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

To Screen or Not to Screen?

The usual purpose of medical screenings, including STI screening, is the early identification of a disease in order to maximize health outcomes. For example, screening for chlamydia and promptly treating this STI can help prevent pelvic inflammatory disease, reduce the risk of subsequent ectopic pregnancy, and preserve women's fertility.[19] However, in the case of HSV, early detection does not alter health outcomes for identified individuals nor does it affect the natural history of the infection. Regardless of when it is detected, herpes cannot be cured. At best, positive serology may help provide an alternate explanation for genital symptoms previously misidentified as yeast infections, urinary tract infections, razor burn, insect bites, friction rubs, allergic reactions, or any other of the myriad misdiagnoses given for subtle, atypical, but not wholly asymptomatic genital HSV. At worst, positive HSV serology may produce significant psychological distress, with repercussions for relationships, emotional health, and sexual well-being.[20]

If screening cannot change outcomes for affected individuals, can it at least help prevent transmission to others? Although the US Preventive Services Task Force has concluded that there is no evidence that screening reduces transmission, there is limited evidence that knowledge of a partner's positive HSV status does help protect against HSV acquisition. In a 1996 study by Wald et al,[21] researchers found that among initially discordant couples, the median time to HSV-2 acquisition was longer for participants whose partners disclosed their HSV status. The behaviors that produced that delay in transmission were not clear, although interestingly, consistent condom use was not one of them.[21] Further research is needed to establish whether individuals who are made aware of their asymptomatic herpes can take effective measures to reduce transmission to others, perhaps by limiting their number of sexual partners, taking antiviral therapy, or committing to consistent condom use.