HSV Blood Test Paranoia
January 15, 2013 12:07 AM   Subscribe

No symptoms present, no evidence of exposure. To blood test or not to test?

Per my usual protocol, I went to get comprehensive STD testing before exchanging bodily fluids with a new partner. I have never been offered an HSV blood test before, but I saw a new doctor this time who offered it. She said that typically most doctors do not offer the test unless people show symptoms, but I could get it “if I wanted to.” At first it sounded like a good idea, but the more time she gave me to think about it, the less good it sounded. So I delayed my blood test to give it more thought. Here are my concerns:

I have never shown symptoms of HSV-1 or HSV-2 but the doctor says that does not guarantee a negative result (i.e. Many people are asymptomatic carriers, or just haven't shown symptoms yet.) My major fear is: IF I get a positive result*, my anxiety and hypochondria will control my life, whether or not it is necessary to be concerned. I will worry about developing symptoms on a daily basis, and I will be more afraid of sexual contact than I already am.

However, I realize that STD testing is not really about me. It's mostly about protecting those I am intimate with. But if this is not a standard STD test that everyone would get, that complicates things. And if the stats of how many people are actually infected with HSV are accurate, wouldn't I just be freaking myself out about something that a large number of people have but so few know about?

Although I'm used to being the only “germaphobe” around a sea of saliva exchangers, I don't really think it will be good for me to be one of the only idiots who actually knows their status and gets to worry about it amongst a sea of ignorant folks who choose to live in oblivion to the fact that such a high number of people carry these infections. I've also never required my past partners to get this blood test so now if I get it, I'm pretty sure I'll require that my partner get it too (whether or not it is difficult or expensive for them to get...which it seems like it might be.) But why change my protocol just because someone is offering me something I wasn't offered before? Why become even more of a germaphobe/STD-aphobe than I already am, just because my doctor is offering me that opportunity?

Lastly, does anyone know if a positive result (or even getting the test in the first place) will have an affect on my individual health insurance coverage?

*Since 50-80% of the population has oral HSV-1, I am fairly certain I will test positive for that. Seeing the result on paper may still be somewhat upsetting/concerning/anxiety-inducing, though probably manageable. Since a much lower percentage of the population has HSV-2, and I am pretty careful, I am guessing I will get a negative result for that - and if not, it may cause serious stress - as a positive result for any STD test is wont to do.
posted by emoemu to Health & Fitness (11 answers total) 1 user marked this as a favorite
If you have any sort of unwellness - particularly something that might be communicable - its not only wise, but your responsibility to know about it and take the appropriate responsible actions related to the circumstances.
posted by blaneyphoto at 12:30 AM on January 15, 2013 [1 favorite]

Commercial HSV-1 and -2 tests are accurate — both for positive and negative diagnoses. But while they would add certainty, it sounds like you have general anxiety issues outside of any diagnosis, whether positive or negative, which may be worth addressing before taking any such test.

Given the high incidence rate of HSV-1, it would be surprising if insurance companies raised rates, but you never know. Until there are stronger privacy laws, it is often a good idea to exercise caution with medical data.
posted by Blazecock Pileon at 1:01 AM on January 15, 2013

Put yourself in the shoes of the partner you are about to exchange the bodily fluids with. What do you think they would want you to do? Assuming your partner was positive for HSV, would you want to find out about it?

Then I think you have your answer. Don't overthink things. You're going to get STD tests to protect your partner - any one of them could be positive or negative and you will deal with that result if or when it happens. Proceed accordingly.
posted by treehorn+bunny at 1:35 AM on January 15, 2013

*Since 50-80% of the population has oral HSV-1, I am fairly certain I will test positive for that.

This has become less and less true as younger generations have become aware of how this is transmitted and more careful about not sharing drinks or saliva when they have a cold sore. It is entirely possible that you will end up testing negative. Relax.

All that aside, this question is 100% related to your last question. They are manifestations of the same mindset and anxiety issues which you have to get treatment for.
posted by deanc at 5:11 AM on January 15, 2013

my anxiety and hypochondria will control my life, whether or not it is necessary to be concerned. I will worry about developing symptoms on a daily basis, and I will be more afraid of sexual contact than I already am.

Quite frankly, I think that seeking out treatment for your serious anxiety issues is far more important than worrying about getting an HSV test. It sounds like anxiety is affecting your quality of life far more than a herpes outbreak ever would.
posted by crankylex at 5:49 AM on January 15, 2013

The cynic in me thinks whoever makes Valtrex has come up with yet another way to gin up herpes-FUD and other bullshit. Not trivializing the disease, but come on - you have to admit it's been hyped up in the last decade or two, in no small part due to pharmaceutical companies seeing a profit from frightened & ostracized individuals (who they help ostracize). So in addition to all the TV ads, let's start preemptively testing for an absurdly common disease so we can start prescribing another unneccessary drug.

