Does it present orally, or genitally? Do I have HSV-1 or HSV-2? Is a cold sore the same as herpes? Discussions about the herpes simplex virus (HSV) and geography usually intersect at the virus’ chosen locale within the human body. Our curiosity for which type it is, where it occurs, and why it matters is closely intertwined with well-known herpes stereotypes and stigmas.
While cold sores can be embarrassing, they do not carry the same negative connotation as genital outbreaks. Under a microscope, the herpes simplex viruses are nearly identical (you can read more about their differences here). In fact, the two strains belong to a family of viruses known as herpesviridae, and share common ties with chickenpox, shingles, and mononucleosis (“mono”). Although these viruses collectively fall under the same family tree, only one is stigmatized. Herpes, whether HSV-1 or HSV-2, whether it presents orally or genitally, whether you got it from someone you love or someone in the moment, does not pick a “type” of person to infect; Herpes does not happen to certain “types” of people. It is society that constructs the idea of difference, value, and worth. It is not only the virus that is demonized, but also, the area on the body in which it resides.
Aside from body parts, herpes and geography converge in conversations about available and accessible testing. Despite the amount of people who carry the infection worldwide, herpes is not included on a standard STD panel. In the United States, the Center for Disease Control and Prevention (CDC) does not currently recommend testing unless a patient shows symptoms of a herpes outbreak. When asking a healthcare professional to be, “tested for everything,” there is typically a failure to mention that herpes is not included in these panels. Some doctors may even decline or discourage a patient’s request to be tested for genital herpes due to lack of symptoms, as prescribed by current CDC guidance.
Many of my blog inquiries this week have centered around the question of testing:
The STD Project offers an overview of private global testing locations, however, I am still curious about testing parameters and healthcare treatment recommendations in these countries. What is included in other countries’ STD panels? How much education do medical professionals receive about STDs/STIs? Are doctors informed about the LGBTQ+ community needs and testing parameters? Is there a significant difference in testing recommendations for herpes around the globe?
Australia: The Australian STI Management guidelines offer serological testing as a “special consideration” and are only to be used “where results will provide meaningful clinical information.”
Canada: According to the Canadian Guidelines on Sexually Transmitted Infections, “culture is the most common method used in public health laboratories in Canada to confirm the diagnosis of HSV.” The guidelines discuss the reliability of cultures, PCR, Tzanck smears, and blood testing. Although “PCR is four times more sensitive than HSV culture and is 100% specific, PCR assays have not yet replaced culture testing in Canada.” The guidelines seem to suggest a recommendation and movement toward type-specific antibody tests, but according to an update of the guidelines, there is “no indication” of screening for asymptomatic patients.
India: The Ministry of Health and Family Welfare, Government of India reports that its major methods of diagnosis is the herpes culture and PCR testing. Blood testing is mentioned, but appears to be secondary to cultures.
New Zealand: The Ministry of Health and New Zealand Sexual Health Society Incorporated (NZSHS) supported NZ Herpes Foundation guidelines for best practice note that “genital herpes is under-recognized and under-treated.” Serological testing is, unfortunately, recommended in limited clinical settings. The guidelines offer recommendations and explanations as to why serological testing is not recommended: 1) indicate past infection, 2) not accurate enough to be offered as “routine,” and 3) does not distinguish the anatomical site of infection. New Zealand seemed to be the most LGBTQ inclusive of all the investigated public sexual health sources.
South Africa: According to the National Department of Health, South Africa 2015 guidelines, do not have specific testing for genital herpes unless a patient presents with a genital ulcer.
UK: The National Health Service (NHS) reiterates the CDC’s guidance, noting that testing for herpes is “not usually done unless you have sores on your genitals or anus.”
WHO Recommendation: Since 2016, 88% of countries have updated their STI guidelines.
Aside from surprise and discouragement, this research brought about an awareness of what resources are lacking and the gaps that need to be filled. I feel confident enough to address testing parameters in the United States, but truthfully, have done little research (until now) as to foreign requirements and guidelines for testing. Sexual rights are human rights, and it saddens me that even though we are encouraged to advocate for our sexual health, available testing does not always translate to accessible testing.