Testing for herpes and genital warts

Originally Published: May 23, 1997 - Last Updated / Reviewed On: February 21, 2014
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Alice,

I have recently gone to a Planned Parenthood STD Clinic. From what they told me, they tested for everything "curable" (i.e., they did not test for HIV, genital warts, or herpes). I know where to get tested for HIV, but my question is: are there tests for herpes and genital warts? What are the odds of someone having herpes or genital warts and being asymptomatic? I plan to use a condom during intercourse regardless, but must I do the same for oral sex as well? Is there any way of knowing for sure if someone is clean of STDs?

Signed,
Confused

Dear Confused,

Just as falling in love takes some courage and trust, so does choosing to be sexual with someone. There is always a risk of "catching something." What people can do is minimize the risk by using condoms, dams, and lube each and every time they have oral, vaginal, or anal sex.

Genital herpes and warts are usually diagnosed by visual examination to see if any lesions or warts are present. If there is a question as to the cause of a sore or abnormal cell changes on the cervix, a tissue sample or culture can be taken to determine what type of virus or other microorganism is responsible. For herpes, it's preferable to have this test done within 48 hours after symptoms first show up for a more accurate result. For genital warts, health care providers often use a colposcope to magnify the area. Vinegar may also be applied to the genitals to make the warts more visible. Internally, Pap smear or biopsy results often indicate the presence of the human papillomavirus (HPV), the virus responsible for genital warts, in women. The HPV test, which determines the presence of HPV genetic material within cells, is used for unclear results from a Pap smear. (The HPV test is inaccurate for men because it is hard to collect an adequate sample of cells from the penis.)

Both genital warts and herpes can be transmitted when there are no obvious symptoms of infection. Just because no warts or other sores are present does not mean that there is no risk of infection with HPV or herpes. If one is concerned about having been exposed to herpes, but has no visible symptoms, a blood test can be used. Many blood tests for herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2 — the virus most often responsible for genital herpes) are available, though they vary in accuracy, some not distinguishing between HSV-1 and 2, while others possibly confusing other herpes viruses (e.g., chicken pox) for HSV-1 or 2. However, according to the American Social Health Association's (ASHA) Herpes Resource Center, a positive HSV-2 result most likely points to genital rather than oral herpes because most cases of genital herpes are caused by HSV-2. For more details about herpes testing, including some specific recommended tests, check out the ASHA Herpes Resource Center web site. No bloods tests for HPV are available at this time.

Herpes can be transmitted when sores are present, or during times of viral shedding, when there are no visible lesions, but the virus is active on the surface of the skin. Although herpes can be transmitted during times of viral shedding, a person is infectious from viral shedding probably for a few days out of the year. The most likely time for herpes to be transmitted is when sores are present. Again, herpes can affect people differently. Some people experience painful episodes of herpes that drive them to seek medical attention, while others have such mild symptoms that they do not notice, or do not consider them a health concern.

HPV can be transmitted through direct contact with a wart or infected area (if a genital wart has been removed, it's possible that virus is still present). The main problem with genital warts, however, is that they often go unnoticed — warts usually do not cause pain, and they tend to take up residence in hard-to-see places (e.g., on the cervix or in the urethra). Moreover, genital warts can be very small and sometimes hard to distinguish from a normal genital bump.

The odds of someone having herpes or genital warts and being asymptomatic are difficult to determine, and there's no way of knowing for sure if someone is free of disease. Your approach of always using condoms is a good way to decrease your chances of becoming infected with a sexually transmitted infection (STI). And yes, practicing safer oral sex is an important part of protecting yourself and your sexual partners, though it's up to you and your partner(s) to decide what level of risk you and s/he are comfortable with. For oral sex on a penis, use dry or flavored condoms; and, on the clitoris or anus, use dams or unlubed condoms (cut lengthwise down the middle). Cheers to you for seeking out more information and taking charge of your sexual health!

Alice