STI Testing Guidelines for Herpes Simplex Virus (HSV) indicate bias

Why don’t we test for herpes in a standard STI panel? We explore this rationale below.

How do you protect a population from an infectious disease? You test for it and you track it.

Current CDC recommendations for Herpes Simplex Virus (HSV-1 and HSV-2) surveillance and testing fail to protect the public from transmission. With 85% of HSV+ people unaware of their status and the majority of transmission from asymptomatic carriers, CDC failure to test creates a loop hole for transmission. What else, aside from preventative and diagnostic testing, is more important?

Additionally, when patients are not explicitly told they aren’t being tested for Herpes providers do not have informed consent. This means even when a sexually active individual is proactive about their sexual health and has standard STI testing, they will not be tested for Herpes Simplex Virus and they are not told Herpes is not included. Meaning they can be HSV+, could be transmitting to multiple partners, and not know it.

Is ignorance bliss?

In the US, the CDC guidelines are based on guidance from the United States Preventative Services Task Force (USPSTF). Read the rationale here.

Here are the key issues they have given for not including HSV-1 or HSV-2 in standard STI testing:

  1. COST: The rebuttal to this is all medical care is voluntary. We don’t not provide an MRI because of cost!
  2. INACCURATE SEROLOGY TESTS: The rebuttal to this is to implement a two-step testing with Western Blot.
  3. PSYCHOLOGICAL BURDEN OF FALSE POSITIVE: We believe that benefit of many outweighs the burden of the few. If 85% of carriers are unaware of their status this creates a loophole for asymptomatic spread. Reduction of transmission, and protection of sexual health, is more important to promote than it is to preserve a carriers ignorance.
  4. POST-DIAGNOSIS BEHAVIOR WONT CHANGE: This a clear double standard with CDC guidelines for STI testing. By promoting ignorance of HSV+ status, you create a loophole for asymptomatic spread from the 85% who are unaware of their status – a dynamic that comprehensive testing could help curtail.

Herpes Activism Opportunity

Email the USPTSF! Tell them their rationale for not testing is paternalistic and based on bias. People have a right to know what they have and be protected from others who do not know what they have. A sample email is here.

USPSTF Board Chair: Dr. Karina Davidson


CDC STD Department Director Dr. Jon Mermin

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