From the Guidelines
Herpes Simplex Virus (HSV) infections are best diagnosed through nucleic acid amplification test (NAAT)/polymerase chain reaction (PCR) diagnostic assays, which have >90% sensitivity and specificity, and can differentiate between HSV-1 and HSV-2 infection. The diagnosis of HSV infections typically involves several testing methods, including viral culture, PCR testing of lesion samples, or blood tests for HSV antibodies 1. PCR is the most sensitive method, detecting viral DNA even when lesions aren't present. Blood tests can distinguish between HSV-1 and HSV-2 antibodies, though they may not detect very recent infections.
For treatment of initial outbreaks, oral antivirals are prescribed: acyclovir (400mg three times daily for 7-10 days), valacyclovir (1000mg twice daily for 7-10 days), or famciclovir (250mg three times daily for 7-10 days) 1. For recurrent episodes, the same medications are used but for shorter durations: acyclovir (400mg three times daily for 5 days), valacyclovir (500mg twice daily for 3 days), or famciclovir (125mg twice daily for 5 days). Patients with frequent recurrences (more than 6 per year) may benefit from suppressive therapy: acyclovir (400mg twice daily), valacyclovir (500mg daily), or famciclovir (250mg twice daily) for extended periods 1.
Some key points to consider in the management of genital herpes include:
- The use of type-specific HSV serologic assays to diagnose HSV-1 and HSV-2 infection, which can help identify the viral type and guide treatment decisions 1
- The importance of antiviral therapy in preventing symptoms and improving quality of life, as well as preventing transmission to sexual partners 1
- The need for patients to use pain relievers, keep affected areas clean and dry, avoid touching lesions, and abstain from intimate contact during outbreaks to prevent transmission.
Overall, the management of HSV infections requires a comprehensive approach that includes accurate diagnosis, effective treatment, and prevention of transmission. The most recent and highest quality study recommends the use of NAAT/PCR diagnostic assays for diagnosis, and antiviral therapy for treatment and prevention of transmission 1.
From the FDA Drug Label
The quantitative relationship between the in vitro susceptibility of herpes viruses to antivirals and the clinical response to therapy has not been established in humans, and virus sensitivity testing has not been standardized Sensitivity testing results, expressed as the concentration of drug required to inhibit by 50% the growth of virus in cell culture (IC 50 ), vary greatly depending upon a number of factors.
The FDA drug label does not answer the question about blood tests for Herpes.
From the Research
Diagnostic Tests for Herpes Simplex Virus (HSV) Infections
- Herpes Simplex Virus (HSV) infections can be diagnosed through various laboratory and point-of-care techniques, including biochemical assays, microscopy, nucleic acid amplification, and microfluidics-based tests 2.
- Serological tests can detect antibodies to HSV glycoproteins G-1 and G-2, which evoke a type-specific antibody response, and can be used to confirm a genital herpes diagnosis, establish diagnosis of HSV infection in patients with atypical complaints, identify asymptomatic carriers, and identify persons at risk for acquiring HSV 3.
- Laboratory tests for HSV include viral isolation, detection of antigen, and detection of HSV DNA using molecular diagnostic techniques, and type-specific HSV serology is becoming more readily available 4.
Blood Tests for Herpes Simplex Virus (HSV)
- Blood tests can be used to detect HSV-1 and HSV-2 infections, including enzyme-linked immunosorbent assay tests and point-of-care tests such as POCkit-HSV-2 3.
- A sample-to-answer real-time polymerase chain reaction (PCR) platform can be used as a laboratory-developed test (LDT) for the detection of HSV-1 and -2 in whole blood, with a limit of detection comparable to that seen in cerebrospinal fluid (CSF) 5.
- Molecular assay-based tools are being developed for the detection of HSV-1 and HSV-2, with a focus on cutaneous and mucosal HSV infections, and can provide sensitive and rapid results 6.
Treatment Options for Herpes Simplex Virus (HSV) Infections
- Antiviral medications can be used to treat HSV infections, and prompt treatment is essential to prevent complications and reduce the risk of transmission 6.
- The use of serologic tests to diagnose genital lesions is inappropriate because positive results may be due to chronic infection, whereas negative results may overlook recent infection, and molecular diagnostic techniques such as PCR are preferred for diagnosis 6.