What is the recommended test for Herpes Simplex Virus (HSV) screening?

From the Guidelines

Herpes screening tests should not be routinely performed on asymptomatic individuals, but for those with symptoms like genital sores or blisters, nucleic acid amplification test (NAAT)/polymerase chain reaction (PCR) diagnostic assays are the preferred method for detecting HSV-1 or HSV-2 infection. When it comes to diagnosing genital herpes, the optimal tests are those that can detect HSV-1 or HSV-2 from a genital ulcer/lesion/suspected HSV outbreak, with NAAT/PCR assays being the most sensitive and specific, having >90% sensitivity and specificity 1.

Some key points to consider when choosing a herpes screening test include:

• The test characteristics of HSV NAATs, which can vary in sensitivity and specificity, and the importance of using assays that differentiate between HSV-1 and HSV-2 infection to provide patients with information regarding the expected natural history of genital herpes 1.
• The limitations of serologic assays, including the lack of sensitivity for HSV-1 assays and the lack of specificity for HSV-2 assays, which can result in false-negative or false-positive diagnoses 1.
• The importance of not obtaining HSV molecular assays in the absence of a genital ulcer to diagnose genital herpes infection, as this can lead to false-negative results due to the intermittent nature of genital HSV shedding 1.

In terms of specific testing strategies, HSV molecular assays, such as NAAT/PCR, are preferred over HSV culture due to their higher sensitivity and specificity. However, if HSV culture is the only test available, it is reasonable to perform it to make the diagnosis of HSV genital ulcer disease, with further investigation through serology warranted if results are negative 1. Type-specific HSV serologic assays, such as Western blot/immunoblot assays, are the gold standard for HSV serologic testing, but have limitations, including the potential for false-positive or false-negative diagnoses.

Ultimately, the decision to perform herpes screening tests should be made on a case-by-case basis, taking into account the individual's symptoms, risk factors, and medical history, and discussing the specific situation with a healthcare provider who can recommend appropriate testing.

From the Research

Herpes Screening Test

• The use of type-specific herpes simplex virus-1 and 2 serology as a diagnostic modality in patients with clinically suspected genital herpes has been studied 2.
• Herpes simplex virus (HSV) type-specific serological tests are now widely available, but indications for their use have not been well defined 3.
• Serological tests for HSV that can accurately distinguish between HSV-1 and HSV-2 are now commercially available, including the HerpeSelect-1 and HerpeSelect-2 enzyme-linked immunosorbent assay tests and the HSV-1 and HSV-2 HerpeSelect1/2 Immunoblot 4.
• The luciferase immunoprecipitation system (LIPS) assay has been investigated as a highly quantitative and high-throughput serological test for evaluation of humoral responses to HSV-1 and HSV-2 5.

Diagnostic Uses

• Type-specific serology (TSS) test for HSV have been used as a research tool in seroepidemiological studies for some years, but TSS as a diagnostic modality for diagnosis of current episode of genital herpes is not well documented 2.
• HSV-2 serology had a sensitivity of 13.33% and 73.33% in primary and recurrent genital herpes and specificity of 83.33% and 85.71%, respectively 2.
• The detection of HSV-2 IgG antibody helps in strengthening the diagnosis of recurrent HSV-2 disease, whereas the absence of HSV-2 IgG antibody helps in excluding genital herpes as a likely cause of recurrent genital ulceration 2.

Screening Recommendations

• Screening of asymptomatic patients is likely to be beneficial among high-risk groups, including those at high risk for STDs and human immunodeficiency virus (HIV) infection who are motivated to reduce their sexual risk behavior, HIV-infected patients, and patients with sex partners with genital herpes 3.
• Universal screening for HSV-2 infection in pregnant women is unlikely to be beneficial 3.
• The targeted use of HSV-2 serological tests for specific diagnostic situations and selected populations should benefit patients, providers, and the community 3.