If you think you have herpes because you have symptoms or suspect that you may have been exposed to the virus through sex, a healthcare provider can offer you a blood test to confirm whether you have been infected with the herpes simplex virus (HSV).
Herpes blood testing is a two-step process in which an initial positive result is followed by a second confirmatory test. A positive result from both tests can be considered a definitive diagnosis of herpes.
While herpes blood tests offer a high level of accuracy, they are not infallible. Moreover, if you have symptoms, they may not be as useful or informative as an HSV viral culture or PCR test (both of which can detect HSV in a swab of fluid from a herpes sore).
This article explores the accuracy of herpes blood tests and outlines the current recommendations for herpes testing in the United States.
How Test Accuracy Is Measured
The accuracy of all medical tests, including herpes tests, is measured based on two values: sensitivity and specificity.
Sensitivity is how often a test correctly identifies someone with a disease. A test that is 90% sensitive will correctly identify 90 people out of 100 who have the disease. Ten people will have a false-negative result.
Specificity, on the other hand, refers to a test’s ability to correctly identify someone who doesn’t have the disease. If a test is 90% specific, that means that 90 people out of 100 will be correctly diagnosed as not having a disease and that 10 people will have a false-positive result.
Accuracy by Test Type
Two blood tests are used to screen for herpes. To ensure that an initial positive result is correct, a second test using a different method of detection is used to confirm the results.
The first test is the enzyme-linked immunosorbent assay (ELISA). An ELISA looks for immune proteins, called antibodies, that are produced by the immune system in response to the HSV. HSV antibodies are present even when there are no symptoms.
If the ELISA result is positive, your healthcare provider may administer a Western blot assay. This second test looks for proteins on the surface of the virus, called antigens, which serve as the virus’ “ID tag.” HSV antibodies produced in response to these antigens help the immune system target its attack.
According to the U.S. Preventive Services Task Force, the accuracy of the two blood used to diagnose herpes breaks down as follows:
With that said, the accuracy of the tests can be affected by the timing of the tests. For an ELISA to return an accurate result, the immune system needs to produce enough antibodies to reach detectable levels.
Testing too early during the so-called window period can end up causing a false-negative result (in which the test says you don’t have HSV even if you do).
Other Testing Options
When an ELISA is confirmed with a Western blot, it is unlikely for a herpes diagnosis to be wrong. But, other tests may be more useful and/or reliable in certain situations. Both tests rely on the direct detection of HSV using fluids obtained from a swab of a herpes sore.
Polymerase Chain Reaction (PCR)
A polymerase chain reaction (PCR) test can detect HSV by making copies of the virus’ genetic material in a process known as nucleic amplification. Even if there is only a small amount of virus, the genetic material can be amplified enough to return an accurate positive diagnosis.
PCR is considered the gold standard of testing in cases where herpes has invaded the brain or spinal cord (typically in people with advanced HIV infection).
Viral Culture
An HSV viral culture is a process in which the virus is “grown” in the lab using a swab of fluid. Compared to all other methods of HSV detection, viral culture is considered the gold standard of testing.
Even so, an HSV viral culture is more time-consuming, taking between three to eight days to return results. Moreover, user error can affect the results. For instance, the test is likely to be less accurate if the healthcare provider swabs the scab rather than the sore itself. Delays in transport or improper refrigeration can also weaken the accuracy of the test.
Limitations of Testing
As accurate as herpes tests are, they are not used for routine screening. This is because, in the absence of symptoms, a positive result doesn’t mean you will ever have symptoms or require treatment. On the other hand, knowing your HSV status may reinforce safer sex practices if you are in a relationship.
This doesn’t mean that you shouldn’t get tested under certain circumstances. According to the Centers for Disease Control and Prevention, HSV testing can be used in asymptomatic (symptom-free) people who:
Had sexual contact with someone with genital herpes Is getting tested for other sexually transmitted infections Has HIV and a history of genital herpes symptoms Is at higher risk of infection for whatever reason (including having multiple sex partners)
Summary
Herpes can be diagnosed with blood tests. This includes the ELISA test that detects herpes antibodies and a Western blot test used to confirm the results. Herpes testing is generally recommended for people with herpes symptoms only.
Although the ELISA and Western blot tests are highly accurate when used together, other direct testing methods may be used, particularly if you have symptoms. This includes a PCR test that can detect the genetic material of the virus and a viral culture that can “grow” the virus in the lab. Both rely on a swab of fluid from a herpes sore.
A Word From Verywell
Although routine herpes screening is not recommended for the general public, it has its place even if you don’t have symptoms. If you suspect you may have herpes for any reason, speak with your healthcare provider to assess your risk and determine if a herpes test is appropriate based on your risks and circumstance.
ELISA test, used for initial testing, detects herpes-specific antibodies. Western blot, used to confirm a diagnosis, detects herpes antigens.
ELISA: Sensitivity of 96% to 100% and specificity of 97% to 100%Western blot: Sensitivity and specificity of over 99%
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