Screening for Genital Herpes is Still Not Recommended for People Without Symptoms
Science Staff: March 2017
It is estimated that almost 1 in 6 people in the U.S. ages 14 – 49 years old have a genital herpes infection.1 Despite the prevalence of this sexually transmitted infection, no effective vaccine has yet been developed, nor has a cure been found. Consistent and correct condom use only gives about 30% protection from spread, since the virus is passed by skin to skin contact.2 Several blood screening tests have been developed with the hope that early detection might help curb the spread of the infection.
In December 2016, the U.S. Preventive Services Task Force (USPSTF) released an updated report regarding screening recommendations for genital herpes. After researching all available data on current screening blood tests, the USPSTF made this statement:
“Serologic screening (blood tests) for genital herpes is associated with a high rate of false-positive test results and potential psychosocial harms.3
The following recommendation was made:
“The USPSTF recommends against routine serologic screening for genital HSV infection in asymptomatic adolescents and adults, including those who are pregnant.”1
The findings of the USPSTF is consistent with the “Sexually Transmitted Diseases Treatment Guidelines, 2015” by the Center for Disease Control and Prevention (CDC), which states that screening in the general population is not recommended. However, the CDC document does say that herpes blood tests should be considered for persons who come in for an STD evaluation particularly if they are at high risk with multiple sexual partners, are men having sex with men (MSM), or are HIV positive.4
There is an important difference between “screening” and “diagnostic” testing. For sexually transmitted infections, screening tests are performed on individuals who are considered at high risk for STIs, but who do not have symptoms. Diagnostic tests are performed on individuals who have signs and/or symptoms of a particular disease or condition. Sometimes the same method of testing is used for both screening and for diagnosis, but the difference lies in whether or not the patient is displaying signs and symptoms. With genital herpes, a culture of blisters or ulcerations is often performed and blood tests are also used for diagnosis.5
Genital herpes can be caused by either herpes simplex type 1 or type 2 viruses (HSV-1 or HSV-2). HSV-1 infections are commonly found in the mouth region, but they are becoming more prevalent in the genital area. HSV-2 is almost always found in the genital area. After being exposed to the virus, a person typically begins to experience symptoms in 4 -7 days; however symptoms sometimes do not occur until several weeks after the exposure. A person may experience headache, or flu-like symptoms, followed by a breakout of very painful blisters in the mouth or genital area that can last for a month to six weeks. Urination can be very painful and some patients need to urinate in a bath or be catheterized.5
When a genital herpes infection is passed from mother to child, it is usually during the birth process, as the baby travels through the birth canal. Pregnant women with a previous diagnosis of genital herpes have only about a 1% chance of spreading the infection to their baby. They should be checked for an active infection just prior to giving birth and offered a cesarean section if herpes lesions are present. A greater danger to the newborn comes when a woman becomes infected for the first time during late pregnancy, since the virus is present in greater numbers with initial exposure. Herpes infection in newborns can be life-threatening and all pregnant women should be educated about genital herpes infections.
Sexual risk avoidance remains the sole solution to preventing genital herpes infections. Medical Institute recommends limiting sexual behaviors to within a life-long monogamous relationship, such as marriage, with an uninfected partner as the best way to achieve optimal sexual health.
- Feltner C, Grodensky C, Ebel C, et al, “Serologic Screening for Genital Herpes Infection US Preventive Services Task Force: Recommendation Statement,” JAMA Dec. 20, 2016, Vol 316, N23 2525-2530
- Martin ET, Krantz E, Gottlieb SL, et al, “A Pooled Analysis of the Effect of Condoms in Preventing HSV-2 Acquisition,” Arch Intern Med 2009; 169:1233-1240
- Fetner C, Grodensky C, Ebel C, et al, “Serologic Screening for Genital Herpes An Updated Evidence Report and Systematic Review for the US Preventive Services Task Force,” JAMA Dec. 20, 2016, Vol316,N23, 2531-2543
- CDC, “Sexually Transmitted Diseases Treatment Guidelines, 2015,” MMWR Recommendations and Reports/Vol.64/No.3
- Grimes J, Fagerberg K, Smith L, Sexually Transmitted Disease: An Encyclopedia of Diseases, Prevention, Treatment and Issues, Volume 1: A-H, p279-312