blot.  There are also a limited number of false positive results on the antibody test.  Some clinicians have erroneous information about the safety of the antiviral medicines.  Some clinicians don't want to take on the longer and emotionally laden discussion about a positive herpes test in a very busy day.  Others are reluctant to discuss the complicated questions that arise - can I still give/receive oral sex?  What about condom use?  And what about mutual masturbation when one partner is infected and the other not.  There are lots of issues here, as you can see.  Even we, on this forum, do not necessarily agree between ourselves on this question.

But I have a different perspective on this issue.  Let's take false positives.  We know that the vast majority of them happen in people who get a particular number on their results on the test - 1.1 to 3.5. This research The Centers for Disease Control says those people need a confirmatory test and the big labs are doing that more often now.  I'm not convinced that the confirmatory tests are terrific but anyone's provider can access the superior herpes western blot through the University of Washington, although it is expensive and out of reach for some. In looking at 7,000 patients in my practice over the years, only 6% of people who did the test fell into the low positive range.  Of those around 50% turned out to be false positives.  So do we through out an imperfect test for a 3% false positive rate, when those tests in question can be sorted out eventually?  I don't think so.  While some say that having a diagnosis of herpes does nothing to change the sexual behavior of those who test positive, that has NOT been my experience in a practice specializing in herpes.  My patients are eager to take daily antiviral medicine which reduces transmission by half.  They work hard on comfortable ways to disclose this challenging information.  And I support these efforts with compassion and education.  Yes, it can take quite a while on a busy day to discuss herpes but a follow up visit can be scheduled to talk more  comprehensively.  Are there tears and emotions to deal with?  Of course, but with emotional support and good things to read or videos to watch, people do get better, psychologically.  Good research shows us this.  And the CDC says that herpes testing should be considered for those seeking STI screening.  So at a minimum, it is my opinion that clinicians should tell people that herpes testing is available, even if they aren't offering it themselves.  I think when patients present for STI screening, they have no idea, in most cases, what is included and what is not.  But if they knew how common herpes was and that it wasn't included in the screen, they would be distressed. And they are distressed, particularly when they go and get an STI screen, then proceed to infect someone else with herpes because HSV 1 and 2 (and yes, the test can distinguish between them, the vast majority of the time) wasn't included in the screen but they didn't know that.   There is a lot more to say about this, but I'll leave it here for now.  This is not an easy discussion to have - people disagree but at least it's all food for thought.

I think I can answer the towel question for you - that is NOT a risk for transmission to family members.

Terri
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15 months ago
Thank you for your answer Ms. Warren. So, a few quick clarification questions: are the statistics you shared related to the reliability of HSV tests true when a person has had no symptoms (i.e. if I have had no symptoms, can I still expect the blood test to be about 97% accurate)? Also, can I be tested for HSV 2 only? And, finally, related to the previous question about the towel, is that a no risk scenario even for chlamydia infections of the eye? Thanks again!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
15 months ago
The statistics we have are related to people who do and people who do not have symptoms.  I don't know where you get the 97% number, that is not a number that I gave to you.  You can order our own herpes IgG test online at several websites and yes, HSV 2 alone. 
The towel answer is for any sort of chlamydia infection. 

Teri
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14 months ago
So, in your practice did you used to recommend that HSV 2 be included in STI screens but without including HSV 1?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
14 months ago
We included HSV 1 and 2 testing in every person requesting an STI screen.  About half the population is infected with HSV 1 as you may know but with the majority of new cases of genital herpes being caused by HSV 1, we also included HSV 1.  We made people aware that there was a 50-50 chance that they would be positive.

Terri
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