Order Guide: Herpes Virus
The following section outlines some key details about the herpes virus, and herpes virus testing.

Testing

We only recommend testing for the herpes virus if you have experienced a suspected genital outbreak or cold sores, or if you have a partner with herpes or cold and have never had an outbreak yourself. If you have more questions about herpes before ordering this test, we suggest consulting a health care provider first.
We DO NOT recommend routine testing for the herpes virus antibodies, as they also carry a false positive rate, and receiving a positive result can promote unnecessary anxiety.

Background

There are two commonly discussed types of herpes simplex virus are HSV-1 and HSV-2. Either one can cause genital herpes or cold sores.
The terms 'genital' and 'oral' refer to the sites of infection and not the types. For example, you can get genital HSV-1 by receiving oral sex from someone who has a cold sore.
Most people who have genital herpes don't know they have the infection because they have mild, short-lived, or no symptoms, or they think the symptoms are due to another condition (e.g., yeast infection, boils, bug bites, friction burns).

Transmission

Herpes is transmitted through direct skin-to-skin contact with an infected partner. Most HSV-2 infections are acquired through penetrative intercourse such as vaginal and anal sex, but non-penetrative exposures including genital-to-genital rubbing are also ways to transmit the virus. With regard to type 1 infections, most of them are acquired through oral sex.

Prevention

Condoms, if used consistently and correctly will reduce, but will not eliminate the risk of HSV transmission or acquisition. They need to protect or completely cover the infected area or the area of potential exposure. They can also be used as a barrier for oral-genital sex if your partner has a history of cold sores.
Valacyclovir 500 mg ingested daily by a patient with genital HSV-2 infection has been shown to reduce transmission to a susceptible heterosexual partner by 48%. The effect of condoms and suppressive valacyclovir may be additive. At present time, TeleTest offers treatment doses for cold sores and genital outbreaks but does supply daily valacyclovir. If you are interested in daily suppressive therapy, please contact a nearby walk-in clinic or your family physician.

