Can You Test for Herpes Without an Outbreak?

Herpes is a common sexually transmitted infection (STI) that many people carry without realizing it. Around one in seven Canadians carry the virus — caused by the herpes simplex virus (HSV) — but most people don’t have symptoms. This makes understanding and managing the virus even more important. 

There are two types of HSV: 

• HSV-1 is typically responsible for oral herpes, which causes cold sores around the mouth. In general, HSV-1 isn’t considered a sexually transmitted infection — most people get it during childhood from non-sexual contact with the saliva of someone with the virus. However, oral herpes can spread to the genitals through oral sex.
• HSV-2, or genital herpes, typically causes sores on or around the vagina, penis or anus. It’s rare for HSV-2 to spread to the mouth during oral sex. 

Genital herpes can be transmitted through sexual activity whether or not symptoms are present. HSV can’t be cured — once you’re infected with the virus, it stays in your body for life and may (or may not) cause periodic outbreaks of sores. 

Testing is important since early detection and treatment can help manage this chronic condition and prevent its spread. But can you get tested for herpes if you don’t have an outbreak? 

Well, you can, but the real question is, should you? Read on to find out.

Who should get tested for herpes?

Not everyone needs to be tested for herpes. Unlike bacterial STIs like chlamydia and gonorrhea, which are very common and easy to diagnose and treat, genital herpes is a little more challenging to screen for. 

In general, HSV testing isn’t recommended for asymptomatic people due to the limitations of a blood test and a high possibility of false results — especially in people with a low risk for infection. A false positive result can have an undue, devastating impact on someone who doesn’t have HSV but thinks they do. 

The Public Health Agency of Canada does not recommend routine screening on people without a history of HSV lesions. 

Symptoms of herpes

The most telling symptom of HSV is the occurrence of one or more sores or blisters on the mouth, genitals, anus, thighs, or buttocks. The sores often begin with a tingling or itching sensation before emerging as small bumps or blisters that eventually rupture, causing a painful ulcer. As the sores heal, they develop a crust and begin to slowly disappear, leaving no trace — for most people, herpes sores don’t scar.

Other symptoms of herpes may include: 

• Fever, body aches, swollen glands, or other flu-like symptoms, which may occur during the first outbreak
• Discharge from the vagina or, in people with a penis, the urethra

How is herpes tested?

Three types of tests are used to diagnose HSV. Your healthcare provider will determine which is best for your situation.

Viral culture

A viral culture involves scraping or swabbing an active sore to get a sample. Special techniques encourage the virus to grow and multiply in a lab setting. The culture is then examined under a microscope to determine whether the virus is present. 

Viral cultures are widely available and can be used to determine the type of HSV (1 or 2) and antiviral resistance. This test is most accurate when the swab sample is taken within 48 hours of the sore developing when the viral load is highest. After that, the amount of HSV in the sample drops, and the risk of a false negative test result increases. 

Nucleic Acid Amplification Test (NAAT)

A NAAT test for HSV is usually performed on a swab sample taken from a sore. This highly accurate test is often the preferred test to confirm a herpes diagnosis, but may not be as readily available. 

Type-specific serology (TSS)

A TSS test is performed on a blood sample to detect the presence of antibodies, which the immune system produces to fight a virus. Since the body will produce antibodies if the virus is present — even if symptoms aren’t — this test can be useful when other tests are negative or not available and symptoms are present. An HSV TSS test can also determine whether the infection is caused by HSV-1 or HSV-2, but cannot detect where in the body the infection is.

What if you test positive for genital herpes?

If you have genital lesions and a test comes back positive, you may be scared and anxious. The good news is that while genital herpes can’t be cured, it can be managed. After the first outbreak, which can be intense, subsequent outbreaks are usually shorter-lived and less severe. After the first year, they typically occur less frequently.

During an outbreak, antiviral medications can help reduce the severity of the sores and the duration of the outbreak. Taking a daily antiviral medication can help prevent outbreaks altogether and reduce the chances of transmitting HSV to a partner. 

Is genital herpes a reportable STI?

While HSV isn’t a nationally reportable STI in Canada, some provinces and territories require healthcare providers to report cases of genital herpes to the local public health unit. Reporting is confidential, so your name and identifying information will be withheld. However, a public health nurse will contact you to discuss the diagnosis and provide you with resources for care and support. 

The nurse will ask for the contact information for any sexual partners who may have been exposed so they can be informed and get tested. Your name won’t be used during the call. If you would rather inform your partner(s) yourself, the nurse can give you tips on approaching the conversation. 

Either way, open communication with partners and using proper precautions during sex are central to preventing the spread of the virus.

How to prevent genital herpes

Condoms and dental dams (internal condoms) can reduce but not eliminate the risk of herpes transmission. Internal condoms provide more coverage, and therefore, may provide more protection. 

If you or your partner has genital herpes, avoid unprotected sex, especially from the first tingling sensation of an impending outbreak, as this is a time when there is the highest risk of sharing HSV with partners. People with oral lesions should avoid kissing or sharing food and drinks during outbreaks. HSV can still spread to others between outbreaks when there are no symptoms. 

When using sex toys, use a barrier method and avoid sharing them to prevent spreading the virus.  Partners with herpes can suppress their viral load and help reduce the risk of spreading the virus with antiviral therapies.  

When to talk to your doctor about HSV testing

More than half of Canadians avoid getting tested for STIs, due in part to the fear of getting a positive result back. But the consequences of an untreated STI can be serious — detecting and treating or managing it early on helps prevent the spread and reduces its negative impact on your life. 

If you develop symptoms of genital herpes, or if you think you’ve been exposed to HSV, talk to your healthcare provider about getting tested. If you don’t have a primary care provider— more than 6.5 million Canadians don’t — Maple makes it easy to take control of your sexual health.

A membership on Maple allows you to speak with a primary care provider, like a doctor or nurse practitioner, 24/7/365 over secure text, audio, or video call in minutes. Primary care providers on Maple can talk to you about any symptoms you may have, offer advice on having safe sex or talking to a partner about STI testing and help you find a place to go for testing.

Understanding herpes and its transmission is crucial for managing this common but often misunderstood infection. Whether you have symptoms or not, knowing your status through testing can help you make informed decisions about your health and the health of your partners. While herpes can’t be cured, early detection and treatment can play a key role in managing outbreaks and reducing the risk of transmission.

The information presented here is for educational purposes and is not meant to replace the advice from your medical professional. Virtual care is not meant for medical emergencies. If you are experiencing an emergency like chest pain or difficulties breathing, for example, please call 911 or go to your nearest emergency room.