People often assume a "full STI screen" covers herpes. It generally does not, and that is deliberate rather than an oversight.
Herpes simplex virus is extremely common, frequently asymptomatic, and blood antibody testing tells you that you have been exposed at some point — not whether you have genital herpes, when you acquired it, or whether you will ever have symptoms. A positive antibody result in someone with no symptoms often creates significant distress without changing management.
UK sexual health guidance therefore generally does not recommend routine blood testing for herpes in asymptomatic people.
How Diagnosis Actually Works
Genital herpes is diagnosed by swabbing an active lesion and testing it with a PCR test. That tells you the virus is present, and which type — HSV-1 or HSV-2.
This has a practical consequence: get seen while you have symptoms. Once a lesion has healed, the opportunity to confirm the diagnosis has largely gone. If you develop painful genital blisters or ulcers, book a sexual health appointment promptly rather than waiting to see whether they resolve.
HSV-1 and HSV-2
HSV-1 traditionally causes cold sores and HSV-2 genital herpes, but the distinction has blurred — a substantial share of new genital herpes cases are HSV-1, acquired through oral sex.
The type matters mainly for prognosis: genital HSV-1 tends to recur less often than genital HSV-2.
What Treatment Does
Antiviral medicines such as aciclovir do not eliminate the virus, which remains dormant in nerve tissue. What they do:
- Episodic treatment — started early in an outbreak, shortens it and reduces severity
- Suppressive treatment — taken daily by people with frequent recurrences, substantially reducing outbreak frequency and reducing transmission risk to partners
Aciclovir is inexpensive as a generic, and suppressive therapy is a legitimate option worth asking about if recurrences are frequent or distressing.
First Episodes Can Be Severe
A first outbreak is often much worse than later ones — painful ulcers, flu-like symptoms, swollen glands, and sometimes difficulty passing urine. That last symptom needs urgent attention, as it occasionally requires catheterisation.
Recurrences are usually milder, shorter, and become less frequent over time.
Transmission
The virus can be transmitted even without visible lesions, through asymptomatic shedding, which is why it spreads so widely. Risk is reduced but not eliminated by condoms, avoided during outbreaks, and reduced by suppressive antiviral therapy.
Being open with partners is the difficult part and the important one. It is a common infection, and the practical management is well established.
Pregnancy
Genital herpes in pregnancy needs specialist input, particularly a first episode in the third trimester, because of the risk of neonatal herpes. If you have genital herpes and are pregnant or planning to be, tell your midwife or obstetrician. This is manageable with the right planning and dangerous without it.
The Psychological Part
A herpes diagnosis often lands harder than its medical seriousness warrants, largely because of stigma rather than symptoms. It is a common, manageable, non-life-threatening infection. Sexual health services deal with it routinely and can provide both treatment and support with the conversations that follow.