Sorry to rant.

To answer - yeah , I'dve passed on the test too. I've not heard of doctors offering that test without symptoms or a /reason/ to (ie, "I slept with someone who has herpes during an active outbreak and didn't use a condom, can you test me?"). I see no reason to get a test for it if you've never shown symptoms. I know all about asymptotic carriers, and the % of the population that has it, and all that jazz. And per treehorn+bunny there is your partner's expectation to consider. But I wouldn't expect my partners to get an HSV test, and don't think they'd be expecting one of me either. I guess I'm not sure I'd ask, but again that goes back to the prevalence and "drummed up/overblown" fear of it. You could always just ask your partner what they got tested for or if "we" should get tested for HSV too, since that's not on the normal list of things to do.

Good luck.
posted by ish__ at 8:21 AM on January 15, 2013

Some bits of history in the wikipedia article echo what ish__ said, that there has been some amount of disease-mongering about herpes by pharmaceutical companies. How that should affect our view of HSV status and testing is up in the air (to me, at least) though.
posted by needs more cowbell at 8:37 AM on January 15, 2013

This is definitely more about your anxiety than about the HSV test. I've done the test in a bout of health-related anxiety and I wish I hadn't. It just made me crazy and it didn't tell me anything I didn't already know (I have gotten cold sores since I was a kid so of course I tested positive of HSV-1).

Honestly, I wouldn't get it. If I were your hypothetical partner, I wouldn't think you were being irresponsible for not getting the blood test done. It is NOT a standard test and many doctors do not perform it. If you had symptoms or a suspicion, that would be another story. Just be safe, sane and open with your sexual partner. If something seems amiss, get it checked out. You are NOT being irresponsible if you do not get this test. Really. Just be open about it and take care of yourself.

And get some help for your anxiety. Believe me, I have been there and back with health-OCD, no blood test is ever going to convince you you're 100% safe and free. With anxiety, there will alwasy be a "what if...."
posted by Katine at 8:44 AM on January 15, 2013 [1 favorite]

Another vote for not getting it. I think you have to be able to tell yourself that you don't "maybe have herpes" until you "maybe have herpes".

Communication about status is a big big deal. Not having a test for something of which you've never been symptomatic or exposed is not.

This is anxiety. What Katine said: 'With anxiety, there will always be a "what if...."' That is so true.
posted by eyesontheroad at 9:21 AM on January 15, 2013

I vote for talking to your partner about it. You guys have, it sounds like, already had a "let's go get tested!" talk. So this should be no more awkward. I would just lay out the stuff you mention above: you've never had symptoms, no particular risk factors, doc says test is optional, you're kinda freaked out about it, and if you get it, you want him to get it. You get to feel good about being open and not hiding anything, and I will almost guarantee that your partner will tell you not to get the test.
posted by rainbowbrite at 10:38 AM on January 15, 2013

I don't think you should get it, and it would distrust a doctor who offered it without prompting (not evidence-based medicine). Even if it's accurate, the test doesn't tell you where you have it: you could test positive and have either strain on your mouth but not your genitals, for example. But it doesn't matter what I think, the U.S. Preventative Services Task Force doesn't think you should get it either. To be even more emphatic, they don't even think asymptomatic PREGNANT people should get it:


" The U.S. Preventive Services Task Force (USPSTF) recommendations for screening for genital herpes were published in 1996 and included:

Routine screening for genital HSV infection in asymptomatic persons using culture, serology, or other tests, is not recommended (D Recommendation).

Routine screening for genital HSV in asymptomatic pregnant women by surveillance, cultures, or serology, is also not recommended (D Recommendation).

Rationale: The USPSTF found no evidence that screening asymptomatic adolescents and adults with serological tests for HSV antibody improves health outcomes or symptoms or reduces transmission of disease. There is good evidence that serological screening tests can accurately identify those persons who have been exposed to HSV. There is good evidence that antiviral therapy improves health outcomes in symptomatic persons (e.g., those with multiple recurrences); however, there is no evidence that the use of antiviral therapy improves health outcomes in those with asymptomatic infection. The potential harms of screening include false-positive test results, labeling, and anxiety, although there is limited evidence of any potential harms of either screening or treatment. The USPSTF determined the benefits of screening are minimal, at best, and the potential harms outweigh the potential benefits.

posted by Violet Hour at 12:28 PM on January 15, 2013

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