Why isn't Herpes a routine testing with the other STIs?

[currious4]

I have learned a lot about HSV2 since I contracted the virus by an asymptomatic partner who didn't know they had it. This is how roughly 70% of individuals get infected by the virus - from an asymptomatic person. How? By shedding. Even if there are no lesions or visible sores in the genital area, asymptomatic individuals are "shedding" the virus on their skin. And condoms DO NOT protect individuals from this shedding virus, since it presents on the skin, around the entire genital area. This isn't common knowledge, and I think this is a crucial factor of how the virus is unintentionally spread.

Therefore, if this virus is inconspicuously spreading - why does the medical community only "test" for herpes when individuals are experiencing symptoms? This seems counterintuitive and honestly an oversight of the physicians who know the insidious nature of this virus. I have tried to find articles, research, literally anything that examines the idea of making HSV1 and 2 testing routine.
Why aren't clinicians testing for HSV 1 and 2 when so many remain asymptomatic carriers? Why isn't this the status quo STI testing, alongside Chlamydia and Gonorrhea?

[WellinformedPerson]

I am in agreement with you. I think the hsv tests should be part of all STD screenings. I've seen some clinicians write that they don't routinely test for it because of the emotional and psychological impact of a positive diagnosis in someone who is asymptomatic, which seems to only add to the stigmatization of the infection.

I would also add that the commercially available  hsv1 IgG test is really not all that good and has recently been shown to miss up to 30% of infections. In fact, I would bet if that was its initial performance when it was first introduce, it would not have been approved for commercial use.

While condoms are not 100% effective, they do provide significant protection since they typically cover the area that would either shed the virus or be the most susceptible to infection.

[currious4]

Thanks for your response. I've heard similar arguments regarding the concern for diagnosing asymptomatic individuals. However, the logic of saving asymptomatic individuals from "emotional and psychological impact" doesn't hold up when 70% of individuals who are infected with the virus are infected when their partners are asymptomatic. And the REAL psychological harm is when those uninfected individuals get their first outbreak and have to inform their asymptomatic partner of the damage they've unintentionally caused them. So while the medical community claims they're saving asymptomatic individuals from the truth now, this oversight has long term psychological effects for both them and their innocent partners.

So often medicine preaches the ethos of "benefiting the larger community" - as seen with the case for vaccinations ( which I fully agree with it). Therefor I am quite appalled that clinicians wouldn't share this approach when it comes to Herpes. Especially when most of the spreading occurs due to individuals not knowing their status.

That is a really interesting point you bring up regarding the IgG test sensitivity. And that adds more nuance to the accuracy of diagnosing asymptomatic individuals. However, this issue shouldn't be a reason to not test everyone; quite the contrary, it should compel researchers to find a better antibody test!

Lastly, I think the condom argument is BS. I'm sorry to be so dismissive, but the herpes virus infects the entire sacral ganglia (nerves that innervate the genital and pelvis area). So outbreaks - as well as asymptomatic shedding - occur around the testicles, anus, and perineal areas of both genders. The virus literally seeps out of the skin of that entire area! Therefore, condoms really do little to protect uninfected individuals from their partner's asymptomatic shedding and actual outbreaks.

[WellinformedPerson]

I agree with you. Since the vast majority of infected individuals claim they did not know they were infected when they past it on to their partners, I personally will not date and have sex with someone if that person will not get tested. A herpes IgG test is not prohibitively expensive, and false positives can be sorted out.

Condoms are certainly not 100% effective, but if used properly they do cover the most susceptible skin to infection. Long-term studies support this. If I was having sex, even condom protected, with multiple random partners of unknown STD status, I would expect my luck to run out. So, I am in no way saying that condoms should be relied for protection. People do get infected even while using condoms.

[WellinformedPerson]

*passed