STD testing: Don't assume older means safer

I was asked the other day if I recommended sexually transmitted disease (STD) testing before sex for older couples. The answer is a firm yes! Requesting that your partner get STD testing is an expectation for many in the younger generations. But the same request is uncomfortable for many older people considering a sexual relationship. If you read through my blog postings, you will see why STD testing is so important! Many of my commenters are not in their teens. They are in their 30s, 40s, 50s, 60s and 70s! Sexually transmitted diseases don't know age. These viruses and bacteria are happy to infect any age person.

STDs remain a major public health challenge in the United States and throughout the world. In the United States, there are approximately 19 million new STD infections each year. Almost half of them are among young people 15 to 24 years of age. That means the other half are in the older population! The Centers for Disease Control recommends all sexually active men and women who are not in a long-term, mutually monogamous relationship should have STD testing.

I know asking your potential partner to get STD testing is a difficult task but it is important! Because so many STDs have no symptoms, it is difficult to know if you or your partner has been exposed to a virus or bacteria.

Asking the question, "Should we get tested first?" is an easier conversation than, "What did you give me?"

Take the approach that you care about each other and you can't know about your status of STDs unless you have been tested. It is important for both of you to have current STD tests. Please take care of each other in this way!

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Herpes testing: What to ask for, when to ask

If you think you might have herpes, you probably want to get it diagnosed as soon as you can. But it's better to hold off on herpes testing for about four months after your first outbreak. Then, when you do get the blood test for herpes infection, make sure it's the correct test — the one that detects an antibody called IgG.

Health care providers often order a different test, the IgM test. A positive IgM test, however, doesn't necessarily mean you have HSV-2, the genital herpes virus.

Herpes testing based on IgM seems like a good idea because your immune system starts producing IgM in early infection with most viruses. Theoretically, an IgM test can tell you whether sores you just developed are or aren't herpes, and it might help you figure out when you were infected.

For diagnosing HSV-2, though, the IgM test has serious shortcomings.

The IgM test doesn't distinguish one herpes virus from another. A new infection with HSV-1, which causes oral cold sores, could give you a positive herpes IgM result. If that's not taken into account, you could be told you have HSV-2 (genital herpes) when you really don't.A positive herpes IgM test could also mean you're having a recurrence of HSV-2. Many people with HSV-2 produce new IgM every time they have a herpes outbreak. With IgM testing, there's no way to know whether you have a new infection or when you initially acquired the virus.

In contrast, IgG testing can distinguish between HSV-1 and HSV-2. It's an important distinction, because HSV-1 is less severe and quite common. Most people have antibodies to HSV-1 by the time they're grown.

The IgG tests approved by the FDA are very accurate. That means there is only a small chance that you would get a false positive or false negative result.

But there is a drawback: You have to wait four months between your first outbreak and your IgG test. Your immune system takes that long to produce IgG against herpes, so a negative result from an earlier IgG test isn't reliable.

If you're not sure whether you have HSV-2, or if you doubt the accuracy of a genital herpes diagnosis you received some time ago, it makes sense to get tested (or retested). Be sure to ask for IgG testing.

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