Routine Testing of Herpes?

[hypochondriac]

Hi Terri,

What are your thoughts on testing for HSV2 as part of routine STD testing? The last time I went to my OB/GYN, she said that they do not test for herpes in the absence of lesions- however, I’ve come across so much information on the internet about asymptomatic herpes and how widespread it is, and it’s fed into some health anxiety I have.

Can a first outbreak of herpes be truly asymptomatic, or it is more that people attribute their symptoms to other conditions?

Prior to this summer, I had 2 sexual partners, both of whom had only had sex with only one other partner other than me. I however got out of a LTR of almost 10 years with one of those partners, and a few months later began seeing someone new, whose sexual history was more robust (~20 partners). He was tested for “everything” and we didn’t always use condoms ( I have an IUD). It was only after that brief relationship (~2months) ended that I realized that doctors don’t always screen for HSV during STD checks. I have no reason to think he has herpes, other then the prevalence of it.

This is probably more of an anxiety issue than a herpes issue, but I had a couple of ingrown hairs this summer on my outer labia near the bikini line (one on the right, later one on the left). One of these was looked at by my OBGYN at my annual, and she confirmed it as an ingrown hair. The second one seemed more like a cystic pimple, and was gone within a couple of days. Neither of these looked like the characteristic herpes lesions. No other symptoms, Regardless, my anxiety has me focusing intensely on whatever is going on down there. Right now I have mild irritation along my bikini line, more on the right then the left, but there is no real redness or pimples, just mild burning, most likely caused by shaving/underwear elastic. Again, I have a lot of anxiety, so I think I’m just amplifying the situation.

However, should I request HSV2 screening at my next STD check? Will the doctor just think I am being crazy?

Thanks!

[Terri Warren]

I never do an STD check without including a herpes IgG antibody test. It is the most prevalent STD in the US and to miss it, to me, is an error. When someone requests a screen for sexually transmitted infections, I think it is inadequate to not test for the most likely thing they would have. Not all clinicians agree but the reasons for that, I think are bogus. Yes, there are a few false positives (2.8%) but we know how to sort those out the vast majority of the time.

Terri

[hypochondriac]

Thanks Terri. As an update, I recently went to a Planned Parenthood, and they basically all but refused to test me for herpes (I’ve never had classic symptoms, just nervous about it). The nurse practitioner explained that the herpes test would not distinguish between HSV1 and HSV2, and since most people have HSV1 it wouldn’t really do me any good. However, from what I’ve read on this forum, that doesn’t seem to be true, and the IGG test is able to distinguish HSV1 and HSV2. However, I opted not to do the test there, since maybe there were using a IGM test or something else, and I certainly don’t want test results that won’t distinguish between the two strains.

I guess I will just have to order my own test through Quest or Labcorp, since my regular OB/GYN also will not test in the absence of lesions.

I do have a couple of questions for you though- over the weekend I’ve noticed a tiny rash or redness (about 1 inch long) along my bikini line just on the right side. It lines up pretty close to where my underwear elastic hits. It’s just red, not visible lesions or bumps really, although what looks hair follicles do seem a little red. It’s not itchy, but did burn a little when I put hydrocortisone cream on it. I also think I have made it worse by checking on it a lot.

1)Is it true that herpes can manifest just as a red rash without lesions?

2) Is the bikini line a common place for herpes to occur?

3) Is it strange that this would only happen on one side of the bikini line? The left side is fine. I’ve been super neurotic the past few months, and have noticed a slight irritation on the right side before, but never very bad and never any lesions.

I’m going to go to a dermatologist this week, to address this and other skin issues. I also know I need to get the blood work done so that I stop convincing myself that every small irritation is herpes.

Thanks!

[Terri Warren]

1)Is it true that herpes can manifest just as a red rash without lesions?

It can, but what you describe sounds like a classic irritation from the elastic in your underwear

2) Is the bikini line a common place for herpes to occur?

Not at all, no.

3) Is it strange that this would only happen on one side of the bikini line? The left side is fine. I’ve been super neurotic the past few months, and have noticed a slight irritation on the right side before, but never very bad and never any lesions.

I don’t think the rash that you describe sounds like herpes, honestly.
You can also order your own antibody test online without a provider order. There are many services that offer this, but the one I recommend most often is healthcheckusa.com

Terri

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