Last Updated on June 4, 2020 by Shuvani Sanyal, MD
Recently, I had a written exchange with a reader about blood testing for HSV1/HSV2. In my interview, I previously mentioned not having taken a blood test to determine which strain of HSV I’m living with*. Diagnosed 14 years ago at the family doctor’s office, with a very obvious genital outbreak, a blood test was neither available nor was it necessary for a herpes diagnosis. As a result, I’m still not certain whether my genital herpes is due to HSV1 or HSV2 and whether I carry one or both strains. While I know I have one strain of herpes genitally, it’s not entirely implausible I have another strain asymptomatically on my lips, for example. Anyways.
That I talked about this out loud had one reader up in arms. [Remember: I talk about living with an STD and STDs in general every day – it should be no surprise there are some one-offs who occasionally drop in to derail my efforts.]
This specific reader’s comments went so far as calling anyone who does not get type-specific blood-testing foolish and irresponsible. Naturally, that got me thinking.
*Update: I’ve finally discovered which strain of HSV I’m carrying!
An Ethical Dilemma?
First, is it actually an ethical requirement those who are diagnosed with herpes via an active outbreak (anywhere on the body) and their partners also determine which strain(s) they carry – in lieu of gauging the level of risk involved in their sexual activities? And, if so, does the same hold true for those who are positive for HIV, HPV, Hepatitis B or C, etc.? Keep in mind: different strains exist for each of those viruses, transmission risks based on strain(s) behave similar to herpes in that a partner with a different strain has a reduced risk than one without the virus at all, and those partners with the same strain have little to no risk of transmitting or infecting previously uninfected areas of the body. Strain-specific testing is possible for most viruses – yet, it can be costly – and, sometimes, strain identification occurs as a component to one’s treatment plan as well (typically, herpes strains are not determined as part of the treatment process, unless diagnosis was done via the blood tests in question). Lastly, when we decide whether this poses a moral dilemma, all of those considerations must be made baring any barriers to healthcare, of course, as that’s an entirely different kind of conversation. 🙂
The main question I’m pondering here is: are those who have not been strain-tested, in fact, foolish and irresponsible?
Is the assumption one must choose to further test their infection to identify the strain they’re carrying laden with stigma and misunderstanding?
A Herpes Blood Test
You can probably see where this is going. Without a doubt, insisting someone is foolish and irresponsible who does not (who you are not treating and/or considering a personal relationship with) test their infection to the extent of isolating its strain is as insensitive as it is foolhardy.
Don’t get me wrong. STD testing – full panels – should be done before and after each new partner and at least once a year no matter what. Eventually, for the sake of curiosity, as well as writing interesting content for the website, I’ll get a blood test done too. Should everyone adhere to a comprehensive safer-sex approach and heed the advice I’ve shared throughout the website, more and more people will be getting diagnosed via those blood tests and there will be far less people this applies to anyway – as a result, the test itself isn’t bad at all. Today, however, we’re not talking about STD testing as a whole or whether someone should ever get blood tested for herpes in general.
We’re talking about those who have symptomatic outbreaks and the many millions of people who are diagnosed as a result of those symptoms sans a herpes blood test – visual diagnosis is a common practice at a lot of family doctors/general practitioners and even at OB/GYN and STD clinics.
Because of the more recent accessibility of herpes blood tests, people are beginning to find out they are positive for HSV before they ever experience symptoms and during their complete STD panels, but that has not always been the case, and it is often not the case for those who’ve active outbreaks. Quite the opposite is true, in fact, as some doctors simply won’t include a herpes test in an STD panel unless explicitly requested. Even then, some still refuse to test for herpes because of the immense stigma attributed to a diagnosis, coupled with not being able to determine the location of one’s infection. (We’ll reserve that conversation for a different day too!)
You can see how easy it is for one thing to begin to equal the other when addressing incredibly sensitive subjects such as type-specific blood testing for herpes. To constructively talk about whether someone should get a herpes blood test, we have to extract the components which could otherwise cloud one’s perspective.
My Personal Experience
Interestingly, not one of my partners has wanted to test to determine HSV strain(s) – if any on their end – we carried. Had they wanted to, I would have been tested. I’m not afraid of needles or the results, and I’ll likely test sooner or later anyhow. Simply, it’s never come up – not even after all of the information and research I provided them and the additional research they did on their own, which, included the differences in risk based on herpes strains. If I’ve ever been anything at all, I’m thorough. 🙂
Simply, determining the strain I’m carrying has never been necessary for my treatment or for my partner’s comfort, so, I haven’t found out which strain(s) of HSV I’m carrying yet. I’ve explicitly chosen not to spend money on herpes blood testing when I’ve been tested for other STDs, because I already knew I carried HSV.
Yes, had we had been type-specific tested together, we might have found out: I have HSV1 genitally, and he had HSV1 somewhere, so, the likelihood of transmitting HSV1 to a different location would have been slim to none – virtually no risk or worry. We might have also found out: I have HSV2, he had HSV1, so, his system would have already built some antibodies to the HSV1 strain he had, and he would be at a much lower risk of contracting HSV2 from me, and vice-a-versa – much less risk and worry. Or, we could have found out: I have HSV whatever and he had none. At which point, we would have had to take the same precautions I’ve been taking all along.
