Understanding Herpes Testing

when thinking about herpes testing it's

important to make a distinction in two

types of testing really one is testing a

person who presents in a clinic or with

a doctor that actually has lesions

genital lesions and so we can test those

lesions with very specific testing to

see if that lesion is caused by herpes

herpes culture is sort of the the old

standby many clinics including ours is

still doing culture the problem with

culture is that it's not it's very

specific meaning that if it's positive

we actually know that herpes is present

but it's not necessarily very sensitive

especially in some of older lesions a

person comes in typically not

immediately after he break he or she

breaks out with with herpes usually

there's a couple of days that go by

during that day shedding of the virus it

decreases and so that the sensitivity of

these cultures is decreasing so we

really need to have much more sensitive

tests and we now have DNA testing as we

do for a lot of other things and so we

can do DNA testing and some laboratories

are actually doing that and it appears

that more and more clinics and doctors

are offering this much more sensitive

tests that test can also make a

distinction between the different types

of herpes herpes simplex virus type one

which typically occurs around the the

mouth of cold sores is basically what we

call that and the genital lesions are

typically type two even though the

proportion of lesions that are caused by

type one in the genital area is

increasing so it's important to to know

what's what's causing these lesions and

having a much more sensitive test would

be of great use for us in the clinics

then secondly there are so-called

serological tests that are testing to

two antibodies meaning you know our

immune system develops resistance

against these viruses

making antibodies and you can detect

those antibodies in the in the blood and

we have very good sensitive as well as

specific to us to detect antibodies

against type 1 or type 2 to summarize

the two types of tests the ones the

direct test for the virus can tell you

immediately whether her pees is causing

that particular lesion right then

there's the antibody tests of body's

immune reaction and it takes several

weeks sometimes up to three months to

develop as a DES body so there's a delay

between on 7 section and when the tests

can be composite and then beyond that

the tests the antibody tests are not

perfect if someone has lesions clearly

the preferred test is a direct testament

virus ideally a DNA test if it's

available because it'll pick up more

infections than culture so we absolutely

agree on that I want to take a slight

tangent and we emphasized what you

looted too and the importance of knowing

virus type there are some physicians out

there who assume say oh it's just herpes

you don't need to know virus type

because herpes is herpes no matter what

and in fact there's a big difference if

you're unlucky enough to get genital

herpes but lucky enough that it's HSV

one typically quiet by oral sex because

HSV one more commonly causes oral herpes

that's actually a good news scenario

because the clinical course and need for

treatment are very different from the

two diseases genital HSV one recurs much

less frequently in fact probably 40

percent of people never have a second

outbreak and the others are typically

have an outbreak once every year or two

as opposed to an average of three four

five up to ten times a year with genital

HSV - the need for treatment therefore

is different the potential risk for

transmission to partners is different

and it is critical for everybody the

genital herpes to know and for their

physicians to know that they have to

know virus type and you can determine

that either by culture DNA testing which

can determine the virus type or by the

antibody tests which are

also the proper kinds of tests there are

some older tests out there that don't

accurately distinguish type one from

type 2 in terms of blood tests so those

people who are getting tested and

physicians and clinics who are ordering

those tests need to be sure they are

requesting a type specific test the

other thing I want to say about antibody

testing by the way is that many labs

automatically offer what's called IgM

testing immunoglobulin type M as opposed

to in any club in type G or IgG testing

in theory becomes positive sooner than

IgG and so an IgM test for some

infections can help detect early as

opposed to late infection the problem is

that often doesn't work that well with

herpes the IgM testing often doesn't

proceed IgG IgM antibody but the test

also has a lot of false positive results

the labs offer these tests because quite

frankly they are very cheap to do they

have a high profit margin and there is

just an assumption that it's a good

thing to do and Doc's not knowing the

difference just order what the lab shows

on its panel and they check off the box

my advice - and this is going to be in

the upcoming revision of the CDC's STD

management guidelines that are going to

be released in early 2015

that IgM testing for HSV has no role

whatsoever doctor's ordering tests

please do not request the IgM test

patients who are perhaps going to an

online site and arranging your own ages

retesting ignore the IgM don't do it

it'll get you in more trouble than it

will help