What should I do if I think I have herpes?

See a doctor while symptoms are still present. The doctor will look at the area, take a sample from the sore(s) and test to see if the herpes virus is present. The test you should request is a specific virus culture or assay for herpes virus. Remember, the test will not work if the sores have healed.

Known available tests:

• Cell Culture Test

• Antigen test

• Pap Smear

Blood tests are often used when a person has concerns about herpes, but does not have any visible symptoms. I n the past, type-specific blood tests were not always accurate because they confused other herpes virus antibo dies such as varicella zoster (chicken pox), Epstein Barr, or mononucleosis for herpes simplex (Types 1 and 2) antibodies. The Western Blot has long been the standard test for diagnosis. It was designed to test for antibodies, but is costly and time consuming.

The Food and Drug Administration (FDA) has recently approved very accurate type-specific blood tests to diagnose herpes. The new tests are roughly one-fifth the cost of the Western Blot and are much faster and easier to administer. One of these, the POCkit HSV2 Rapid Test by Diagnology is an accurate test for genital herpes caused by herpes simplex virus type 2 (HSV-2). The "POC" in POCkit stands for "Point Of Care", which means the test can be done in a doctor's office and can provide results in less than 10 minutes. Meridian Diagnostics has developed a test for HSV-1. With Meridian's Premier test, the health care provider takes a blood sample from the arm and the blood is sent to the lab for results. Results could take a few days depending on how fast the lab can do the test. Another test which requires blood to be drawn and sent off for results is HerpeSelect from Focus Technologies. These tests cannot determine whether the HSV infection is oral or genital. However, since most cases of genital herpes are caused by HSV-2, a positive Type 2 result most likely indicates a genital infection.

Identifying Your Type ...Anna Wald, M.D.

Most readers know they have genital herpes, however, not everyone knows whether they have HSV-1 or 2. Is there any practical reason to find out?

The main reason, according to Anna Wald, M.D., would be in a situation where both partners have genital herpes. Such a couple might reasonably take no precautions to prevent transmission, since both are already infected. If one partner has genital HSV-1, however, and the other has HSV-2, they might infect each other with a second type.

Specifically, the person with the milder genital HSV-I might acquire HSV-2, resulting in more shedding and more recurrences.

Diagnosing genital HSV- 1 after the primary episode is no easy task, however. Because the infection seldom recurs, a culture from an active outbreak can be hard to get. And since many people have HSV-1 orally, a finding of HSV-1 by Western blot serology (blood test) would not positively identify genital infection.

One solution could be a process of elimination, suggests Wald. A Western blot can tell whether or not you have HSV-2. If you are seronegative (negative by blood test) for type 2, but positive for type 1, that gives you a strong clue as to the cause of your outbreaks.

"If you have infrequently recurring genital herpes, and you are seropositive for type 1 but not type 2, you probably have genital HSV1," reasons Wald.