Needless to say, the precautions I’m used to taking with partners and which have become part of our sexual routine have not hindered any pleasure, love, or desire. Rather, because they are habit, our sex lives have been very infrequently interrupted by my having herpes and not knowing whether they have a strain of the virus or which strain I’m carrying specifically. We adhere to precautions as if I were infected with HSV2 and my partner were entirely uninfected with either strain and our sex lives flourish. Period.
What the Conversation Failed to Address
This is where the brash comment from the aforementioned reader stops making sense. It’s void of humanity and fails to acknowledge relationships – the grey area most websites shy away from when discussing STDs, because this is where STDs reach beyond a callous remark about foolishness and irresponsibility and delve into the human condition – love, emotion, connection, and choice.
Consider this, if you will, and let’s set aside our conversation about STDs, for just a moment…
Should you call your Grandma and learn she’s come down with the flu, do you have her go to the doctor to determine what strain of the flu she has before going over to her house to care for her – ostensibly, to make sure you’ve either gotten the right flu shot or already been sick with the same strain earlier in the year? No. Of course you don’t. You march your more than happy to help butt right over to your Grandma’s house, you take the dog out, do the dishes, AND you make her some homemade chicken noodle soup. Sure, you hope you don’t get sick too, but you go over there. Because, why? Because you love your Grandma.
Back to STDs…
I’m aware a lot of STDs do not go away like the flu. So, before you rush to the comments section, let me stop you right there by telling you: continue reading, lest you miss the point. 🙂
The reason you don’t treat your Grandma like a science experience when she’s ill is because you love her. You have a relationship and a bond established, and that bond supersedes a mental fight or flight mechanism as well as the psychological disgust factor which resides in all of us. You take as many precautions as you feel are necessary, like maybe washing your hands and clothes after caring for her, and then you carry on with your day.
The Psychology of Disgust
In the logic of evolution, humans, quite simply, should have no interest in ingesting or being near things that – like excrement or rotting carcasses – are liable to infect or otherwise harm us, right? Disgust, from that standpoint, seems like an open-and-shut case of survival by aversion: we develop a primal response to harmful things that is so strong, and so automatic, even the most spectacularly slow-witted among us are smart enough to walk the other way (foolish?).
The key problem, as Freud and others later observed, is that humans don’t really exhibit aversions towards most of what we consider disgusting – including our own excrement – until we are taught to.
When we have sex, we temporarily ‘suspend’ our capacity for disgust while we swap fluids and enter one another’s bodies – something most of us would do only under certain circumstances (doctors, for example).
Intriguingly, in most cultures the same word used to describe feces and decay is also applied to morally-dubious acts–what Haidt and Arizona State University psychologist Carol Nemeroff, Ph.D., call ‘sociomoral disgusts’. While physical disgust is usually pretty similar around the world, sociomoral disgust varies widely by culture.
What that means is, we are socialized by our disgust and, in turn, use it to socialize others; what better way is there to stop people from doing something they feel is undesirable than to ‘make’ that something – whether eating rancid meat or, in India, defying the caste system – disgusting (irresponsible?).
Despised acts and the people who commit them then can be hated and considered immoral without actually being at all disgusting. The puzzle for psychologists is to pinpoint where ‘contempt’ leaves off and disgust begins.
The debate about testing for your specific strain of STD after already having been diagnosed visually is just that: a matter of contempt – one which the reader was aiming to embed a level of sociomoral disgust into my other reader’s psyche and thus, influence their actions and reactions.
Lucky for you, that’s where The STI Project boldly goes, so, you don’t have to. Or, rather, so, you have somewhere to reference when you do.
A Personal Choice Between You and Your Partner
That I’ve had no interest from partner’s wanting to discern exactly which strain of HSV I have and that I’ve not experienced rejection due to having an STD (for others reasons, sure – yet another story), leads me to believe testing for HSV strains in particular is a choice which must be made between partners/practitioners, should be respected by others, and not sociomoralized (regarded as foolish and irresponsible).
Understand, everyone sets aside their psychological disgust factors when engaging in sexual activities, caring for loved ones, etc. That others do as well does not make them foolish or irresponsible. It makes them human.
Remember little ol’ Grandma?
You love her and you gauged the risk you were willing to take with your health and your body based on the information you knew, and you chose which precautions were necessary to negate those risks based on that same information. If you get sick, you’ll know why and you’ll deal with it.
The same holds true for those in a relationships with someone with HSV. Choosing strain-specific testing (after having been diagnosed via visual symptoms) is similar and is a personal choice – a choice that is up to each and every person/couple individually.
If you fully communicate, educate, and respect one another, there are no ethical issues surrounding your choice, as a couple, to either determine your risk in greater detail or remain comfortable with the information you know.
Some couples will choose to know as much as possible. If you do, cheers! That’s great! If you haven’t chosen to decipher the strain of your infection, cheers! That’s great! You’ve both made a personal choice based on your needs and wants and you’ve not let others dictate (‘sociomoralize’) those choices for you.
[Remember: this post is geared toward those who already know they have an STD via a professional visual diagnosis. If you don’t know, get tested.]
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What did you think about getting blood tested for herpes or other strains of STDs? Have you made a choice in either direction? Share your thoughts in the comments section below!