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  December 14, 2012 

A Genital Herpes Conundrum Begets a Herpes Testing Verdict

"Knowledge is precious, especially when tempered by prudence." 

By: Victor Battles 

Because of improvements in methodology in recent years herpes blood tests for diagnosing genital herpes have made herpes testing more accurate and reliable.  Currently available FDA approved tests are highly sensitive and specific, which means they result in few false positive and few false negative herpes test results.  Given the reliability of these tests, when ordered appropriately, they can provide answers to some of the puzzling questions and concerns that arise following an apparent new onset of signs and symptoms of herpes.

For the purpose of this discussion and to illustrate the central point, consider a scenario in which two individuals (partner at A and partner B) have been involved in an intimate relationship for approximately one year. Partner B has been monogamous throughout the relationship and has never been diagnosed with genital herpes, but on day notices the acute onset of signs and symptoms of the disease including blisters in the genital area.  After seeing a physician and being diagnosed with genital herpes via testing of fluid from the blisters partner B is rather distraught, angry, disappointed and confused.   

Because partner B has never had any prior signs or symptoms of genital herpes he or she assumes that the std was contracted from partner A and wonders if partner A is aware of having it but concealed it or is unaware. Before any form of guilt is attributed to partner A however, partner B needs to be absolutely certain that the newly experienced signs and symptoms is in fact an initial outbreak and if so the std was contracted from partner A.  Judicious herpes testing can provide answers.   

Today's commercially available herpes blood tests diagnose genital herpes by detecting antibodies produced by the body which are directed against the herpes simplex virus which causes the disease. Antibodies are small molecular particles generated by one's immune system (defense mechanism) in an attempt to fight off and rid the body of foreign particles including those that cause infection. Antibodies that are produced early on, generally within days to a few weeks following infection, are called IgM antibodies. Those that are produced much later, sometimes up to 6 months after infection, are called IgG antibodies.   

Because the std may not cause the body to produce IgG antibodies for weeks to months following infection its purpose is primarily for establishing a diagnosis chronic disease well after the initial infection.  The herpes blood test which measures IgM antibodies, on the other hand, is for diagnosing acute disease unless a diagnosis has been made via testing of fluid from the area of an outbreak as was the case in scenario presented.   

IgM antibodies usually recede or vanish after the initial acute infection but IgG antibodies usually remain detectable as long as infection is present, whether it is active or latent. Since there is not any known means of eliminating the virus from the body once infection is established, IgG antibodies are presumed to remain detectable throughout the life of an individual who has been infected.   

In the scenario presented partner B could prove with reasonable certainty that the disease was contracted from partner A if partner A undergoes herpes blood testing and has elevated IgG antibodies, partner B undergoes herpes blood testing and has elevated IgM antibodies within 4-6 weeks of the outbreak, and partner B's IgM antibodies begin to decline 4-6 weeks after the genital outbreak. One caveat to relying on IgM antibodies alone to diagnose acute genital herpes and an initial outbreak however, is the discovery through recent research that in some individuals IgM antibodies rise again during recurrent genital outbreaks, in which case herpes testing of partner B with measurement of IgG antibodies at least 6 week intervals and as far out as 6 months from the initial genital herpes outbreak if necessary could confirm that partner B contracted genital herpes from partner A if the IgG antibodies were initially not elevated but rise during the period of time just stated.  

The scenario discussed in this article is but one example of how herpes blood tests can elucidate some of the questions and circumstances surrounding newly discovered disease.  Appropriate herpes testing can also be helpful in other scenarios depending on the circumstances if the herpes testing is done thoughtfully and methodically.   

This article is for informational purpose only and is not intended to be legal advice or a substitute for medical consultation with a qualified professional. If you are seeking legal advice or are unsure about your medical condition you should consult an attorney and/or physician.


For more information about herpes testing and for sources of  STD testing in general click here.

The author is a board certified internist who began solo practice in 1983. In addition to direct patient care he has been involved in clinical research. He is currently a disability consultant and owner of Proactive Health Outlet. 


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