I recently got tested for STIs, but my doctor said she didn’t want to test for herpes since I didn’t have symptoms. Why not?

Oh boy. This is a complicated one. First though, we want to say that it’s great that you’re taking charge of your sexual health and getting tested for sexually transmitted infections (STIs)!

Let’s go over some basics.

Herpes is an extremely common STI that’s mostly transmitted through direct skin-to-skin contact during oral, anal, vaginal or manual sex (fingering, hand jobs). You can also get oral herpes (which causes cold sores or fever blisters, which are small, reddish bumps on the edge of your mouth) through kissing or sharing drinks or food. Herpes is not curable, which means once you get it, you’ll have the virus for the rest of your life. However, there are medications that can shorten or prevent outbreaks, and make it less likely that you’ll spread the virus.

Health care providers usually only test for herpes if you’re having an outbreak.

A person who is having a herpes outbreak will have very painful sores (called lesions) that look like pimples or blisters on your genitals or mouth. If you’re having an outbreak, your doctor will test you for herpes through a physical exam and by swabbing the lesions. There is a blood test for herpes, but doctors don’t usually recommend it. This is for several reasons.

First, it’s not always reliable. The test brings back some false positives, which means the test says that you have herpes when you really don’t!

To understand the second reason doctors don’t always do a blood test for herpes, we need to talk about the two main strains of herpes: HSV-1 and HSV-2.

HSV-1 is the strain of the virus that usually causes oral herpes (which, again, shows up as cold sores around your mouth). Sometimes, HSV-1 can cause genital herpes, but this is rarer. Most people who have HSV-1 got it when they were young through non-sexual contact (something like being kissed by grandma when you were a baby). Many never have ANY symptoms. In fact, almost half of the population has HSV-1.

HSV-2 generally causes genital herpes. (Though sometimes HSV-2 can infect the mouth, and sometimes HSV-1 can infect your genitals.) The blood test for herpes doesn’t always distinguish between HSV-1 and HSV-2. This means you may get a positive blood test for herpes when you only have HSV-1.

Unlike other STIs like gonorrhea and chlamydia, herpes doesn’t cause serious, permanent damage to your body when it’s not treated. Because of this, EVEN if you test positive for herpes, your doctor may not give you any treatment. Everybody experiences herpes differently, and you may only have one outbreak, or one every year, or one every month. It doesn’t really make sense to treat someone for herpes when they have never had an outbreak.

This is all pretty complicated. Really, what you need to know is that unless you have symptoms, you don’t need to get tested for herpes.

You can help prevent getting herpes by never sharing food or drink, and always using condoms when you have sex. Keep in mind that condoms greatly reduce the chance of getting herpes, but they don’t totally prevent it. If your partner has a lesion that is not covered by the condom, it is still possible to get herpes. It’s also possible to get herpes when your partner is not having an outbreak. However, the risk is much greater if your partner has an active lesion.

Also, remember that having herpes (or any STI) does NOT make you dirty, or say anything about who you are as a person.

If you have any other questions about your health and are 10-22 years old and live in NYC, you can make a free, confidential, nonjudgmental appointment at the Mount Sinai Adolescent Health Center. We provide comprehensive healthcare to teens and young adults, including sexual health and sex education services.