If you have noticed symptoms that could be caused by the herpes virus you should visit your Doctor as soon as possible, while symptoms are still present.
Your Doctor will examine your condition and should take a swab or sample of the infected tissue. This can be analyzed for herpes.
There are several tests that are used to diagnose herpes, some are more accurate then others.
Methods of testing include diagnosis by:
Some clinics will use diagnostic tools other than the recommended tests. Among these, two are generally not recommended; the Tzanck test and the Pap smear, neither of which is a specific test for herpes.
Tip: If you have active symptoms and the sores have not yet healed you should ask your Doctor for a specific virus culture or assay for the herpes virus.
Blood tests are generally used in cases where no visible symptoms are present.
In order to confirm a diagnosis of a Genital HSV infection it is necessary to prove the presence of the herpes simplex virus.
Because it is possible for a person with genital herpes to have another sexually transmitted infection at the same time, a full genital check should be made. For women this may include a cervical smear test.
Getting a herpes diagnosis - What you should know:
How to know which test to get:
Important points to consider:
The initial examination may involve:
The doctor might also swab the urethra and anus for a laboratory test.
For women, the examination usually includes:
Swabs of the cervix and anus are sometimes taken
for laboratory samples.
There are three common types of laboratory tests for genital herpes and several others that are less widely used.
Laboratory tests are usually based on two categories: sensitivity and specificity.
Sensitivity refers to the likelihood the test is correctly diagnosing herpes. Specificity is the probability of correctly saying a patient does not have herpes. Speed and cost are also taken into account.
For patients who have sores or other outward signs of infection, the leading methods are:
Viral culture looks for the presence of the virus in the lesion. Viral culture is very specific:
A poor sample may cause sensitivity to drop. Even if herpes lesions are present, there may be very little active virus left in the lesions. In this case, the culture will come back as a "false negative" (the test says there is no herpes even when the patient has genital herpes).
Often about 20% of culture tests produce a "false negative" when a patient has a first episode of herpes. With recurrent episodes, when less virus is present, the rate of false negatives goes up to 50%.
It takes anywhere from two to seven days to get viral culture results
back from the laboratory, which may mean several visits to your Doctor before a
diagnosis is confirmed.
Serologic tests take a very different approach. They detect "antibodies. " These are substances produced by the immune system to fight off infection.
Blood Tests (serologic tests) detect herpes by looking for antibodies in the blood or serum. Blood tests can be performed even when no symptoms are present. If antibodies are found in the blood, herpes simplex is latent in the body. Blood tests do not require swabbing a lesion, so they can be done long after symptoms have faded.
Serologic testing has the advantage that it can be done even when a person has no symptoms, so it is a very effective way to detect an established herpes infection.
Type-specific blood tests are ideal for those who have had a history of genital symptoms but have never had a successful confirmatory test. The sensitivity and specificity of blood tests is better than culture or antigen tests, but there are two important factors to consider.
The first factor is timing. If this is the first exposure to herpes, a person may take several weeks to develop the antibodies that the test looks for.
The second is that some blood tests cannot tell the difference between the two types of herpes, HSV-1 and HSV-2. For this reason, anyone seeking an accurate diagnosis of genital herpes must be sure to get a "type-specific" serologic test, which can accurately distinguish HSV-2 from HSV-1 antibodies. Most commercially available kit assays currently cannot make this distinction despite their claims.
Type-specificity in a blood test does not depend on the antibody class being detected (either IgM or IgG), but on what the antibodies are directed against (referred to as their antigens).
In herpes, most type specific antibodies are directed against a protein called glycoprotein G (gG). The gG in HSV-1 (called, unimaginatively, gG1) differs substantially from the corresponding gG in HVS-2 (called gG2). Therefore, herpes blood tests which are based around specific detection of antibodies to either gG1 or to gG2 will be type-specific. People who are getting a type-specific test for genital herpes should ensure that the test they receive detects antibodies to gG2 since there are still blood tests out there which claim to be type-specific but which are not.
While a blood test may reveal infection with HSV at a time when no genital symptoms are present, confirmation of the genital HSV infection is still essential. If the blood test is specific for detection of antibodies to HSV type 2, the likelihood of genital HSV infection is increased, but still not proven. The doctor may ask you to re-visit for a swab test when genital symptoms or discomfort appear.
Caution: Usually, it takes two weeks to three months after exposure to herpes for antibodies to appear in the blood. Some blood tests detect antibodies sooner than others. However, once antibodies are found they remain in the body for life.
If you have never had symptoms before but want to be tested for herpes, a type-specific blood test is the only way to find out your status. Getting tested may be relevant if you:
What is the difference between a 'Type-Specific'
test and one that is not
number of similar tests are produced for research purposes. Commercial products
are just becoming available this year. These tests detect
antibodies (known as "IgG") that differ between HSV-1 and HSV-2. It is now recommended that clinicians avoid serum tests other than type-specific tests.
* There are several research labs that can perform type-specific tests, but the most reliable and widely used of these research tests is the Western blot.
The third type of test, the antigen test, is used less frequently and also looks for the presence of virus in the lesion. Unlike the culture method, this test does not require growing the virus but rather seeks to identify herpes by the presence of antigens, fragments of the virus that are known to stimulate the immune response.
A swab is taken similar to the method used for viral culture. In general, antigen detection assays are less sensitive than viral culture. Antigen-detection is usually done only in research laboratories or large reference laboratories.
Antigen tests can produce results more quickly than cultures and are sometimes less expensive. However, better samples are needed than for cultures and many do not determine whether the sample is infected with HSV-1 or HSV-2.
The three different methods of herpes diagnosis:
Why isn't everybody tested if Herpes is so widespread?
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