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

Pretest Counseling Strategies

Given the lack of strong evidence that HSV-2 screening reduces harm, the decision whether or not to screen asymptomatic individuals is not clear-cut. The clinician and patient have to carefully consider the decision and its implications. A negative HSV-2 IgG may come as a huge relief, especially to someone with a known exposure to herpes. However, anyone who chooses to be tested needs to be prepared to cope with a positive result.

There are no clear guidelines about what HSV pretest counseling should include. The following key points about asymptomatic herpes can correct common misunderstandings and help patients decide if finding out their HSV status is the right decision for them.

  • Herpes is common and a lack of symptoms or known exposures cannot be taken as proof that a person is not infected. Most people with herpes have no symptoms.[1]

  • Herpes serology is a test that does come back positive in individuals who have no suspicion at all that they may be infected.

  • Herpes can be transmitted in the absence of symptoms. Most herpes infections are transmitted this way.[1]

  • Antibodies to herpes can be detected as early as 2–3 weeks after initial infection, although detectable antibodies can take up to 16 weeks.[2] (pS175)

  • Herpes is a highly stigmatized infection. Being diagnosed with herpes can be distressing.

Clinicians should explore their patients' motivation for testing and should probe how being diagnosed with HSV might affect the way they approach intimate relationships. Would a diagnosis of genital herpes affect their sexual behaviors? Would they be willing to disclose their status to current and future sexual partners? Would they consider using daily medications to reduce the risk of transmission? Although this discussion will take up valuable office time, it may be helpful for clinicians to bear in mind that in the near future, they will likely be notifying about 1 in 6 of the patients whom they have screened that they have been found to have genital herpes. The time spent on education before testing will have laid the groundwork for the delivery of that result.