Should You Add Herpes to Your Screenings?

Every responsible, sexually active adult should routinely get screened for sexually transmitted infections (STIs), along with requisite Pap smears, at least once a year. If you have multiple partners, testing should be more frequent: at least every three to six months.

What many people may not know, though, is that the standard screening for STIs doesn't normally include testing for genital herpes, an often misunderstood infection.

What does STI screening typically cover, what is genital herpes and how often should you request a test for herpes?

How often should I be screened for STIs?

It's been estimated that almost 50 percent of American adults have no idea how often they should be tested for STIs, and 19 percent of sexually active adults have never taken an STI test, according to a LetsGetChecked survey published in 2019. 

Unfortunately, this is unsurprising given the U.S. school system's lack of sex-positive, informative sex education. (Take note that 53 percent of 2,000 adults in the survey reported receiving abstinence-only sex ed at school.)

The bottom line should be that if you're sexually active, undergoing testing for STIs is an essential part of protecting your health.

Sex educator and author Laura Boyle, who teaches consensual nonmonogamy and STI education in New Haven, Connecticut, recommended that people in monogamous relationships should be tested annually.

"Monogamy is not protective against STIs in and of itself," Boyle said.

Remember that if you don't have access to health insurance, there are many clinics that offer low-cost or free testing. Some standard recommendations from the Centers for Disease Control and Prevention (CDC) for STI testing include:

• Testing for gonorrhea and chlamydia annually if you're sexually active
• Testing for syphilis, HIV, hepatitis C and hepatitis B if you're pregnant or trying to get pregnant
• Testing for HIV at least once a year
• Discussing testing options with your healthcare provider if you engage in oral or anal sex
• Getting a full screening every three to six months if you have multiple or anonymous partners

What exactly does standard STI testing include? (Hint: not genital herpes.)

When your primary care physician or gynecologist does a blood test to screen for STIs/STDs, they're usually checking for the big four: gonorrhea, chlamydia, syphilis and HIV. People with biologically female reproductive systems also get tested for HPV during their Pap smear, as there is no HPV testing for male genitals.

You have to specifically ask to be tested for other STIs, such as genital herpes, or oral and anal HPV.

What is herpes?

In the 2019 LetsGetChecked survey, 34 percent of respondents believed an STD/STI can be transmitted from a public toilet seat and 24 percent believed that sharing a glass of water could lead to infection.

This is likely due to some widely held misconceptions regarding genital herpes. Let's bust some myths right now, explore when and how you get tested for genital herpes and why the stigma can be much worse than the actual condition.

Genital herpes is a sexually transmitted infection caused by either of two types of viruses, or a combination of both: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).

HSV-1, or "oral herpes," is the cause of cold sores forming around the mouth during an outbreak. Most people with oral herpes contract it from nonsexual contact with saliva, but it can be spread to genital regions and cause genital sores and blisters through oral sex. While it's difficult to ascertain exactly how many people have HSV-1 because many carriers never experience symptoms, it's estimated that anywhere between 50 percent and 80 percent of the global population have it.

"People have a lot of stigma about it, but a lot of people have gotten it nonsexually," Boyle explained. "I have had HSV-1 since I was 9 years old because both of my parents had cold sores and somebody gave me a kiss as a child, and I had one outbreak when I was a preteen."

HSV-2, or "genital herpes," is essentially the same thing, except it's spread primarily through sexual or skin-on-skin contact. About 13 percent of the global population ages 15 to 49 are carriers of HSV-2, though again, many never experience outbreaks.

Testing for either kind of herpes is done through a swab or blood test, but results may be inaccurate if you aren't suffering an outbreak during the time of the test.

Testing for herpes is a personal choice most of the time

Since testing for herpes is highly inaccurate unless you have an active outbreak, and herpes on its own doesn't carry many risks, whether or not somebody chooses to include herpes testing in their regular STI screenings is generally a personal decision.

Even if you've never had a cold sore or genital sore in your life, you could still have HSV-2, unless you've never had any type of sexual contact. And statistically, it's more than likely you already have HSV-1. Even if you do not have any symptoms of herpes, you can still infect your sex partners. If you are pregnant, you may choose to have a screening because genital herpes can be spread from mother to child through vaginal birth.

Boyle noted that in many ways, herpes is more like a skin infection than an STI, although having sex during an outbreak increases your risk of another infection entering your body through the open sore. Moreover, there isn't a way to protect yourself from genital herpes if you're having penis-in-vagina sex, as condoms only protect against diseases you catch from any contact with ejaculate, not skin-on-skin contact.

However, there are options, such as thin, latex underwear or dental dams, to prevent the spread of oral or genital herpes during oral sex.

The choice to test for herpes is ultimately up to your own level of comfort with your risk profile. If you've had a breakout, then you know for certain you may have herpes. Another option is to assume you probably have HSV-1 and choose to test for HSV-2, even though there may be a chance of a false-positive result.

"There are two ways of looking at it," Boyle said. "You get tested for it and you know your status and you take steps to prevent spread or you get scared about it and act like it's a really big deal. Other than stigma, though, it's essentially an uncomfortable skin disease."