After speaking a lot with OB/GYN providers in the past few weeks, I would like to vent about HSV testing in pregnancy. There are so many reasons given for not testing in pregnancy, but to me NONE of them hold a candle to the value of testing.
If the statistics are true that about 1 in three women in their 30′s have HSV 2, and 90% of them don’t know, ASKING pregnant women if they have genital herpes is almost worthless. Yes, you will catch a few, but miss 90% of those infected!
If you believe the research that shows that people who test positive for HSV 2, but have no outbreaks shed asymptomatically at the same rate as those having 1-12 outbreaks, then wouldn’t it be useful to know who is infected, rather than basically playing Russian roulette with the pregnancy?
If you believe that viral suppression treatment for women with herpes at the end of pregnancy is the right and valuable thing to do, would you not then want to know who all the infected women are? If you believe that the woman who gets new herpes in the third trimester has a 30-50% chance of infecting her baby, would you not want to know which women are vulnerable and which of their partners is infected?
Pregnant women are routinely tested for syphilis, gonorrhea, chlamydia, rubella, HIV (in many states), and their pap smears hopefully look for HPV. Why, then, we would not test for herpes?
In my next blog, I will share with you the reasons I am given for not testing. Some of you will be amazed, others of you will not be surprised. Suffice to say, in preview, we are letting social stigma and emotional upset guide testing decisions. This is not true for all clinicians, but many. Perhaps testing for HSV in pregnancy will need to come from patients, driving clinicians to test. But it should be the other way around, I think.