What does a low positive herpes test mean

Herpes is one of the most stigmatized, feared, and misunderstood sexually transmitted infections (STI). We test many patients for herpes at our OBGYN offices in Queens and Long Island, and we get lots of positive results, which understandably cause lots of anxiety for affected patients. In this blog, we’ll break it down for you. Bottom line: There’s no need to freak out about positive results.

There are two types of herpes simplex virus, which can cause painful sores on the mouth and/or genitals.  

• HSV-1 primarily causes sores on the mouth. It can be contracted by kissing a person with the virus, or sharing personal items (e.g., utensils, lipsticks, or toothbrushes).

• HSV-2 usually causes genital lesions and is generally transmitted by sexual contact.

It used to be said that “HSV-1 causes lesions above the waist and HSV-2 causes lesions below the waist,” but this an oversimplification: Oral HSV-1 can be communicated to the genitals by oral sex and genital HSV-2 can be similarly communicated to the mouth. Both HSV-1 and HSV-2 can cause lesions in the mouth, the genitals, and in other areas (around the anus, in the eyes, or in areas where skin has been traumatized).

At our OBGYN offices in Queens and Long Island, we provide STI testing for hundreds (maybe thousands) of women each year, and diagnosis of genital herpes is incredibly common. Women are understandably shocked when they hear that they’ve tested positive, and we often have to “talk them off the ledge.” There are a lot of myths and misconceptions about herpes out there. Here are 4 reasons why a positive herpes test is not the end of the world.

• Exposure to HSV is very common. When we test for herpes, we do blood tests which tell us whether your immune system has ever “seen” the herpes virus: Once you have been exposed to herpes, your body creates antibodies which will remain present for the rest of your life. Exposure is incredibly common: According to the CDC, about 1 in 8 people ages 14 – 49 has been exposed to HSV-2, and half of people have been exposed to HSV-1. That’s right…that good-looking guy you’ve been flirting with has about a 50% chance of having HSV-1! Most people however are unaware that they have been exposed, because they’ve never noticed an outbreak. It’s not until patients are tested that they learn they have HSV. Many people have been exposed to the virus, but are completely unaware.

• Symptoms of HSV are often short-lived and mild. Many people who test positive for herpes antibodies have no symptoms; often, they can’t recall even a single outbreak. Other individuals affected by the herpes virus have repetitive outbreaks of painful sores in or around the mouth or vagina; some may notice only vaginal irritation or discharge (FYI, if you have any of these symptoms, you should be seen ASAP). Generally, the first exposure to the herpes virus causes the most severe outbreak, during which skin lesions may be accompanied by systemic flu-like symptoms. Recurrent outbreaks typically occur in the same location where the initial outbreak occurred, but recurrences tend to be mild.

Many people who live with herpes outbreaks learn that they are prone to certain “triggers”: One patient tells me that she gets outbreaks when she’s sleep-deprived, and another tells me she gets lesions when she eats a lot of chocolate. People with herpetic infections can thus learn to manage their triggers to minimize the chance of an outbreak.

For those who get frequent outbreaks—say, more than 3 or 4 per year—medications are available which shorten the duration of symptoms and decrease the likelihood of spreading the virus. If you get frequent outbreaks and are have not discussed the possibility of using medications to suppress the herpes virus, you should call us for an appointment.

• HSV is NOT a catastrophe in pregnancy.  Many of my patients who are diagnosed with genital herpes are understandably worried about the implications herpes infection in pregnancy: They fear that won’t be “allowed” to conceive or will not be able to deliver vaginally. These myths exaggerate the true risk of herpes in pregnancy. Infants are generally at risk only if they pass through a birth canal while their mother has an active HSV lesion. We carefully examine women in labor if they have a history of HSV, and if a lesion is seen, a C-section is advised. Medication is often used during the last few weeks of pregnancy to decrease viral shedding and reduce the risk of an outbreak on the day of childbirth. While many, many people test positive for prior exposure to herpes, it’s rare for us to have to do a c-section for this reason. For the vast majority of women, HSV infection has no consequences in pregnancy.

• You can still have sex. A diagnosis of genital herpes is not the end of your sex life. If one partner has a history of HSV infection, medication can be used to decrease viral shedding and reduce the risk of sexual transmission of the virus. Condoms can drive this risk even lower. Of course, if you have a history of herpes infection, we would encourage you to be open and honest with your partner so that you can work together to find satisfying solutions.

A diagnosis of herpes is not the end of the world, but women should know where they stand. We encourage testing for all sexually active women. If you suspect you may have had exposure to the herpes virus, you should come see us for an evaluation. We’re here to answer your questions candidly and discuss a long-term management strategy.