Should we get a screening test for genital herpes?

Quick boost #2 - Why do we only test for certain STD's?

A common request at routine physicals is to add screening tests for sexually transmitted infections like HIV, gonorrhea, chlamydia, and syphilis. Often people ask to be “tested for everything,” and there is some dismay when I counsel against screening for “everything” including genital herpes. In this short post I’ll share some validation for generally holding off.

In a recent reaffirmation statement published this year in JAMA, the US Preventive Services Task Force continues to advise that the harms of screening asymptomatic individuals for herpes outweigh the benefits. Blood tests like IgG and IgM antibody levels have low specificity and high false-positive rates. There is also no evidence that taking preventive viral medications like Valtrex to reduce possible viral shedding or improve health outcomes among asymptomatic carriers works. The potential harms of screening include anxiety and damage to personal relationships due to the implications of possible diagnosis. The USPTF therefore concludes that the harms of screening for herpes outweigh the benefits. Guidelines from the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control concur.

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My professional experience supports this recommendation. But first, please note that this article was published in JAMA on February 14th, 2023. Valentine’s Day. Nice. When people have really insisted that I include a blood test for herpes in their routine labs, it usually goes like this. Antibodies against type 1 herpes show up. This virus normally just causes cold sores, and up to 70% of us will test positive. Antibodies against type 2 herpes show up perhaps 20% of the time, but many people will be shocked to discover these antibodies if they have never had an actual genital herpes outbreak. What now? If you’ve never had an outbreak, but you are testing positive, does that mean that you have herpes and can transmit it to others? Do you need to tell future partners? How do you explain this to your spouse? Is the test a false positive? What are the chances you’ll go on to have an outbreak someday? I’m not saying it’s better to bury your head in the sand, or to not open Pandora’s box… the USPTF, AAFP, ACOG, and CDC all did that for me.

HSV virus as seen by electron microscopy

If you want a deeper dive on this subject I can recommend the following chapter available online, but this concludes QB #2… I’m going to try to stop typing now as I keep practicing the art of the short post mixed in with my regulars!