Importance of Testing and Diagnosis in Genital Herpes

Table 1.

Presentation	Clinical Diagnostic Challenge	Laboratory Test
Genital ulcers	Lesions may have nonherpetic etiology	Culture or PCR HSV type-specific serology
Skin splits, excoriations	Lesions may be subtle and difficult to visualize	PCR or culture HSV type-specific serology
Nonspecific local symptoms	May be attributed to nonherpes sources	HSV type-specific serology
Asymptomatic shedding	No local lesion to sample for virus	HSV type-specific serology

Table 1. Role of Laboratory Tests in Diagnosing Genital HSV

HSV = herpes simplex virus; PCR = polymerase chain reaction

Table 1.

Presentation	Clinical Diagnostic Challenge	Laboratory Test
Genital ulcers	Lesions may have nonherpetic etiology	Culture or PCR HSV type-specific serology
Skin splits, excoriations	Lesions may be subtle and difficult to visualize	PCR or culture HSV type-specific serology
Nonspecific local symptoms	May be attributed to nonherpes sources	HSV type-specific serology
Asymptomatic shedding	No local lesion to sample for virus	HSV type-specific serology

Table 1. Role of Laboratory Tests in Diagnosing Genital HSV

HSV = herpes simplex virus; PCR = polymerase chain reaction

Table 2.

Test/Source	Source	Comments
Western blot	University of Washington, Seattle	Limited availability Reference test; not FDA-approved
HerpeSelect ELISA IgG for HSV-1 or HSV-2	Focus Technologies	Widely available FDA-approved
HerpeSelect immunoblot IgG for HSV-1 or HSV-2	Focus Technologies	Good for low-volume testing FDA-approved
POCkit-HSV-2	Diagnology (company no longer in business)	Off market; may return under another name FDA-approved
Captia ELISA for HSV-1 or HSV-2	Trinity	Seeking FDA approval

Table 2. Glycoprotein G-Based HSV Serology Tests

HSV = herpes simplex virus; ELISA = enzyme-linked immunosorbent assay; FDA = US Food and Drug Administration

Table 2.

Test/Source	Source	Comments
Western blot	University of Washington, Seattle	Limited availability Reference test; not FDA-approved
HerpeSelect ELISA IgG for HSV-1 or HSV-2	Focus Technologies	Widely available FDA-approved
HerpeSelect immunoblot IgG for HSV-1 or HSV-2	Focus Technologies	Good for low-volume testing FDA-approved
POCkit-HSV-2	Diagnology (company no longer in business)	Off market; may return under another name FDA-approved
Captia ELISA for HSV-1 or HSV-2	Trinity	Seeking FDA approval

Table 2. Glycoprotein G-Based HSV Serology Tests

HSV = herpes simplex virus; ELISA = enzyme-linked immunosorbent assay; FDA = US Food and Drug Administration

Corey L, Handsfield HH. Genital herpes and public health: addressing a global problem. JAMA. 2000;283:791-794. Abstract
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Ashley RL, Wald A. Genital herpes: a review of the epidemic and potential use of type specific serology. Clin Microbiol Rev. 1999;12:1-8. Abstract
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The Impact of Genital Herpes

As the most prevalent sexually transmitted infection and the most common cause of genital ulcer disease, genital herpes presents a growing public health concern.^[1,2] Although herpes simplex virus type 2 (HSV-2) is the major cause of genital herpes, a significant proportion of presenting episodes are due to herpes simplex virus type 1 (HSV-1).^[3,4] Exposure to HSV in the birth canal during labor and delivery can result in severe infections in the neonate.^[5-7] Growing evidence implicates genital herpes as a risk factor in HIV acquisition and transmission.^[8,9]

Over 20% of adults in the United States have serologic evidence of infection with HSV-2.^[10] In some sexually transmitted diseases (STD) clinics, HSV-2 seroprevalence reaches 80%.^[11,12] HSV-2 infection affects all socioeconomic classes. In 1 large study of suburban primary care populations whose members were predominantly married, employed, and well educated, the prevalence of HSV-2 infection was over 25%.^[13] Only about 1 in 10 HSV-2-infected individuals has a history of genital herpes.^[10,13] Not surprisingly, HSV is transmitted most often to sex partners or to neonates by individuals who do not know that they are infected or during times of asymptomatic viral shedding.^[14,15] Behavioral interventions, such as condom use and suppression of viral shedding with antiviral agents, can prevent transmission.^[16,17] Thus, diagnosis is a key factor in slowing the spread of genital herpes.

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Transmission of Genital HSV

References

Table 1.

Table 1.

Table 2.

Table 2.

References

Faculty and Disclosures

Importance of Testing and Diagnosis in Genital Herpes

The Impact of Genital Herpes

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