Common Questions about Results

Should I get checked for herpes?
We only recommend testing for the herpes virus if you have experienced a suspected genital outbreak or oral cold sores in the past, or if you have a partner with herpes or cold sores and have never had an outbreak yourself. If you have more questions about herpes before ordering this test, we suggest you consult a health care provider first.
We DO NOT recommend routine testing for herpes virus antibodies, as they also carry a false positive rate, and receiving a positive result can promote unnecessary anxiety and stress.
Will I be called for a positive herpes result?
You will receive notification of a positive herpes result through our portal. We do not call by phone, however, for having a positive herpes virus result unless you specifically request a call from one of our doctors. Given the high prevalence of the herpes virus (see our Interpreting Your Results section on prevalence), you will receive an email asking you to review the results and reach out to us if you have concerns. We can provide treatment for cold sores and a genital outbreak with common, effective anti-viral medications. Please send us an email to [email protected]
Commonly asked questions
(A) I tested 'reactive' for HSV 1 or HSV 2. Does this mean I have genital herpes or cold sores?
HSV 1 or HSV 2 antibodies are produced when you are exposed to the herpes virus. This can occur through sexual and non-sexual contact. HSV virus can be acquired through non-sexual contact - sharing a drink with someone (even a relative) with an active or recent cold sore. Most people don't know that cold sores are actually caused by the herpes virus, and are quite common. You can also contract HSV through kissing. Over 90% of the world is positive for one or both viruses. (Reference 1)
HSV can also be transmitted through sexual contact. Performing or receiving oral/anal/vaginal intercourse can result in exposure to the Herpes Virus. If you’ve experienced blisters in the genital region, you have likely had a herpes outbreak. Most infections are common and often do not have symptoms.
If you are experiencing an outbreak, a physician at a local walk-in clinic or urgent care center can swab the area and give you a definite answer if it is a herpes outbreak, and the strain (HSV 1 or HSV 2).
(B) What’s the difference between HSV 1 and HSV 2?
Both HSV 1 and 2 are nearly identical viruses - HSV 1 can cause cold sores but also genital herpes. HSV 2 can cause cold sores but also genital outbreaks. Scientists make the distinction between HSV 1 and HSV 2 based on the frequency we find each virus in the oral and genital regions. HSV 1 is more likely to be found in the oral region and HSV 2 is more likely to be found in the genital region. This does not mean if you test positive for HSV 2 that you have had genital exposure, as the exposure may have been oral (cold sore). This is why doctors rely on whether you’ve had symptoms of an outbreak in the past to determine why you’re positive.
(C) I tested positive for herpes, but I don’t recall ever having genital sores or cold sores.
Having a positive test means you were exposed to the virus at some point in your life. Many people never have symptoms and never experience an outbreak. In general, you are more likely to transmit the herpes virus to a partner if you have an active outbreak or are experiencing prodromal symptoms (i.e. burning, tingling, or pain before an eruption is about to occur). Asymptomatic transmission (having neither prodromal symptoms nor an outbreak) can occur, but the risk can be reduced by avoiding intercourse around the time of a recent outbreak.
(D) I have had cold sores, but I have never had a genital outbreak. Can I still get genital herpes?
Yes. Contracting genital herpes requires exposure to the virus through bodily fluids. If someone has cold sores and performs oral sex on you, even if you are positive for the virus, they can transmit the virus to you in the genital area even though you have antibodies to the virus. As such, we advise against sexual contact of any nature (oral or genital) if there are any ongoing outbreaks in any partner.
(E) Can herpes can be cured?
The herpes virus cannot be cured, but we have very effective antiviral medication to treat an outbreak or prevent transmission. Some people never experience an outbreak in their lifetime, and others may only experience an outbreak once every few years. Others may have an outbreak more frequently. If you would like a prescription of Valtrex (valacyclovir), a commonly used oral antiviral medication to treat cold sores or genital herpes, please email us at [email protected] and our physicians will be in contact with you to send in a prescription to a local pharmacy of your preference.
Cold sores are treated with Valtrex (valacyclovir) tablets for a single day; genital outbreaks are treated for a total of three days. For some individuals with multiple outbreaks a year, they can be on once-daily dosing suppressive therapy that prevents outbreaks.
(F) I tested positive for HSV 1 or HSV 2. Should I start medication now?
Medication for the herpes virus is only suggested if you are experiencing an oral outbreak or a genital outbreak. For oral outbreaks, we typically prescribe 4 pills of valacyclovir in the morning and evening for one day when a cold sore is about to erupt or has erupted. For a genital outbreak, we give you a tablet twice daily for three days. These medications do not 'cure' herpes but treat an active flare. If you have no flares (i.e. no cold sores or genital outbreaks) and only a positive result, we don't routinely recommend suppressive (daily Valtrex). If you tested positive and have more questions, email us at [email protected] and we will be in touch.
(G) Could my result be an error?
Our Ontario public health laboratories use the Liaison HSV 1 and Liaison HSV Type 2 Specific IgG Assay - it has a sensitivity of 96.9-98.9% (misses 1.1-3.1% of infections) and a specificity of 91.3%-96.8% (false positive rate of 3.2% - 9.7%). The test result can be negative early in the course of an infection, which is why we encourage repeat testing if you are symptomatic at the 3-month point. There is a change of a false positive result, which is why we encourage you to get checked for the HSV antibody only if you have had cold sores or a suspected genital outbreak in the past. If you have had a swab positive for HSV in the past, and a negative antibody result you likely have the herpes virus and the blood test represents a false negative result. We recommend seeking out the opinion of our physicians if you would like further clarity before being intimate with a partner.
(F) My Herpes test says 'indeterminate'. What does this mean?
If you have an indeterminate Herpes Antibody Test and have had symptoms of cold sores or a genital outbreak recently, it may represent an 'early' antibody response that will become positive with a repeat test in 12 weeks. A repeat test is encouraged for certainty if you have had symptoms. If you have not had any outbreaks in the past, or any known exposures it can also represent a false positive and we don't recommend a repeat test at this time.

Additional Resources

STD Facts - Genital Herpes