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Why I’ll (probably) never suggest you do a Herpes blood test.

Herpes blood tests are a complete waste of time and money. They can even destroy relationships. Here’s why:

If I had a dollar for the number of couples I have had in my office at breaking point because some other doctor recommended Herpes blood tests as part of a sexual health screen ….or worse yet they thought they were smart enough to take themselves off to a lab to do a battery of tests with no counseling.


These poor couples are furious with each other because they have tested positive for Herpes and they want to know “who cheated”

Well, I don’t know that ANYONE cheated.

You see Herpes Simplex is just one of many of the family of Herpes viruses that can stay in your body for years and years, very quietly causing no symptoms.  A Herpes virus lives in your nerve roots, Then when you get run down,  your immune system can’t hold it at bay, so it travels down the particular nerve root it’s living in, to the skin that the nerve supplies and causes blisters and ulcers. If it’s your mouth you get oral Herpes and if it’s your genitals you get genital herpes. That’s why you tend to get cold sores in the same spot.

Now the thing with Herpes Simplex is that You may never have had a symptom when you got it… 70% of people don’t! so you may have contracted it and never got a blister….so how would you have known when or how you contracted it?

Now, I hear some of you in the know saying – ah but the antibodies can tell us that! IGM is recent infection and IGG is past infection – Nope, in this case, because the Herpes virus is still living in your body, the antibody test is NOT a reliable indication of this either. 

Herpes Simplex doesn’t even have to be sexually transmitted. What about Herpes 2 I hear you say? Isn’t that the one that causes Genital Herpes? Well let’s clear that one up right now:

Classically, Herpes 1  causes “cold sores” on the mouth. You know, the ones that rear their heads when people are run down or stressed? Those are said to be due to “oral herpes” and you can get that just from kissing. Or a peck on the lips from Granny when you were 2 years old. Granny may not even have had an ulcer yet, she just may have been shedding virus from the skin, and you, when you were 2, may never have gotten a cold sore, but you got the virus!

Herpes 2 is supposedly Genital Herpes. The one you get from Genital/Sexual contact.

Well, lots of people have oral sex, which means mouth on genitals which means the 1 and 2 have become mixed up, but they both case blisters and ulcers so they are practically interchangeable. Which means that Herpes 1 and 2 can both cause blisters in the oral or genital area. And Granny….well she’s a granny… she had children so she isn’t a virgin and may have had lots of oral sex when she was younger – or maybe she still is. Why shouldn’t she?

So Granny who never had an ulcer in her life might have given you a peck on your lips when you were 2 and you may or may not ever have had a cold sore on your mouth , but 2 decades later you decide to do a blood test and oops – you test positive for Herpes 2 and your partner is furious with you. Or, maybe you don’t get your first “attack” of blisters until you are 30 and then you think “What the hell, I never had Herpes before, my wife/husband is cheating on me” –

Ah, no, you can blame your granny! Or maybe your wife’s granny, who gave it to your wife on her lips when she was 2 and then maybe you were having oral sex with your wife (who never had an ulcer either) and then you got Genital Blisters. Who can unravel that?

What a mess!!!

Something like 70-80% of the population is likely to test positive for Herpes antibodies on a blood test! I for example, have never had a herpes ulcer in my life, but if you tested me I am more likely to get a positive result rather than a negative one. So if you don’t have blisters what’s the point in testing and winding yourself and your partner up? We can’t do anything about it anyway!

But what if I do get blisters?

Ah the joys. Herpes blisters classically start with tingling in the area they are going to appear followed by one or more blisters which can get sloughed off the form shallow ulcers. They can be sore.The first attack tends to be the worst, and can even involve fever and if it’s oral herpes, you may have trouble eating and drinking. If you have blisters in the genital or oral area see a doctor and they can usually tell CLINICALLY -that means without doing any tests- if this is  Herpes Simplex. They could in theory send a swab of the blister to a lab – and really, its not usually necessary. Sometimes if we aren’t sure and we think it might be something else, we can do this.

If you have Herpes blisters, that’s when you are most infectious. It’s now irrelevant whether its 1 or 2, as explained above..So maybe refrain from sex if you have an active blister or ulcer. Now, you might still be able to pass on Herpes to your partner even when you don’t have an ulcer or blister. This is called skin shedding …that’s most likely to happen right before you get an attack of blisters. – When you get that warning tingling. So if you know you get blisters and you have a new partner, you should let them know. If you have an attack, then your doctor can give you antiviral medications to lessen the severity of the attack. If you are someone who has very frequent attacks then you can actually take antiviral pills for 3 months or so to try to prevent attacks and also to try to reduce the amount of Herpes virus in your system (the so called viral load) to prevent future attacks even after you atop the antivirals. so don’t despair.

The upshot…. If you test positive for Herpes on a blood test you’re pretty normal. If you don’t you either have a super immune system or you’ve never been kissed….

Don’t bother doing the test.. we have no idea what it means!

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