Genital Herpes - Should You Be Screened?
Counseling people about sexually transmitted illnesses is not as easy as it used to be. Some of these infections are quite a challenge to deal with in a population. Treatments are increasingly ineffective as resistance evolves. Further, increasing numbers of people carry these illnesses without symptoms and unknowingly spread their misfortune to others. With herpes, this is particularly frustrating.
If I have a patient who questions whether he or she may have genital herpes, we engage in a confusing discussion on whether to screen for the illness or not. Hopefully, this blog will shed some light on the difficulties in screening for genital herpes.
Genital herpes is a sexually transmitted viral infection manifesting on the skin of the genitals. When signs of infection occur, a painful, blistery rash develops that eventually becomes open sores that last for a few weeks. Transmission of the illness happens mostly during the presence of skin symptoms, but it can also happen when there are no symptoms. When no symptoms are present, the virus lies dormant in the nerves deep beneath the skin.
Nationwide, 16% of people (one in six) aged 14 to 49 have genital herpes. This rate of infection seems to have remained stable over the last decade. Rates of infection are higher in females due to the increased susceptibility of the female genitalia over that of males. Most people who are infected do not have symptoms. Of those that do, the number of outbreaks decrease over the years. Herpes infections are considered life-long. Although medication can lessen symptoms or prevent some outbreaks, there is no cure presently.
Type 1 or Type 2?
There are two types of herpes simplex viruses: type 1 and type 2. In years past, things were simple:
- Type 1 caused cold sores on the mouth
- Type 2 caused genital infection.
Things have gotten complicated, however. Presently, it is more like a 75/25 situation where:
- 25% of oral herpes (cold sores) are caused by type 2
- 25% of genital herpes is caused by type 1.
Testing for Genital Herpes
Things are relatively simple if a patient comes in with a genital rash or sore that may be herpes. I can rub a swab over the lesion and send it to the lab for culture. This accurate test which requires just a few pieces of herpes DNA will tell me if herpes is present or not.
Patients who have had an exposure with no symptoms or who simply want to be screened, present me with a much more difficult situation. A blood test can be done to test the blood for our body’s response to a herpes infection, both type 1 and type 2. However, the problem lies in the fact that an estimated 70-80% of Americans have oral herpes (cold sores) symptomatic or not!
If a patient without genital symptoms does get cold sores, I know that they will have a positive test in some capacity. I cannot tell them based on the fact that they tested positive for type 1 that they are not also an asymptomatic genital carrier as well. If a person does not have oral or genital symptoms and has a positive type 1 test, I can only tell them that they are likely infected with the cold sore virus, but may have genital type 1.
Get the picture? It becomes as clear as mud. Only a negative type 1 and type 2 test can reassure a patient, but persons with these results are a minority due to the large prevalence of oral infection.
Herpes is common and it’s insidious. There are many people out there who have genital herpes and don’t know it. Unfortunately, without symptoms, screening is fraught with confusion and ambiguity. Without sounding like a public service announcement I’ll say the obvious:
Chose your partners carefully and use a barrier method of protection.
While the present stance on herpes is that it is a life-long infection without cure, there is hope. Research is happening behind closed laboratory doors. With the advent of a secondary preventative vaccine for shingles (caused by the varicella member of the herpes family), a vaccine to prevent and give to those suffering with herpes seems in reach.