Screening for Asymptomatic Genital Herpes

Is Serologic Testing Worth It?

Leia Raphaelidis, FNP


Journal for Nurse Practitioners. 2014;10(3):194-199. 

In This Article

Abstract and Introduction


Genital herpes is very common, but most people who have it are not aware of their status because they do not have symptoms. Serologic testing can be used to identify asymptomatic herpes, but the benefit of screening is not clear-cut. Clinicians should be aware of the issues surrounding herpes screening to help their patients decide if they should be tested and to counsel those who test positive.


Genital herpes is one of the most common sexually transmitted infections (STIs) in the United States and is lifelong and incurable, yet only a small fraction of individuals with herpes are symptomatic or aware of their infection.[1] Historically, the gold standard for the diagnosis of genital herpes has been via a physical examination and direct testing of mucocutaneous lesions during an outbreak, thereby limiting the diagnosis to symptomatic individuals.

However, over the past decade, developments in testing technology have made it possible to accurately detect herpes antibodies in serum ( Table 1 ), thus providing a way to diagnose herpes regardless of the presence or absence of lesions. Based on a surface protein called glycoprotein G, these tests reliably differentiate between antibodies to herpes simplex virus type 1 (HSV-1) immunoglobulin G (IgG) and herpes simplex virus type 2 (HSV-2) IgG.[2] Screening asymptomatic individuals via serology has emerged as a widely available and relatively affordable testing option, leading to the following question: Should clinicians be screening their patients for asymptomatic herpes? Arguments have been made for and against screening, and the subject remains controversial.[3–6]

The US Preventive Services Task Force and the Centers for Disease Control and Prevention (CDC) recommend against routine serologic screening in the general population, citing a lack of evidence that screening reduces herpes transmission and expressing concern that the potential harms of screening outweigh the potential benefits.[7] However, the 2010 Sexually Transmitted Diseases Treatment Guidelines from the CDC state that some experts believe that clinicians should perform herpes serology for high-risk individuals presenting for STI evaluation.[8] This article discusses the clinical complexities of asymptomatic herpes and the issues surrounding screening for this highly stigmatized infection. Clinicians ordering herpes serology need to be well versed in the subject of asymptomatic herpes and be prepared to counsel those patients who are deciding whether or not to get tested and those who do test positive.