Ask the Experts: Herpes : I Wanna Know

Below are some of the questions people like you have sent us about herpes.

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Is it possible for the herpes simplex 1 virus to turn into the herpes simplex II virus? Is it possible to test negative for both types and then test positive a few months later, even without an outbreak? What about having a “false” positive test result?

Herpes simplex virus-1 (HSV-1) is similar to herpes simplex virus-2 (HSV-2), with the main difference being that HSV-1 is most often experienced as an oral/facial infection while HSV-2 is more commonly related to genital herpes. The two types don’t somehow change into the other type. It is true that either type can infect genital or oral skin, which can cause confusion. HSV-2 rarely infects oral tissue, though, and a blood test positive for HSV-2 typically indicates that an individual has genital herpes, even if they’ve never experienced symptoms.

Blood tests also can be used when a person has no visible symptoms but has concerns about having herpes. Blood tests do not actually detect the virus; instead, they look for antibodies (the body's immune response) in the blood.

The accurate herpes blood tests--known as type-specific blood tests or serology--detect IgG antibodies. Unlike IgM antibodies, IgG antibodies can be accurately broken down to either HSV-1 or HSV-2. Research (RA Morrow et al., 2002 and 2005) corroborates this finding: labs that used non-gG-based tests (“non-specific” tests) for herpes had high false-positive rates for HSV-2 antibodies. But 100% of the labs using gG-based tests (“type-specific” tests) accurately reported that the blood sample was negative for HSV-2.

The challenge here is that the time it takes for IgG antibodies to reach detectable levels after initial infection can vary from person to person. For one person, it could take just a few weeks, while it could take a few months for another. So even with the accurate tests, a person could receive a false negative if the test is taken too soon after contracting the virus. For the most accurate test result, it is recommended to wait 12 - 16 weeks from the last possible date of exposure before getting an accurate, type-specific blood test in order to allow enough time for antibodies to reach detectable levels. False positives are rare with type-specific blood tests when used in this manner.

--Gary A. Richwald, MD, MPH

I’m only 15. I was in a serious relationship for two years with this guy but out of anger I let another guy perform oral sex on me. I haven’t had sexual intercourse for over 5 months but now am starting to think I have herpes because my vagina has been very irritated and red and maybe a little swollen. I have looked at pictures of herpes but what I see doesn’t look the same. Do I have an STD? Does this sound like herpes?

Trying to figure out what symptoms mean can really make people nervous, because some of the symptoms of herpes and other STDs seem the same. This makes it all the more important that you visit a health care provider if you think you have an STD. What you described doesn’t necessarily sound like typical herpes symptoms, but it is still important to go see your health care provider. It’s okay to tell your health care provider that you’re really worried about herpes. You may want to ask for a herpes culture test if you have any open sores or bumps on your genitalia. Some providers may be able to do a blood test to see if you have herpes. Other tests for chlamydia, gonorrhea, or even a yeast infection, could help you understand your symptoms, get the right treatment, and help put your mind at ease. While it is possible to get genital herpes from oral, vaginal, and anal sex, the only way to know for sure is to get tested for herpes and other STDs. Getting everything checked out can also be a good time to plan how to be safe and healthy the next time you have any kind of sex.

--J. Dennis Fortenberry, MD, MS
Indiana University School of Medicine

I read on your website that the herpes virus does not last very long outside the body. I’m sending you two studies I found online that suggest HSV can live for two hours at room temperature. Which information is correct? It seems to me bathrooms might be a real risk.

Research suggests HSV outside the body begins to degrade fairly quickly. The real issue is whether or not herpes virus on objects poses a risk for transmission: let us assure you there is no documentation that HSV has ever been contracted through inanimate objects. In the book ASHA publishes, Managing Herpes, the authors write:

Can you get herpes from a toilet seat, for example, or a dirty towel? The basic answer on the risk of getting herpes from inanimate objects like these is something along the lines of "generally impossible." The main reason for this goes back to our earlier discussion about transmission, about skin to skin contact, and about the likely places where herpes can take hold. If you rubbed a herpes sore against a towel, for instance, some of the herpes simplex virus could be deposited onto the towel. The virus may persist outside the body for several hours, but soon it begins to lose its ability to invade and colonize new cells.

While the possibility of HSV transmission through objects cannot be discounted, experts do believe the risks are slight. A common sense approach will suffice: with the example mentioned above, it might be smart not to dry you face with a towel immediately after using it to dry an area that has herpes lesions. Again, let us stress the risk here is minimal at best, and don’t lose sleep over “what if…” scenarios. It’s also a good idea not to use or share sex toys during outbreaks, and to clean them thoroughly after each use.

--The HRC Staff

Excerpt taken from: C Ebel, A Wald. Managing Herpes, pp. 62-63. (c) American Social Health Association, 2009. Available at http://www.ashapublications.org/managing-herpes-living-amp-loving-with-hsv1.html.

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Below are some of the questions people like you have sent us about herpes.