From the Guidelines
To test for HSV-2, a healthcare provider should perform a PCR (polymerase chain reaction) test, which detects the virus's genetic material from a swab of an active sore or lesion, as it is the most accurate test available 1. When it comes to testing for HSV-2, there are several options available, including:
- PCR (polymerase chain reaction) test: This is the most accurate test and detects the virus's genetic material from a swab of an active sore or lesion 1.
- Blood test: This checks for HSV-2 antibodies and can determine if you've been infected in the past. The IgG antibody test is preferred as it can distinguish between HSV-1 and HSV-2 1.
- Viral culture tests: These are less sensitive than PCR, but can still be used to diagnose HSV-2 infection 1. It's essential to note that testing is most accurate when symptoms are present, ideally within 48-72 hours of lesion appearance. Home test kits are available but are generally less reliable than tests performed in medical settings. If you suspect HSV-2 infection, it's crucial to get tested promptly, avoid sexual contact until you receive results, and inform recent sexual partners so they can also get tested. Early detection allows for appropriate treatment and helps prevent transmission to others. In terms of serologic testing, type-specific HSV serologic assays can differentiate between HSV-1 and HSV-2, but have limitations, including low sensitivity for HSV-1 and low specificity for HSV-2 1. Therefore, it's essential to use these tests in conjunction with other diagnostic methods and to interpret the results with caution. Overall, the key to accurate diagnosis and effective management of HSV-2 infection is to use the most accurate diagnostic tests available and to interpret the results in the context of the patient's clinical presentation and medical history.
From the Research
Testing Methods for HSV-2
There are several methods available for testing HSV-2, including:
- Serological tests that detect antibodies to HSV glycoproteins G-1 and G-2, which evoke a type-specific antibody response 2
- Enzyme-linked immunosorbent assay (ELISA) tests, such as HerpeSelect-1 and HerpeSelect-2 2
- Immunoblot tests, such as the HSV-1 and HSV-2 HerpeSelect1/2 Immunoblot 2
- Point-of-care tests, such as POCkit-HSV-2, which allows blood from a finger stick to be tested in a clinic 2, 3
- Chemiluminescent immunoassay (CLIA) tests, such as BIO-FLASH® 4
Performance of Testing Methods
The performance of these testing methods has been evaluated in several studies:
- A study comparing commercial methods of immunoblot, ELISA, and CLIA for detecting type-specific HSV-1 and HSV-2 IgG found that all three methods showed excellent and equivalent performance characteristics 4
- A study evaluating the POCkit HSV-2 test found that it had a sensitivity of 96% and a specificity of 98% compared to viral culture and Western blot analysis 3
- A review of the performance data of HSV type-specific serology test kits found that they are important diagnostic tools for establishing the etiology of genital symptoms and identifying patients with unrecognized genital herpes 5
Recommendations for Testing
Recommendations for testing for HSV-2 include:
- Screening of asymptomatic patients who are at high risk for STDs and HIV infection, HIV-infected patients, and patients with sex partners with genital herpes 6
- Using type-specific HSV-2 serological tests for specific diagnostic situations and selected populations 6
- Considering the use of point-of-care tests, such as POCkit-HSV-2, for rapid and accurate identification of HSV-2 antibody in subjects with established HSV infections 3