From the Guidelines
Diagnostic Tests for Oral Herpes (Herpes Simplex Virus, HSV)
Oral herpes, caused by the Herpes Simplex Virus (HSV), is typically diagnosed using a combination of physical examination, medical history, and laboratory tests. The most recommended diagnostic tests include viral culture and polymerase chain reaction (PCR) test to confirm the presence of HSV 1.
- Viral Culture: Although less sensitive than PCR, viral culture can be used to diagnose HSV, especially when PCR is not available 1.
- Polymerase Chain Reaction (PCR) Test: PCR is highly sensitive and specific for detecting HSV DNA from clinical specimens. It is the preferred method for diagnosing HSV infections, especially for genital herpes 1.
- Type-Specific Serology Tests: These tests, such as enzyme-linked immunosorbent assay (ELISA) or immunoblot, can determine if a patient has HSV-1 or HSV-2 antibodies. However, they have limitations, including false-negative results during the window period and false-positive results due to cross-reactivity 1.
- Direct Immunofluorescence Assay and Tzanck Smear: These tests are not recommended for diagnosing HSV due to their low sensitivity and specificity 1.
It's essential to note that asymptomatic shedding can occur, and diagnostic testing may not always detect the virus. Therefore, a comprehensive clinical evaluation and medical history are crucial for an accurate diagnosis. The choice of diagnostic test depends on the clinical presentation, availability of tests, and the need to differentiate between HSV-1 and HSV-2 infections.
From the Research
Diagnostic Tests for Oral Herpes (Herpes Simplex Virus, HSV)
The diagnosis of oral herpes (Herpes Simplex Virus, HSV) can be achieved through various methods, including:
- Clinical diagnosis, as herpes labialis is often asymptomatic or mildly symptomatic 2
- Additional testing, such as polymerase chain reaction (PCR), if the diagnosis is uncertain 2
- Laboratory tests, including:
- Tissue culture isolation facilities for HSV 3
- Rapid assays to detect HSV using monoclonal and polyclonal antibodies in enzyme-linked immunosorbent assay (ELISA) and immunofluorescent assays 3
- Detection of HSV deoxyribonucleic acid (DNA) by hybridization methods 3
- Type-specific serology tests based on glycoprotein gG-1 and/or gG-2, such as Diagnology's POCkittrade mark HSV-2 and Focus Technologies' HerpeSelect enzymelinked immunosorbent assays (ELISAs) and Immunoblot 4
Considerations for Diagnostic Testing
When selecting a diagnostic test for HSV, considerations should include:
- The sensitivity and specificity of the test, particularly in populations with low prevalence of HSV 3
- The availability of testing facilities and the need for rapid diagnosis to initiate antiviral therapy 3, 5
- The importance of accurate diagnosis in understanding the natural history of HSV infections and developing effective treatment and prevention strategies 5