The Decisions Couples Can Make After Genital Herpes Testing

At least 50 per cent of people who have been infected with "genital" herpes never realize they have had symptoms. Up to 90 per cent of people, in some studies, who have been infected with "oral" herpes never realize they had symptoms of the disease, either.

Since both of the two most common forms of herpesvirus can be transmitted through oral sex, it's possible to get "genital" herpesvirus infections in the mouth and throat and "oral" herpesvirus infections of the genitals and other regions below the belt. From a treatment standpoint, it's a lot more helpful to think in terms of HSV-1 and HSV-2.

HSV-1 is the milder form of the disease. Up to 90 per cent of us are exposed to it when we are toddlers through the oral secretions of other children. It can cause nasty blisters on the lips along with a high fever, or the virus can just retreat to the nerves of the face, waiting to be activated months, years, or decades later.

HSV-2 is the more serious form of the disease. It's more commonly associated with genital outbreaks. Only about 20 per cent to, in some subgroups, 40 per cent of the population is ever infected with this form of herpes. But half of the people who contract this virus never have symptoms, either, or don't have symptoms until they develop some kind of immune deficiency.

One of the reasons you can be infected with the "genital" herpesvirus, HSV-2, and not ever know it, is that getting HSV-1 as a child protects you against HSV-2. It's as if your immune system gets to "practice" on HSV-1 so you don't have severe symptoms with HSV-2. But you can still transmit the virus, and if you are in a relationship, as lover or parent, you will want to know whether you have the disease. Here are the three most important things you need to know.

You need to know whether you have HSV-1 or HSV-2.

There is more than one laboratory test for HSV. Not every test gives the same level of information.

  • Blood tests just tell you that you have had some kind of herpes infection.
  • One of quicker lab tests, called a Tzank smear, which requires taking a sample of a blister, also can only tell that you had some kind of herpes infection, not whether it was HSV-1 or HSV-2. This is helpful in making sure you don't have some other, rare viral disease.
  • A direct fluorescent antigen test of a scraping from a blister can tell whether you have HSV-1 or HSV-2 in a two or three hours, but not every lab can do it.
  • Growing the cells scraped from a blister in a tissue culture in the lab is a highly accurate way of telling whether you have HSV-1 or HSV-2, or both, but the procedure takes 48 hours and it can take a week for the results to get to your doctor to be given to you.
  • A newly approved test called the Multicode-RTx is approved for testing vaginal swabs, but it is not approved for testing men or children under the age of 18. It can distinguish between HSV-1 and HSV-2 in about three hours.

Why should you care whether you have HSV-1 or HSV-2? If both you and your partner already have HSV-2, there is not a lot to be gained by taking precautions to prevent transmission of the disease during sex. Women would still need to take precautions to prevent transmitting the disease to their babies. And if neither you nor your partner has HSV-2 and you both have HSV-1, there is little danger of transmission to your child or to each other.

There are also other possibilities. Since herpes tends to be "site specific," sometimes when one partner is infected in one site and the other is not, the couple makes decisions on styles of sexual intercourse they will enjoy together.

The most complicated choices come when one partner has HSV-2 and one does not. If the other partner has HSV-1, then his or her immune system has partial defenses against HSV-2. It's possible he or she would never come down with HSV-2 even if they engaged in unprotected sex. It's also possible he or she could come down with a severe outbreak, depending on the strength of the immune system. Neither partner, however, should ever have sex when there are visible blisters.

Visible blisters are a cue that you can go to your doctor and get a diagnosis that you can't get from just having a blood test. Testing now can help you and your partner have the fullest possible sex life while keeping each other safe

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